We now know that COVID-19 is a real threat to our community, and is spreading across the world. Many of us are isolating ourselves in our homes, schools are closed, and fear and uncertainty is palpable. Perhaps the hardest part is not knowing how long we will be here, how long this thing is going to last.
There is a lot of misinformation about this virus and its treatment. The fact is, there is not yet an approved treatment that effectively kills the virus or mitigates the disease. We can’t yet skip out of our houses knowing that if we get the virus, we have something to treat it with.
But if we hunker down and just wait a bit, we may have that soon. There are scientists working around the clock on treatments. I’ll tell you some of them that are likely to pop up as effective treatments of this virus.
But first, here’s how the virus progresses
Before can can talk about how to treat the virus, it’s important to understand what is known about how this disease progresses, and why it sometimes causes quite serious illness.
The virus that causes COVID-19 (SARS-CoV-2) is just like any other virus in that it commandeers healthy cells and turns them into virus-making factories. Different viruses target different parts of the body. This one starts in cells that line the back of the throat and the trachea. Here’s how it progresses:
Because your immune system has never seen this virus before, it takes a bit of time for it to respond. This puts the immune system a bit behind in the race.
As a result, your immune system gets really angry, and it starts generating lots of inflammation to try to kill the cells that are making the virus – your cells! In some patients, this response gets so big that it becomes a “cytokine storm” that spreads to other parts of the body, causing multi-organ failure. This is why some experience heart failure, and/or end up on dialysis.
What is the process for developing drugs against COVID-19?
Finding a drug and getting it approved takes some time. The first line of attack is to test and potentially modify drugs and vaccines that are already on the market for other similar diseases. There are several drugs that were used against previous coronaviruses that are now being tested.
In fact, the World Health Organization (WHO) is now conducting a huge, multi-nation test called SOLIDARITY, focusing on four of these drugs. In the meantime, scientists are also developing new drugs and vaccines that are specific to this virus. In all cases, the drugs must undergo rigorous testing. Here are the testing steps:
For a drug that has already been developed and deemed safe for other uses, the testing can be fast-tracked for clinical testing. If they work, those drugs can be ready in a matter of months.
For those that are newly developed, including vaccines, the testing has to start with in culture, then with testing in animals. Verifying safety of the drugs and testing their effectiveness in humans can take anywhere from 6 months to 2 years. Some of the treatments described below are already several months into this process, so we may not have long to wait!
Ok, so how do we treat this thing?
1. A Vaccine
Of course, the best way to protect people from this disease is to prevent them from getting it at all. A vaccine contains a piece of the virus or a whole virus that has been killed or weakened. When your immune system encounters it, it produces antibodies to the virus. Your immune system then “remembers” the virus, and when the real virus invades, your immune system can quickly clear it before you get sick.
Scientists across the globe have made at least 20 different vaccines. Some are in the first stage of clinical trials, but the full progression through the additional stages could take up to a year. So we likely will have a vaccine, but we need something to get us through in the meantime.
2. Antibody Therapy
If you can’t get your body to fight against the virus itself, why not use someone else’s ability to fight it? When people are sick with COVID-19, they produce antibodies to it to help them fight it off. After they recover, the body still has those antibodies. Scientists can use the blood from those patients to collect and purify the antibodies. Then those are injected into someone who is still fighting the virus. The antibodies bind to the viruses in the new patient and kill them.
At this time, we still don’t know whether people make antibodies to this new virus and, if so, how many or for how long. So, more research is needed for this type of therapy. As more and more people recover from the disease, scientists will have more blood to use for this.
3. An antiviral
When you don’t have your own or someone else’s antibodies to combat the virus, the next best thing you can do is to use drugs to kill the virus. Those drugs can either kill the virus directly, or make your body produce responses that kill the virus. Here are some promising drugs already being tested on humans with the virus:
Interferon-beta
This is a substance that is already produced by the immune cells in our bodies. It is a cytokine that acts to stimulate the body’s own anti-viral response, protecting against cell damage and decreasing the replication of the virus. In addition, this drug is used as a treatment for some autoimmune conditions such as Multiple Sclerosis, indicating that it could also help to control the immune response during the progression of COVID-19. A version of this drug by Synairgen plc is now in Phase 2 clinical trials.
Remdesivir (the anti-Ebola drug)
Remdesivir is one of the most promising treatments for COVID-19. It’s an anti-viral drug that acts by blocking an enzyme that is needed for replication of the virus in your cells. This drug was initially developed in the fight against Ebola, but was abandoned for better options. However, in early trials, it shows promise for Covid-19. The drug is currently in Phase 2 clinical trials.
Kaletra® (HIV combination drug)
Kaletra® is a combination of two drugs (Lopanavir and Rotonavir) that are protease inhibitors. They stop the virus from cutting a key protein that is needed to successfully make new functional viruses.
This drug is currently part of clinical trials conducted by the World Health Organization (WHO).
4. Anti-inflammatories and immunosuppressants:
Another way to fight the effects of the COVID-19 infection is by preventing the “cytokine storm” that appears to cause much of the damage. There are several drugs out there that are already used to treat autoimmune diseases, which is basically an overreaction of the immune system. Here are a couple that have shown some promising results for COVID-19.
Kevzara® and Actemra®
These drugs target receptors in your cells called Interleukin-6 receptors. Normally these receptors are a key part of the immune response that generates inflammation. When this drugs deactivate the receptors, they can prevent the “cytokine storm” that damages your organs.
Both drugs are currently in stage 3 trials.
5. Drugs that target the virus AND protect against damage:
Of course, when you’re fighting a virus, you don’t really want to impair the immune system while letting the virus run rampant, so it may be better to try drugs that can knock back the virus while also protecting against damage. There are some promising candidates:
Plaquenil/Hydroxychloroquine (the anti-malarial drug)
This drug was touted by President Trump as the answer to our COVID-19 problems, however there is still much work to be done to test it. Originally developed as an anti-malarial drug, it is now used against autoimmune diseases because it can help prevent inflammation.
It also combats viruses by hindering the virus from using specific parts of the cells, called endosomes, to get into the cells. As a result, it slows the rate that the viruses infiltrate cells in your respiratory tract. So it doesn’t kill the virus, but gives the immune system time to catch up to it, preventing the full-blown infection.
This has already worked well in culture and in animal studies, and has shown promise in some phase 1 clinical trials in China and France. This drug is part of a large phase 3 clinical study conducted by the WHO.
Olumiant® (Baracitinib) and Jakafi® (ruxolitinib)
These drugs are both currently on the market for treatment of autoimmune disorders like lupus and rheumatoid arthritis. Baracitinib was recently identified by machine-learning algorithms as a potentially effective drug against COVID-19 because it not only dampens the inflammatory response, but also can prevent the virus from entering respiratory cells, much like Plaquenil does (though using a different mechanism). Jakafi works in a similar manner. Both are currently in clinical trials.
What’s the Take-Home?
Scientists continue to make fast progress developing treatments that may help kill the virus and tame the infection. We do not yet have a magic bullet. But, if a combination of these treatments prove effective, they can help to make the virus less lethal and buy us time to generate a vaccine.
We need to help scientists and doctors by sheltering in place and increasing social distance until they approve an effective combination of drugs that can reduce the severity of the virus. It is critical that we do this.
There are many possible treatments coming, and there IS a light at the end of this tunnel.
We just have to be patient and reduce the patient load in hospitals while the scientists and doctors do their work.
Wash your hands, stay home, and stay safe everyone!
For more facts about COVID-19, see my previous post.
For an even more comprehensive list of potential treatments against COVID-19, check out this link.
