Abstract
This article discusses the evolving real-world practice using nitazoxanide, non-steroidal anti-inflammatory drugs (NSAIDs) and/or azithromycin (Kelleni's protocol) to manage the evolving manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron EG.5.1, its descendant HV.1 as well as BA.2.86 and its descendant JN.1 subvariants in Egypt in 2024. These subvariants are well-known for their highly evolved immune-evasive properties and the manifestations include some peculiar manifestations as persistent cough besides high fever in young children as well as high fever, persistent severe cough, change of voice, loss of taste and smell, epigastric pain, nausea, vomiting, diarrhea, generalized malaise and marked bone aches in adults including the high-risk groups. It's suggested that the ongoing SARS-CoV-2 evolution is continuing to mostly affect the high-risk groups of patients, to some of whom we've also successfully prescribed nitazoxanide and/or NSAIDs for post-exposure prophylaxis of all household contacts. We also continue to recommend starting the immune-modulatory antiviral Kelleni's protocol as soon as possible in the course of infection and adjusting it in a personalized manner to be more aggressive from the beginning for the high risk patients, at least until the currently encountered surge of infections subsides.