Is the Coronavirus Treatable?
Fighting the COVID-19 pandemic is a top priority in medical research and pharmaceutical development. Hundreds of organizations are working on innovations to reduce the impact of SARS-CoV-2 — the coronavirus that causes COVID-19 — and prevent further infection.
What are the recent advancements in treating COVID-19? What therapies are in development? And when might a coronavirus vaccine be ready for the general public? Paul Auwaerter, M.D., M.B.A., an infectious diseases expert, and Arturo Casadevall, M.D., Ph.D., M.S., an expert in microbiology and immunology, provide an update.
How Is COVID-19 treated?
Treatment for COVID-19 depends on the severity of the infection. For milder illness, resting at home and taking medicine to reduce fever is often sufficient. The more severe cases require hospitalization, with treatment that might include supplemental oxygen, assisted ventilation and other supportive measures.
“Two drugs that have a role in treating severe COVID-19 infection are the anti-viral remdesivir, which recently received full FDA [Food and Drug Administration] approval for treatment of hospitalized patients with COVID-19, and the corticosteroid dexamethasone,” Auwaerter says.
“The Food and Drug Administration has also given emergency authorization to use convalescent plasma [CP]. The data supporting the usefulness of CP for hospitalized patients is less robust than that for remdesivir or dexamethasone, but studies in progress will hopefully better clarify its role.”
The Race to Develop Vaccines for COVID-19
Medications for COVID-19
Pharmaceutical companies and laboratories worldwide are working to develop medicines for COVID-19. Many clinical trials are underway to test drugs, including investigational compounds and medications already approved by the FDA for other illnesses to see if one or more can have an impact on COVID-19.
Anti-viral medications are available to treat several diseases, such as influenza. Anti-viral drugs don’t kill a virus but instead limit the production of new viruses in host cells.
Effective anti-viral treatments can shorten the duration of the illness and lessen complications in some people. Since the coronavirus that causes COVID-19 is new, there is limited evidence regarding specific anti-virals that may work against it. Doctors and scientists are looking at experimental anti-virals to find effective treatments for the new disease.
One anti-viral drug, remdesivir, was initially developed for the Ebola virus. Researchers are testing remdesivir to see how it might help patients with COVID-19, and the results of some of these studies are available.
A study conducted in China did not show any benefit in treating patients with COVID-19. However, the National Institutes of Health reported that in a U.S. clinical trial (ACTT-1), remdesivir helped patients with COVID-19 recover faster when compared with patients who did not receive the drug.
“Final results of the ACTT-1 trial show a 31% shorter recovery time [10 days versus 15 days] in patients who were treated with remdesivir,” Auwaerter says. “In the study, patients who were able to leave the hospital or return to their normal activities were considered recovered. The patients who appeared to benefit most were those who needed supplemental oxygen but who were not so ill as to require intensive care unit stays or mechanical ventilation.”
In May 2020, the FDA made remdesivir available to patients in research trials and hospitalized patients through an emergency use authorization (EUA). On Oct. 22, 2020, the FDA approved the drug for treatment of all hospitalized adult and pediatric patients with suspected or laboratory-confirmed COVID-19, whether the illness is mild or severe. The drug is an intravenous medication with a course of treatment that lasts five to 10 days.
The possible role of monoclonal antibodies — laboratory-engineered proteins that act like antibodies in the human immune system and fight disease — Is being explored. Monoclonal antibodies can be used to treat cancer and other conditions.
At least one company is studying the possible benefit of combining different types of monoclonal antibodies into a “cocktail” to treat patients with COVID-19.
Other studies are investigating a potential role for tocilizumab in managing SARS-CoV-2 infections. This monoclonal antibody drug is FDA approved to treat autoimmune illnesses such as rheumatoid arthritis. In patients with severe COVID-19, these and similar drugs that combat inflammation are under study to see if the use of such medications may improve the intense immune reaction (also known as cytokine storm) to the virus that some patients experience in later phases of illness.
