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SARS-CoV-2, the Delta subtype (+) plus and new oral antiviral drugs

Recently, the attention of epidemiologists as well as the media and the public, has focused on a new subtype of the Delta variant, A.Y.4.2. the so-called Delta (+) plus, which was first detected last July. This subtype shows new mutations, S: Y145H and A222V in the S pin of the virus and was found in 8% of strains examined by sequencing in the UK, alerting all public health services worldwide. It should be noted that the United Kingdom has an excellent molecular epidemiological surveillance system for Covid-19, analyzing a large number of pandemic virus strains on a daily basis. A small number of cases has been reported in Denmark, the USA, Israel but also in Russia and most recently in Greece.

For this new subtype, A.Y.4.2. not much information is known, but it is speculated that it may be 10% more contagious than the Delta variant, and if true, this will make it the most contagious Covid-19 variant to date. It should also be noted that vaccines provide adequate protection against this subtype. However, information indicates that new vaccines are probably being prepared by Pfizer and other companies that will cover these subtypes as well.

Antiviral drugs administered

In addition to the concerns about the course of the pandemic, two new antiviral drugs have come to change (?) the landscape and give hope that something promising can happen in the treatment of the new coronavirus.

The first, under the brand name Lagevrio (molnupiravir) by Merck and Ridgeback’s, which has been approved for use in the United Kingdom by adults with at least one risk factor, is expected to be approved by the FDA for US and EMA for EU. According to the instructions, Lagevrio is most effective when taken in the early stages of the disease, so its use is recommended as soon as possible after a positive COVID-19 test and within five days of the onset of symptoms. Note that it is the first oral formulation approved against Covid-19.

The second antiviral drug that gives hope is Pfizer’s PAXLOVID ™ (PF-07321332; ritonavir) which, as shown in clinical trials, significantly reduces the need for hospitalization as well as the number of deaths from Covid-19. It is an orally designed SARS-CoV-2-3CL protease inhibitor that is also active against virus variants and is expected to be approved for home use.

Protection measures

But apart from the treatment, whose results we do not know for sure, how will we be protected from the subtypes and variants but also SARS-CoV-2? The best way to protect yourself is to get vaccinated with the repeated third dose of resuscitation. We must also continue to apply personal protective measures for COVID-19, such as the use of a mask indoors and when we are close to people who have not been vaccinated and who are not able to walk the prescribed distances.

We must also meticulously take care of hand hygiene by washing our hands frequently and using alcohol-based antiseptics, avoiding the use of gloves altogether.

Applying all of the above and anticipating the effectiveness of the new drugs that may change the therapeutic landscape and being vaccinated with the third dose, we hope that this winter may finally be a little better than the previous one.

Nikolaos Malisiovas

Medical Director of Euromedica group