Hong Kong’s medical community knows something about coronaviruses given its experience with the first SARS 17 years ago and of course the most recent SARS-CoV-2 pandemic. The top pandemic doctor there, Yeun Kowk-Yung from University of Hong Kong, suggests a path forward to keep COVID-19 patients out of intensive care, where the probability of death rises significantly. Stop them from entering in the first place by taking far more proactive measures once an individual is in fact infected with SARS-CoV-2. This top doctor emphasizes early and aggressive hospitalization and treatment in a bid to minimize disease escalation and mortality. His approach may be working as, according to a recent Bloomberg report, the COVID-19 death rate in Hong Kong at 2% is well below the worldwide average.
TrialSite breaks down this recent information originating from a Bloomberg journalist Jason Gale.
How is Dr. Kwok-Yung’s approach different to those in Britain or the United States?
Dr. Kwok-Yung shared for Bloomberg, “In places like the U.K. or U.S., usually if you have mild symptoms, you are not admitted to a hospital at all—you just wait at home until you feel very bad or you have shortness of breath.” This is quite different than approach they are taking in Hong Kong reported Mr. Gale where they admit most people test positive so they can be treated immediately and aggressively.
Why do they take this aggressive approach in Hong Kong?
Well the top infectious disease provider shared that first and foremost the transmission of the coronavirus is greatly reduced in the community. Yes, it may seem more draconian that mild COVID-19 cases are hospitalized and isolated but it’s certainly made a difference in the total volume of cases and death rates.
Moreover, with the huge number of clinical trials with potential treatments the number of hospitalized patients affords a chance for more robust matching of patients to clinical trials. Patients can receive targeted advanced investigational treatments immediately as the infections start to worsen.
Why is this important?
According to Yuen, writes Bloomberg’s Gale, the amount of SARS-CoV-2 virus or “viral load” accumulating in patients peaks at this point the time symptoms appear.
What are some treatments the Hong Kong team use?
Although recently shown not effective, the University of Hong Kong suggests that use of the antivirals ribavirin and Kaletra (lopinavir/ritonavir) can work. Yuen suggests that he wasn’t surprised by the recent World Health Organization findings because the drug’s were not given right upon infection onset.
Yuen told Bloomberg, “We know that one drug is not good because all of these are very modestly active.” Continuing he suggested “We need early cocktail therapy to get good results.” Hence the combination of ribavirin, Kaletra and interferon to COVID-19 patients in the first week of disease onset actually reduces the duration of the illness by six days and shortens the hospitalization period by a week based on a study back in May.
Interferon, part of the Hong Kong cocktail, evidences potential efficacy against COVID-19. In fact Bloomberg reported that based on its interview with the Hong Kong top doctor the early use of interferon, at least in some patients, may help combat the virus and reduce death rates. For example, recent clinical trials published in journal Science reveal that approximately 14% of patients with critical SARS-CoV-2 infections actually have inadequate levels of interferon, which is required for immune system defense against viral pathogens. TrialSite has chronicled a few studies suggesting the importance of interferon as a potential treatment.
Yuen Kwok-Yung, the Henry Folk professor in infectious diseases, University of Hong Kong; a graduate from University of Hong Kong since 1981 is actually a microbiologist, surgeon and physician and according to Mr. Gale he ”has been at the forefront of the city’s response to infectious outbreaks for decades.”
Call to Action: Follow the link to read Mr. Gale’s piece in Bloomberg in its entirety.