“Vaccine and Medicine Treatment: Achievements and Expectations Online Symposium”, hosted by İstanbul University Clinical Research Excellence Application and Research Center (İÜKAMM), was held with the participation of leading experts from many branches of Medicine. In the symposium undertaken by the moderatorship of Prof. Dr. Yağız Üresin, the deputy director of İÜKAMM; the infrastructure of early diagnosis, rapid intervention and low mortality success revealed by the İstanbul Faculty of Medicine during the COVID-19 pandemic was examined and the gains and expectations reached in the medicine and vaccine studies were discussed.

During COVID-19 Days Vaccine and Medical Treatment: Achievements and Expectations Online Symposium, began with the speech of Prof. Dr. Mustafa Oral Öncül; İstanbul University Vice-Rector and İstanbul Faculty of Medicine Infectious Diseases and Clinical Microbiology Faculty member. Mustafa Oral Öncül began his speech commemorating his colleague Prof. Dr. Murat Dilmener, İstanbul Faculty of Medicine Member. Prof. Dr. Öncül stated that the world has encountered a number of pandemic risks before, but COVID-19 was the most effective pandemic attack encountered in recent years. Prof. Dr. Öncül said that the world has encountered a number of pandemic risks before, but coronavirus is far more effective than the Zika virus encountered in the past. And he added: “At this point, 3,600,000 people in the world have encountered COVID-19. About 249,000 of them died due to COVID-19. Worldwide mortality rate is about 6.8 percent".

"In the Northern Hemisphere, the plateau stage of the disease is largely completed, while in the Southern Hemisphere, there are many signs of the early stages of the disease." Prof. Dr. Öncül stated that the Southern Hemisphere will experience the winter season in the coming period, so it will encounter more of the disease.

“We Can Say That Our Country Has Passed the Test Successfully”

Prof. Dr. Öncül stated that, despite the overall rate of 6.8, higher rates could be encountered in different parts of Europe, adding: “Today we see a mortality rate of about 6 percent in the US. This rate is about 12 percent in Spain, 14 percent in Italy and 15 percent in France. In Turkey, mortality rate is now around 2.7 percent. When we look at it, we can say that our country has given a good test in this respect. From the early stages of the pandemic, the approaches of the organization, health teams and the Ministry of Health have been very successful. We can see the impact of this in all areas. Of course, at this point, we have to give a big share to the doctors and health workers who have made great sacrifices. In addition to the hard work, a very good organization was carried out. Multidisciplinary approaches were laid out. One of the best examples of this is the İstanbul Faculty of Medicine. In the process from the preparations that started before the pandemic to the present day, our Faculty of Medicine displayed a selfless, pioneering and successful struggle.”

“The Contribution of Our Faculty of Medicine in the Treatment Protocols of the Ministry of Health is Great”

After the current situation evaluation of Prof. Dr. Öncül; the Dean of İstanbul University- İstanbul Faculty of Medicine Prof. Dr. Tufan Tükek delivered his speech on 'Covid-19 Treatment Protocols'. He said: "This symposium is perhaps the first time that a program on COVID-19 has been organized with such a deep dimension and participation from all branches." Prof. Dr. Tükek stated that programs related to the management of chronic diseases or health policies generally related to 'COVID-19' have been made. Prof. Dr. Tükek said: "We can say that mortality rate in Turkey is low and success in health is achieved by the implementation of these protocols. There is also a great contribution made by the esteemed professors of the İstanbul Faculty of Medicine to the treatment protocols implemented by the Ministry of Health. In many areas, from the determination of the protocol to the writing phase, the contributions of our dear teachers are very important.”

How is the Treatment Decided?

