Abstract
The new severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused more than 40 million human infections since December 2019, when a cluster of unexplained pneumonia cases was first reported in Wuhan, China. Just a few days after the coronavirus was officially recognized, it was identified as the causative agent of this mysterious pneumonia. This paper discusses the pros and cons of antiviral drugs from the selective pressure and possible drug resistance point of view. We also address the key advantages of potential selective pressure-free treatment methods such as the use of sparsely and densely ionizing low-dose radiation (LDR). It is known that LDR has the capacity to modulate excessive inflammatory responses, regulate lymphocyte counts and control bacterial co-infections in patients with COVID-19 and different modalities. Substantial evidence shows that viruses are constantly mutating and evolving. When an antiviral immune response is unable to eliminate a virus, viral evolution is promoted. Therefore, it is of crucial importance to limit the use of antivirals/vaccines against SARS-CoV-2 when their effects on viral fitness are not fully understood. Furthermore, to limit the spread of the virus, it is essential to develop a vaccine that is available for as many people as possible. However, with the advent of vaccines or new therapies, the new situation may force the virus to evolve. Given this consideration, selective pressure-free treatments for COVID-19 are of great importance.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19 [1], like SARS-CoV and MERS-CoV, is a single-stranded RNA beta-coronavirus
These researchers mostly focused on some key bioeffects of low-dose radiation therapy (LDRT) such as anti-inflammatory and immunomodulatory effects and proposed that local irradiation of lungs with radiation doses ranging from 0.1 to 1 Gy could be beneficial for treatment of severe pneumonia in patients infected with SARS-CoV-2
It is well documented that where the treatment course is effective, no viral genomes will be successfully replicated, but where the treatment is ineffective and some genomes find the opportunity to replicate, selective pressures may lead to rapid adaptation causing viral resistance [75]
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19 [1], like SARS-CoV and MERS-CoV, is a single-stranded RNA beta-coronavirus. To develop the most effective vaccines against rapidly spreading SARS-CoV-2, there are different methods: innovative RNA vaccines, and viral vector- or protein-based vaccines [3]. In addition to the lungs, ACE2 is expressed in many organs such as the intestine, kidney, bladder, liver, heart and brain; SARS-CoV-2 can damage multiple organs and cause organ failure, in particular ARDS [5,6,7]. The large expansion of SARS-CoV-2, high rate of cell death (through necrosis, apoptosis and pyroptosis), damage to lung epithelial and endothelial cells, vascular leakage, failure of the renin–angiotensin system, thrombosis, hyper-inflammatory responses and cytokine storm are among the major pathological events occurring in COVID-19 [8,9]. The results from the larger trials have been negative and none of the tested drugs showed any major positive effect on hospitalized COVID-19 patients up to now
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