Jan 27, 2021
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Russian “army” of drugs. Once again about immunity in a pandemic

The correspondent asked what conclusions about a new viral infection can be made by medical experience Head of the Laboratory for Vaccine Prevention and Immunotherapy of Allergic Diseases, Research Institute of Vaccines and Serums named after Mechnikov, professor, D.M. Mikhail Kostinov

Chinese, British – now everything is one

– Mikhail Petrovich, if at the beginning of the pandemic, doctors talked about a thousand unknowns when they met COVID-19, then now, probably, scientists and medical practitioners have gotten to know the virus more thoroughly and can talk about the course of the disease in detail? What, in particular, does Russian medicine say? What are our positions in the fight against coronavirus and its strains?

– If we start our conversation with prevention, then we can say that Russia was one of the first countries (after China) to demonstrate a strong structure for organizing surveillance and those measures that helped us to slow down coronavirus infection. This is the first thing.

But if we talk about the development of coronavirus, then in Russia, as in other countries, mutations arise, and there will be many more. I am not saying this in order to scare anyone. The mutation does not always change the properties of the virus, but sometimes it does. For example, the British strain is more contagious (contagious – Ed.), But causes the disease in severity of the course the same as the others. In fact, in order for a completely different virus with new properties to form, the mutation must be very pronounced, at least 5-10%, and in those mutations that are occurring now, there is not even 1%. And in fact, mutations do not create anything new for someone who has not yet met with a coronavirus. Such a person does not care what strain he meets – Chinese, British or some other. It is impossible to say in advance whether he is infected or not, whether he will be ill or suffer the disease easily. It all depends on the immune system, age, the presence of chronic diseases.

A lot has also been achieved regarding treatment in Russia – we have learned how to heal based on our own experience and the experience of other countries. A huge body of specialized medical literature is now available, where medical researchers share their experiences. And we know how they treat in the West, what difficulties they face, what mistakes they make. At the beginning of the pandemic In the United States and Western Europe, the sick quickly died due to the fact that the pathogenesis (the mechanism of the origin, development and individual manifestations of the disease – Ed.) Of this disease was not known. And now it is known that the leading place in it is the formation of inflammatory mediators (substances of biological origin responsible for the manifestation of inflammatory reactions – Ed.) In the vascular bed, which, against the background of cellular suppression of immunity, lead to the formation of immunothrombosis. And the publications of our Western colleagues helped us to competently approach the treatment of such patients.

In this context, it is important that we have a highly professional school of resuscitation, therefore, in resuscitation and intensive care units, including those on artificial lung ventilation, the percentage of surviving people in our country is higher than in the West. And in general, the number of deaths from covid is lower.

We are criticized for allegedly incorrect diagnostics, but perhaps those who write this simply do not have the information. In our country, including during a pandemic, after a lethal outcome, a competent postmortem examination is carried out with an assessment of the PCR tissues of the damaged organs and the exact cause of death is established.

Immune response

– What conclusions about the prevention of viral diseases appeared during the pandemic and what do doctors now recommend focusing on?

– It is worth knowing that for the prevention of coronavirus infection in Russia there is its own “army” of drugs and means that help the body to effectively fight the coronavirus and survive. These, of course, are not new drugs – they have been known for a long time, but they were often not paid attention to, and now they are being talked about.

Why has it become important now? Because when studying the pathogenesis, they noted that the cornerstone of infection is the activation of interferon production, which depends on the intracellular receptors of innate immunity. If there are many receptors, then they easily recognize a viral infection. The process of meeting the virus and the receptor ends with the activation of the latter, which leads to the launch of the immune response. With early recognition of infection and early initiation of an immune response, a favorable outcome of the disease can be expected.

Back in the spring, in the recommendations of the Ministry of Health of the Russian Federation, it was said that interferons, as well as synthetic immunotropic drugs, are recommended for the prevention of respiratory infections during COVID-19. It is necessary to pay attention to immunity primarily because everything is connected with the immune system: any of the systems of our body acts with the involvement of immune mechanisms.