Prof. Dr. Tükek emphasized that the treatment decision in our country is made according to the severity of the disease and therefore it is necessary to shape the disease with categories such as mild, moderate, and severe. "We do not treat patients with the underlying disease, and we do not treat patients who are above or below the age of 50 and who are in the class of mild diseases." Prof. Dr. Tükek stated that when patients have shortness of breath, they are taken to the department of severe diseases. Severe disease class is an important disease group that determines treatment and tries to prevent going to intensive care. Prof. Dr. Tükek said: “The following data help us to determine the heavy illness group: Saturation being below 90 percent saturation at room air, respiration rate over 30 in a minute, the number of lymphocytes being under 800 at the time of patient application; CPR being over 40, ferritin being over 500, D-Dimers being over one thousand. Besides, findings of pneumonia at lung X-ray in determining the heavy-illness group help us. It is now known that those who are already over 50 and have an underlying chronic disease should be evaluated separately. I want to say the importance of hydroxychloroquine. Although it is not yet supported by the United States and other countries, we have at least observed that hydroxychloroquine is very successful when used in early treatment. These patients can get heavier after the first week. Especially shortness of breath and lung symptoms can become deep. In a situation like this, we want them to come back to the hospital. In addition to severe cases, we also add azithromycin to prevent infection. Favipiravir is used in anti-viral treatment in our country, especially in patients whose clinical table does not improve on the third day and fourth day, and whose fever does not fall, to be given for 5 to 7 days. Remdesivir could not be used in Turkey except in a few cases. But we know it's being used as an anti-viral agent around the world. The U.S. is particularly insistent on this medicine. Oxygenization is one of the methods we have successfully applied in our faculty. Antiinflammatory therapy is another. We have observed that tosilizumab is very useful in a number of patients." He also said that convelasence plasma has recently entered treatment protocols with an increase in those recovering. After Prof. Dr. Tükek, Prof. Dr. Yağız Üresin started his presentation on “Preventive and Virus-targeting Treatments”. Prof. Dr. Üresin pointed out that in the process of COVID-19, the biggest profit have been made by the companies that produce reinforcing foods. Prof. Dr. Üresin noted that some information and news were received in this direction, about the subject. He also stated: “Some of the raw ingredients of vitamins have become unavailable on the markets. There is so much production and presentation that their raw materials cannot be found. People consume vitamins, supplements, herbal products for prevention purposes”.

“The Association of Dieticians in the United Kingdom has not put forward any nutritional products or nutritional contributions and currently does not accept any claims, as fact”. Prof. Dr. Üresin said that although an Oxford publication found that there is a link between Vitamin D deficiency and COVID-19, this does not mean COVID-19 ends when Vitamin D is taken. And also, there are no studies showing this.

“Complementary Therapies May Interfere with the Original Treatment”

Prof. Dr. Üresin noted that complementary therapies may be harmful. Prof. Dr. Üresin said: “Although serious details have been entered in the laboratory and animal studies, there is no study providing evidence clinically at this point, and additionally; there may be a danger. These complementary therapies may interfere with the treatment process and interact with the actual medicine. Products may have problems with their own safety. One of the most important dangers of this can be demonstrated by creating a sense of hope that is not based on reality, preventing people from performing the most important measures such as social distance”.

After Prof. Dr. Üresin completed his speech, Prof. Dr. Ahmet Gül gave information about the following subject: ‘Information About Hyper Inflammatory Response in Cytokine Storm and Pathogenesis’. Prof. Dr. Gül said that as the number of cases related to the disease and both microbiological and serological reviews increased, it was understood that a significant group of patients were asymptomatic. Around 46 percent of the investigations on the islands, no symptoms of the patient. Prof. Dr. Gül added: “However, a significant group of patients also have symptoms. These symptoms are usually accompanied by fever, sore throat, cough, and shortness of breath. But other than that, muscle pain, gastrointestinal symptoms and headaches also began to be among the symptoms that are increasingly striking”.

“The Course of the Disease Differs in the Second Week”

Prof. Dr. Ahmet Gül pointed out that in some patients, the disease is very mild; they recover spontaneously, with the support treatments or first-line treatments. Prof. Dr. Gül said that despite all the treatments, a patient rate not exceeding 10 percent is in need of intensive care support or lost. He added: “In fact, it is the same disease, the same factor, but there is a serious difference in this course. When we look at this difference, we can see it in the first clinical series evaluations from China. We see a difference between patients who are hospitalized and who are symptomatic and who have significant respiratory symptoms, and who have survived, recovered, gradually deteriorated and passed away from the second week. The main factors that negatively affect survival are advanced age, high sofa scores and increasing D-Dimer values, which we have seen accompanied by coagulopathy over time. When we look at this whole course, we see that the period in which the difference occurs is usually the second week. In other words, the second week after you start to feel the symptoms of the virus, the period of survival, the most important difference in the course of the disease occurs”.

Differentiating Symptoms in Severe Patients

Prof. Dr. Ahmet Gül explained the differences observed in patients with severe diseases. Prof. Dr. Gül said that this difference is caused by the hyper inflammatory response. He said : “C-reactive protein values, which increase together with fever, are also an important difference”. Prof. Dr. Gül made the following explanation: “D-dimer becomes increasingly prominent, especially from the second week. Lymphopenia falls more significantly than the patients who survived. Interleukin 6 levels increase again the second, or sometimes the third week. And high numbers (increases) especially in troponin values slightly later in the period, after the third week. And increases in lactate dehydrogenase values. However, when we look at other series, we can add to these differences the accompanying liver enzyme elevation, thrombocytopenia, pyrogen reduction and coagulopathy”.