“Studies of tocilizumab have been mixed, with some observational studies suggesting a role, but randomized prospective trials have not yet shown a mortality benefit,” says Auwaerter.
Dexamethasone for COVID-19
Results from the RECOVERY clinical trial show that the steroid drug dexamethasone reduces deaths in hospitalized patients who have COVID-19. Dexamethasone has been used for many years to treat inflammation from many diseases including asthma, Crohn’s disease and certain cancers.
Using dexamethasone to treat COVID-19 appears to be most beneficial for patients who require mechanical ventilation and, to a lesser degree, patients who need supplemental oxygen. For patients who don't need oxygen and who are less ill, the study showed a trend toward worse outcomes, so the drug may not be the best choice for all hospitalized patients with COVID-19.
Dexamethasone may be processed differently in Black people than in other people. Johns Hopkins researchers note that this difference, along with other considerations, means more research on the drug will be helpful to more solidly confirm its role as a safe, effective treatment for COVID-19.
Hydroxychloroquine has been used for decades to prevent malaria and to treat some autoimmune disorders such as lupus. On June 15, 2020, the FDA revoked its authorization to use hydroxychloroquine to treat COVID-19, based on a large, scientific study that showed no benefit to patients treated with the drug. The FDA reports that the use of hydroxychloroquine is associated with serious heart rhythm problems and other safety issues. Other studies worldwide have halted their clinical trials on use of these drugs for COVID-19.
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Convalescent Blood Plasma Therapy
When people become infected and ill from a virus and then get better (convalesce), their immune system has successfully produced antibodies to fight that virus. Doctors have used forms of antibody therapy for over a hundred years in medical treatment.
A team at Johns Hopkins that includes Arturo Casadevall is collecting antibodies from the blood plasma of people who have recovered from COVID-19. Plasma is the clear, straw-colored fluid portion of the blood that carries blood cells, platelets and proteins, including antibodies.
Researchers at Johns Hopkins and other institutions are finding out if using antibody-filled plasma from people who had COVID-19 and recovered can lessen the severity of the illness or protect those not yet infected — or both.
On Aug. 23, 2020, the FDA granted an EUA for plasma antibodies, which means they are likely to be both beneficial and safe for patients. “Coming from the FDA as opposed to a pharmaceutical company, this was a big step in establishing this therapy as an effective treatment,” Casadevall says.
The evidence behind the FDA decision is compelling, at least in terms of the treatment’s potential impact on coronavirus-related mortality. “When given to patients with COVID-19 early enough in the course of their illness, it can reduce the chance of dying by 50%,” says Casadevall.
“However, conclusive evidence for its efficacy must await the completion of randomized controlled trials. Numerous such trials are ongoing in the USA and other countries, which should provide definitive information in the months ahead.”
COVID-19 survivors can donate plasma at Johns Hopkins through the Red Cross. The antibody concentration in plasma varies from person to person. Casadevall explains that plasma donated by people who have lived through severe COVID-19 — about 20% of donors — is particularly rich in antibodies.
At Johns Hopkins, clinical trials led by Shmuel Shoham, M.D., and David Sullivan Jr., M.D., are determining if plasma antibodies can shorten the course of COVID-19 or protect family members of people infected with the coronavirus.
Is there a coronavirus vaccine?
Not yet. While advancements in treating COVID-19 continue, so does the search for a vaccine targeting SARS-CoV-2. Vaccine development typically takes years, and as of now, there is currently no FDA-approved vaccine. Several vaccine developers, including Johns Hopkins, are working with companies to begin testing their versions in humans in late 2020 and early 2021.
Auwaerter explains: “Phase III vaccine studies in progress may offer evidence of vaccine efficacy before safety data, as the latter takes a couple of months longer to sufficiently understand. Late 2020 and the first quarter of 2021 may see preliminary results from several vaccine trials that could lead to availability.”
The logistics involved in distributing doses of the vaccine will take time also. For example, a vaccine might need to be transported and stored under strict temperature conditions, affecting its availability in some areas.
What you need to know from Johns Hopkins Medicine.