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Dawn of mankind? Is future a utopia?


Piotr Kochan



The world today

One might say – we are coming to an end.
The end of 2020. The end of the road.
The end of the world as we know it.
And not only in death but in economic death of many companies, brought upon by COVID-19.

Many religious people speak of punishment for the wrongdoings of humankind. Others speak of conspiracy theories ranging from a weaponized virus to the pharma industry, intelligence services or billionaire concepts.

The pandemic truth is probably very different. It may be nature alone or with help of irresponsible humans taking its toll.

We cannot rule out the destruction of our planet, either by human or natural causes. In my opinion, it’s only a matter of time, and everyone who hopes it won’t happen is mistaken. Whether it will be overpopulation, pollution, environmental contamination, atom bombs, cosmic collision, dying sun or any other cause – it is inevitable. It’s only a matter of time. We are just a grain of sand in the universe. One must realize we are not to last forever as humans, as earth.

As I’m writing this editorial, to complement my editorial from March [1], the pandemic figures are not optimistic. Citing today’s WHO figures: “Globally, as of 4:11 P.M. CET, 31 December 2020, there have been 81,475,053 confirmed cases of COVID-19, including 1,798,050 deaths, reported to WHO” [2].

For Poland welcoming the new year, today’s figures (31.12.2020 10:00) are not optimistic either, and very different from March 2020 data I wrote about [1], with 1,294,878 confirmed cases since the beginning of the pandemic and 28,554 deaths [3]. The figures tend to decrease over weekends when there are less tests performed.

Many persons with accompanying diseases have died. It’s difficult to estimate the number of people who died due to inadequate care owing to other conditions such as neoplasms, cerebrovascular accidents or cardiovascular diseases, but without a doubt the numbers are staggering. And those estimates will only be known when the pandemic is over.


A new hope

There is a light in the tunnel. When I wrote the March editorial, there was no recommended treatment for COVID-19. Currently many organizations around the globe have worked out COVID-19 treatment recommendations. I personally would like to recommend Sanford Guide updates to be found on: https://webedition.sanfordguide.com/en/sanford-guide-online/disease-clinical-condition/coronavirus

Polish version of the updates is available on: http://www.sanfordguide.pl/covid19/

The current regimens from the Sanford Guide website include:

“Not hospitalized, mild-to-moderate COVID-19
Supportive care, consider anti-SARS-CoV-2 monoclonal antibody therapy (bamlanivimab or casirivimab plus imdevimab) for outpatients with high risk of disease progression, available through Emergency Use Authorization). Should be administered early in the course of disease; do not give after day 7 of symptoms (earlier is better).

Hospitalized, no supplemental oxygen requirement
Consider use of remdesivir for patients at high risk of disease progression.

Hospitalized, requires supplemental oxygen
Remdesivir + dexamethasone.

Hospitalized, requires mechanical ventilation or extracorporeal membrane oxygenation
Dexamethasone + remdesivir (benefit of remdesivir unproven, but recommended by some authorities).

Recommended dosing
Remdesivir
Adult dosing (wt > 40 kg): 200 mg IV loading dose on day 1, then 100 mg IV daily maintenance dose. Infuse each dose over 30-120 min.5 day course if not on ventilation/ECMO. If no clinical improvement at 5 days, extend to 10 days. 10 day course for patients on mechanical ventilation/ECMO.

Pediatric dosing (wt 3.5 - 40 kg): 5 mg/kg loading dose on day 1, then 2.5 mg/kg maintenance dose. 5 day course if not on ventilation/ECMO. If no clinical improvement at 5 days, extend to 10 days. 10 day course for patients on mechanical ventilation/ECMO.









































































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figure1
Figure 1. Still shot from the film published by Boston Dynamics on its YouTube channel of three robots dancing to the tune of Do You Love me? The film may be seen on: https://youtu.be/fn3KWM1kuAw
[please click on the image to enlarge]



Dexamethasone
6 mg once daily IV or po x 10 days for patients on supplemental oxygen or receiving mechanical ventilation. Do not use in patients who do not require supplemental oxygen or mechanical ventilation: no benefit, possible harm (see Comments).

