Reply To: SARS cov2 and Covid 19

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Another small study suggests that improvement in clinical management of patients with covid 19 who require increased oxygenation by injections of a licensed drug, a Kinin B2 receptor antagonist, icatibant, to 10 patients and 20 controls, in a case controlled study of patients with covid-19 requiring oxygen therapy:

Pulmonary edema is a prominent feature in patients with severe coronavirus disease 2019 (COVID19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the cell via angiotensin converting enzyme 2 (ACE2).1
ACE2 is involved in degrading the kinin des-Arg9-bradykinin, a potent vasoactive peptide that can cause vascular leakage. Loss of ACE2 might lead to plasma leakage and further activation of the plasma kallikrein-kinin system with more bradykinin formation that could
contribute to pulmonary angioedema via stimulation of bradykinin 2 receptors.2 We investigated
whether treatment with the bradykinin 2 receptor antagonist icatibant in patients with COVID-19
could be used as a treatment strategy.

Of course this will need confirmation through a large randomised study, but together with the study published on the use of dexamethasone, may help save some lives until more effective targeted therapy is found.

Interestingly it has also been observed that the rising number of cases in this second wave is associated with less severe disease including the number of deaths. Although this is at present anecdotal, the ratio of new cases to deaths seems to confirm this at present. A number of reasons may be at play but one of them is probably also due to better management of the severely ill patients due to increased understanding of the disease process.