A Critical Difference: Viral Load

Prof. Dr. Gül noted that, in a group of patients starting from the second week, a different process and increased lethality took place. Prof. Dr. Gül underlined that one of the factors affecting this is the viral load. He said: “Some patients have a higher viral load when they first start the process”. Prof. Dr. Gül made the following explanation: “In the case of more of the virus entering the body, there is a condition that is triggered by a delayed interferon response. He said: “In both cases, due to the proliferation of the virus, or because of a higher proportion of virus entering the body from the start; viral load makes a critical difference”.

“We Need the Success of All Research Groups”

After Prof. Dr. Gül completed his speech; Prof. Dr. Gabriela Santi, (the director of Research and Teaching at the Zurich University Hospital and the Founding President of the International Network of Clinical Research Center) delivered her speech. Prof. Dr. Senti thanked everybody for this invitation and underlined that it is very important to cross borders, to speak together, to develop medicines and therapies in such difficult times of isolation. She said: “We need the work and success of every research group in these difficult times”. Prof. Dr. Senti pointed out the importance of fighting together against the same big problem, stressing that there should be a large number of successful medicines and vaccines. She added that she worked as a Research and Teaching Director at Zurich University Hospital for 4 years and worked as a Clinical Immunologist in vaccine research for 20 years. The first session of the symposium was completed when Senti presented “Approach of a Swiss Research Group by Using Viral Like Particles”.

"Plasma Therapy is an Ancient Method”

In the second session, the following panelists took place: İstanbul University, İstanbul Faculty of Medicine Infectious Diseases and Clinical Microbiology Faculty Member Prof. Dr. Atahan Çağatay; Department of Chest Diseases Faculty Member Prof. Dr. Mustafa Erelel, Cardiology Department Lecturer Prof. Dr. Sabahattin Oman, Department of Internal Medicine Faculty Member Prof. Dr. Sevgi Kalayoğlu Beşışık and Anesthesiology and Reanimation Faculty Member Prof. Dr. Figen Esen. The second session the speakers focused on the treatment, medicine and vaccine studies for COVID-19, as well as answering questions from the participants.

In the online symposium, Prof. Dr. Sevgi Kalayoğlu Beşışık gave information about the plasma treatment: “Plasma is a method used in the past, it is not a discovery. We already used immunoglobulin in time. It is too early to give plasma to the patients and say they are suddenly healed, and also it is too soon to say that plasma theraphy is not effective. Our concern is the immune response to the virus (natural immunity and adaptive immunity from sequencing), which is the main objective of passive transfer of the immune. I have said beforehand that it is an experience with specific plasma. However, if we think of COVID-19 specific; there is even a massive meta-analysis that has been applied in SARS and MERS, there is a compilation of data saying that this theraphy actually reduces mortality. But the same data has not been obtained on Ebola. Based on this; we can apply it for COVID-19. The first publication about the subject came from China, and from there it became a current topic. The FDA set and then approved the criteria for the application of this plasma on April, 8”. Prof. Dr. Kalayoğlu Beşışık also added that a guide was prepared in Turkey on April 10.

“This Virus Comes Across as a Challenge”

Department of Anesthesiology and Reanimation of İU Faculty of Medicine, faculty member Prof. Dr. Figen Esen began her speech about the process of transferring to intensive care and the related applied treatments. She made the following explanation: “When we look at the rates, our Faculty has low rates of transfer of patients to the intensive care. This really shows that the treatment of patients in the ward and similar approaches to intensive care that we do at the primary level in the ward have worked in some way. On the other hand, there is no clear explanation for what worked for the transferring of patients into intensive care and the arduous process after that. Because as far as I am concerned, this virus comes across as a real challenge”. She also added: “It is a challenge that has spilled all the theoretical knowledge and practices we know. We were prepared for the supportive treatments rather than medical approaches. But COVID-19 presented a very different clinical picture”.

"We Started Vitamin C Applications before COVID-19”

Prof. Dr. Figen Esen continued her speech by adding the following information: “We started the practice of Vitamin C by addressing a single-centred study of septic shock. No response was received in the multicentered study which was conducted later. On the other hand, we had started Vitamin C applications before COVID-19. We have applied approaches like dornase Alpha to very few patients”. Prof. Dr. Esen added that it is pretty hard to say anything about how much benefit Heparin, dornase Alpha and cortisone are getting, especially with regard to the intensive care patients.

‘During COVID-19 Days Vaccine and Medicine Treatment: Achievements And Expectations’ online symposium went on with the BioNTech company Co-founder and CEO, Prof. Dr. Uğur Şahin's presentation titled “Rationales for Developing COVID-19 mRNA Vaccines” and he gave information on vaccine development in Germany. The symposium ended with the question and answer section.

News: Tuğçe AYÇİN - Gizem AYGÖR
Translation: Yasemin UĞURLU
İU Department of Corporate Communication