Monoclonal Antibody Therapy recommended for outpatients as single dose therapy.
Bamlanivimab (Lilly) 700 mg administered as a single infusion in a healthcare setting. For use in SARS-CoV-2 confirmed adults and paediatric patients (12 years of age and older weighing at least 40 kg) with mild to moderate COVID-19 who are at high risk for progressing to severe COVID-19 and/or hospitalization.

Casirivimab + Imdevimab (Regeneron) combination 2,400 mg (casirivimab 1200 mg + imdevimab 1,200 mg) single IV infusion. Indicated in adults and paediatric patients (12 years of age or older weighing at least 40 kilograms) with mild to moderate, SARS-CoV-2 confirmed, COVID-19 who are at high risk for progressing to severe COVID-19.

Alternative Regimens Baricitinib 4 mg orally daily (for up to 14 days) + Remdesivir 200 mg on day 1, then 100 mg IV daily for up to 10 days. Baricitinib should only be used in the rare situation where corticosteroids cannot be used.”

COVID-19 vaccines

After FDA and EMA conditional approvals There are ongoing efforts with COVID-19 vaccines and current vaccination campaigns in many countries in the EU and beyond. You may read the details on the Sanford Guide websites dedicated to COVID-19, listed in the previous section. In Poland the first group to be vaccinated will be the healthcare personnel, followed by the elderly. I did sign up for it.

So far the vaccine had very few adverse events, mostly related to hypersensitivity reactions. As the first report about the immunity in SARS-CoV-2 survivors demonstrates it to last for 5 to 7 months, the vaccine will not have a lifelong effect, unfortunately.

WJOMI 2020 Outstanding Contribution to Medicine Award

The choice of the 2020 laureate of the yearly World Journal of Medical Images, Videos and Cases Outstanding Contribution to Medicine Award was postponed due to COVID-19 pandemic. We still have not been able to present the award to last year's awardee –Mr Jerzy Owsiak. Despite the award presentation and interview been scheduled in Warsaw, we had to cancel these activities owing to the first pandemic wave and the restrictions it brought. We hope we can return to the awards as soon as the situation normalizes.


Novel technologies inspiring WJOMI Editor-in-Chief

Ever since I remember, I was always fascinated by novel technologies, including medical technologies. The recent launch of the Cyberpunk 2077 video game has just spiked that interest. The world shown there on one hand looks tempting with possibilities of life prolongation and body augmentation. On the other hand it has that gloomy Blade Runner atmosphere with the general phrase: "why did mankind end up so bad?".

But besides the glitches of the game reported by many gamers, I found myself surprised that even in such a modern society there are no or just a few robots. In my opinion the robot chase and introduction of these machines to the streets is done at a very slow pace. Of course, money's the limiting factor, but availability of robots even for the richest people is still close to none. An I'm not only talking about personal use, but medical use esp. for paraplegic or homecare patients. Usually the ones in existence are highly specialized, but not used for personal reasons. Time will tell, how safe this technology will be. AI in machines may be very tricky, to say the least. A self-learning machine with an 'urge' to hurt humans.

Another interesting topic is in the future of transplantology. In my opinion the only way to improve the situation in the global sense is to start bio-3D-printing. This is not sci-fi. This is already being done using the recipient's cells, for example with lab printed blood vessels, pancreas etc. Such printed organs could then be transplanted into the recipients.

Waiting for more!


References:
[1] Kochan P. How to live and survive the coronavirus pandemic? WJOMI awards the 2019 Certificate of Outstanding Contribution to Medicine to Jerzy Owsiak. World J Med Images Videos Cases 2020; 6:e9-13.
[2] World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Access valid on 31 December 2020: https://covid19.who.int/
[3] Ministerstwo Zdrowia. Koronawirus Informacje i Zalecenia. Raport zakażeń koronawirusem (SARS-CoV-2) aktualne na: 22.03.2020 21:00. Access valid on 31 December 2020: https://www.gov.pl/web/koronawirus/wykaz-zarazen-koronawirusem-sars-cov-2
[4] Ripperger TJ et al. Orthogonal SARS-CoV-2 Serological Assays Enable Surveillance of Low Prevalence Communities and Reveal Durable Humoral Immunity. Immunity 2020; 53:925-33. DOI: 10.1016/j.immuni.2020.10.004


Conflict of interest: none declared

To cite this article: Kochan P. Dawn of mankind? Is future a utopia? World J Med Images Videos Cases 2020; 6:e56-9.

Published on: 31 December 2020






































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