Is prophylactic treatment possible?

Like many European countries, Russia was markedly affected by COVID‐19. 

The first step in ‘fighting’ the epidemic was a nationwide lockdown, implemented on March 30, 2020. Most of the multidisciplinary hospitals were rapidly repurposed as dedicated COVID‑19 centres and health workers re-trained and deployed as infectious disease specialists. The outcome was the creation of a cohort of trained and dedicated staff readily available to support patients in intensive care units who needed mechanical ventilation.

In reviewing protective options for colleagues, clinicians were aware of azoximer bromide (Polyoxidonium®, PO), developed at the State Scientific Center of the Institute of Immunology of the Ministry of Health of the Russian Federation and available for clinical use since 1996. Azoximer bromide is a high molecular weight synthetic immune modulator drug, which is believed to increase an individual’s resistance to local and general infection and is indicated for the treatment of viral infections. Azoximer bromide is excedingly well-tolerated in multiple infectious diseases of viral and bacterial aetiology. In a letter to the editor of the Infectious Diseases and Tropical Medicine journal the team report on their observations.

Healthcare professionals started propylactic dosing with azoximer bromide and continued their clinical duties. The medical team was exposed to over a thousand patients infected with COVID-19 during care delivery. Many of these patients experienced severe symptoms and were maintained on non-invasive, instead of invasive, ventilation.All of the professionals taking azoximer bromide remained symptom free and tested negative for COVID-19 during the 5-month dosing period (with the exception of one member who became infected during a 10-day break in dosing). There were fewer cases of COVID-19 among the medical personnel than in the neighbouring department despite both using the same personal protective equipment (PPE).

Although the present observations are purely subjective in nature, it does raise the question of whether azoximer bromide could be used prophylactically to protect medical professionals in similar risk situations. Further work is clearly needed to address this question.