THE number of new cases of Covid-19 hovers at around 40,000 per day with between 200 to 300 deaths, as we move into winter where traditionally the figures for hospital admissions and fatalities rise, partly due to flu as well as other respiratory illnesses, particularly among the most vulnerable groups.

The UK Medicines and Healthcare Regulatory Authority’s (MHRA) recent decision makes England and Wales the first countries to approve molnupiravir (tradename Lagevrio) the only oral antiviral treatment currently available for Covid.

Previously treatment for active Covid has been in the form of expensive monoclonal antibodies which are given intravenously and require specialist supervision in a hospital setting.

Molnupiravir, initially designed to treat flu, becomes the first oral medication to redress this.

Developed by the American companies Merck, Sharp & Dohme (MSD) and Ridgeback Biotherapeutics, it is an oral tablet which has shown to halve hospital admissions in a small study of 775 patients with acute “mild to moderate” illness, testing positive for Covid.

Among those given the treatment just over seven per cent were hospitalised vs 14 per cent in those receiving a placebo. Within 29 days, there were no deaths in those given the active drug against eight for patients prescribed pills.

Molnupiravir interferes with an enzyme required for coronavirus to replicate, hence it reduces the ability of the virus to multiply and overcome the body’s immune system.

A trial of the drug in those already hospitalised was halted due to poor results and the MHRA are keen to point out that molnupiravir should be given “as soon as possible”, in those who have had a positive test, ideally within the first five days of illness.

The UK has at present agreed to 480,000 courses of the drug which should be available within the month. At current trends, demand will far outstrip supply, hence the drug will be initially limited to those most vulnerable due to age and comorbidities, for example diabetes and/or heart disease.

Vaccination status will not matter, although authorities have been rapid to iterate that this should not be seen as an alternative to being immunised.

At the same time, Oxford scientists have identified a gene, LZTFL-1, which may go some way to explaining the far higher rate of illness and deaths among south Asians afflicted by Covid.

The high-risk version of this gene is present in almost two thirds of those of south Asian heritage versus only 15 per cent of those of European ancestry.

As an airborne pathogen, Covid enters the body through the lungs. Part of the defensive mechanism against it breaching the lining of the lungs, also known as the respiratory epithelium, is the ability of these cells to “despecialise” in an attempt to resist entry of the virus into the body.

The despecialisation process also reduces the amount of a key protein, ACE-2 on the surface of the respiratory epithelium. ACE-2 assists the virus in attaching itself to the lungs in the first place. In those with the high-risk version of the gene, this important process does not happen, hence the lungs are more vulnerable to entry of the virus.

The scientists have advised two important points. Firstly, and obviously, this cannot entirely explain the increased numbers of infection and deaths among certain groups, pointing out that a whole host of factors are at play.

Secondly and of equal significance, this high-risk gene does not alter or reduce the body’s immune response to Covid, hence there is still every reason for anyone who can get vaccinated to do so.

The pandemic has changed the way we think and act in many ways, however it is vital to remember that despite advances we are sadly far from an end to it.

The rules of social distancing, rigorous hand hygiene, always considering Covid-19 and getting a test if you have any potential symptoms still apply, and hopefully will contribute toward a stabilisation and potentially reduction in cases at a time of year when healthcare resources are under increasing strain.

Although many places have reduced the strictness of their mask policy, perhaps wearing one may still be a small reminder to us of all the other things we need to be doing to hopefully reduce our risk and stay safe.

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