– What medications for strengthening the immune system have worked well during a pandemic?

– Just the ones I just mentioned. The difference between them is that interferon preparations cannot be prescribed at the height of the disease – they are prescribed for prophylactic purposes or at the very beginning of the disease, 3-4 days after infection. If at this time they did not have time with them, then in the future they can only bring harm and aggravate the patient’s condition. They cannot be used at high temperatures, since they can negatively affect the pathogenetic mechanisms during illness.

And drugs that restore immunoregulatory cellular mechanisms can be used in the acute period. I am talking now about azoxymer bromide, in the market called Polyoxidonium. It can be used for prophylaxis, and when contact with the virus has just occurred, and at the height of the disease. The earlier the treatment is started, the better the effect.

Studies that were done up to last year, including twenty years ago, showed that it can activate intracellular receptors, that is, innate immunity. This means that when a virus enters the body, immune cells are ready to meet it, immediately recognize it and begin to activate. There is a cascade of reactions that help a person cope with an infection. And in this case, the outcome is favorable.

Many studies also demonstrate that the outcome will be positive if the immunotropic drug is prescribed not on the first day of illness, but later on the third, fifth, tenth day, although, of course, gaining time is very important. Moreover, in studies in patients with severe diseases (for example, with severe pneumonia), it was shown that azoxymer bromide can reduce Interleukin 6, and this is one of the main cytokines of the most dangerous reaction of the immune system – a cytokine storm. Preventing it is one of the important tasks of treating patients with COVID-19.

We think that it can be effective in the process of rehabilitation, since now there is already evidence that suppression of immunity is observed after patients are discharged from the hospital, when the critical condition has passed.

– There is a lot of controversy about immunotropic drugs: these are good, and these are bad …

– Immunotropic drugs are not divided into good and bad – rather, this applies to doctors, because each drug has its own area of ​​application. I always teach doctors: turn on your brains, you are not computers. There is a standard, but there are many options.

Of course, we work according to protocols, but protocol is not an exact science like mathematics or physics. Each person is individual, therefore, the practice exists so that each time, analyzing his previous experience, he approaches the patient individually, trying to achieve the maximum result of treatment, and here everything depends on the art of healing. A smart doctor will always look for the best therapy option – for this he will read, attend conferences, listen to colleagues, pay attention to the lessons that life teaches and which, by the way, can give more than an institute, because education is only the basis, which makes it possible to study further and use the entire world experience.

Recently, for example, colleagues recommended to drop in at a conference of students of the Faculty of Biophysics at Sechenov University – I listened to the speaker, something caught on, and I had my own new idea. A certain click – and it is already clear what I should do next, what to take into account, what else to pay attention to when working with patients. To master the art of healing, you need to constantly learn.

“You can eat, but the effect is not the same”

– Despite the pandemic, people continue to live, they want to communicate, meet. What do doctors recommend to make communication safe?

– I always say: a healthy person with a healthy immune system will recover. Why do children rarely get COVID-19? Because they have a completely different immune system, it reacts differently. The child is naive, his immune system is also naive, she wants to learn everything, and therefore easily forms immunity. And COVID-19 has a long incubation period, which makes it possible for the naive immune system to pave the way for an immune response without getting tangled up in the jungle of previous immune experience.

Despite the fact that a lot has changed, life goes on and we continue to travel by public transport, work and communicate. For middle-aged and older people, as well as for those who have any diseases, I recommend taking prophylactic immunotropic drugs. But make the choice of the drug competently, based on the recommendation of doctors. A competent doctor will be able to assess your health status and recommend the best drug for you.

In addition, the person himself needs to act rationally. For example, a woman visited a friend or with a child at a mass event, or maybe she “walked” for half a day in a shopping center – it is better to drink a prophylactic drug for a week. And someone is sitting in the country – he does not need anything. The child learns on distance – also do not worry.

And the psychological moment is also important: the outcome of the disease depends on the mood of the person himself. Train the nervous system with positive attitudes, this has a beneficial effect on immunity.

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