Regardless of whether you have Covid-19 or another illness: Doctors in the hospital follow a kind of protocol or instructions during treatment. These guidelines are developed collectively by the medical community.
The treatment guideline for Covid-19 was last updated on November 23. Intensive care physician Stefan Kluge only presented them at the congress of the German Interdisciplinary Association for Intensive Care and Emergency Medicine. On the subject of drugs, he stated: “There are actually two drugs that have emerged here. One is in the foreground: This is cortisone therapy, the so-called dexamethasone, which we now give as standard to ventilated patients.” This clearly led to a reduction in mortality.
Dexamethasone and remdesivir are used
Remdesivir shortens the illness by a few days, explains Thea Koch, Director of Intensive Care Medicine at Dresden University Hospital. “This is a drug that hinders and reduces virus replication and should therefore be used as early as possible during the illness when the viruses multiply drastically. In the later phase it is then no longer as effective.”
In addition, Covid-19 patients in the intensive care unit very often receive drugs for thrombosis prophylaxis. “That means that in the end it is very, very clear what you can use,” says pharmacy professor Karsten Mäder from the University of Halle. “What is also written down in the guidelines: You have to see whether a bacterial co-infection is taking place. Then you naturally proceed with the specific antibiotics.”
The guideline clearly advises against other drugs, including chloroquine, which has shown no effect in studies.
Every drug has to be tested
Every drug must be tested in clinical studies before Covid patients can be treated with it, explains lung specialist Hubert Wirtz from Leipzig University Hospital. “If you lie in a normal hospital, you only get treatment methods that are approved or that – let’s say in individual cases can be decidedly used by the doctor, and if that is not the case, then you are carefully informed.” Then that’s part of a study. You would never just try something with the patient like that.
Consent to experimental therapy
As in any other case, doctors prescribe the approved medication and inform those affected about the means used. If drugs are to be administered as part of experimental therapies, express consent is required. Just like the case in Dresden:
There one of the so-called antibody cocktails is given in a clinical study: a convalescent serum, explains medicine professor Thea Koch – i.e. plasma from patients who have survived the disease. “If the patients are able to give their consent,” says Koch, “the patients themselves or the relevant caregivers are asked, informed and consent must then be available, otherwise we are not allowed to administer it.”
So far, the serum has been used more than ten times in Dresden and in some cases has had positive effects, says Koch. However, the effectiveness has not yet been sufficiently proven in a large study.