What Coronavirus Experts Need You to Know About Covid-19 Treatments
Coronavirus experts explain the various potential treatments being suggested for Covid-19, from antiviral medications to drugs.
The first thing everyone needs to know: There are no drugs currently licensed to specifically treat Covid-19. But chances are you’ve probably heard about different potential candidates, from vitamin C to malaria medications to a drug that once held promise for fighting the Ebola virus. Currently, doctors are working to treat Covid-19 patients with “supportive care,” meaning rest, keeping them hydrated, and giving pain relievers as necessary.
None of the potential therapeutic options are proven. Still, there are “probably an almost uncountable number of clinical trials underway,” says Gregory Poland, MD, a spokesperson for the Infectious Diseases Society of America (IDSA). Most of these trials are focused on repurposing existing to drugs to use against the new coronavirus, SARS-CoV-2, while others are looking at creating entirely new therapies. Hopefully, the trials will start to give us answers soon. But in the meantime, Dr. Poland says, he doesn’t “see anything that stands out, that says ‘Whoa here’s the blockbuster.'”
Until then, there are several options—including a therapy that received conditional approval from the Food and Drug Administration (FDA)—that researchers hope will be effective against Covid-19.
Convalescent plasma is plasma from patients who have recovered from Covid-19 and whose blood contains antibodies to fight the virus. “You take antibodies from people documented to have had the disease and recovered, and then administer them to people with severe disease,” explains Dr. Poland, who is also a professor of medicine and infectious diseases at the Mayo Clinic in Rochester, Minnesota. Although convalescent plasma has been used to treat measles, SARS, and other contagious diseases, little is known about how it would work with Covid-19.
One small study published in the Journal of the American Medical Association reported that five patients critically ill with Covid-19 in China improved after being treated with convalescent plasma. But since there was no control group, there’s no way to know if they might have improved anyway.
However, one potential problem is finding enough individuals who have recovered from Covid-19, says Mahalia S. Desruisseaux, MD, also an IDSA expert. Donors need to fulfill a number of requirements and also need to have a compatible blood type, according to OneBlood, an organization that works with blood and stem cell products for scientific research. Despite some potential complications, the agency did recently approve the first rapid test to detect Covid-19 antibodies.
Hydroxychloroquine and chloroquine
Hydroxychloroquine and chloroquine have been around for decades and are currently approved to treat malaria and autoimmune conditions like lupus and rheumatoid arthritis, according to the Centers for Disease Control and Prevention (CDC). Despite the media’s widespread coverage, there’s only limited evidence from lab and animal studies (not human studies) to suggest they might work against the new coronavirus.
Both drugs “are known to have anti-inflammatory properties that may make them effective against inflammation due to Covid-19,” says Dr. Desruisseaux. They may also interfere with the virus’s ability to replicate in cell cultures—but this has not been conclusively borne out in human experiments.
There are 40 locations across the country participating in clinical trials, says William Schaffner, MD, an infectious diseases specialist at Vanderbilt University Medical Center in Nashville.
On March 28, the FDA issued conditional approval of the drugs for the treatment of Covid-19 when clinical trials weren’t available. Just remember that both hydroxychloroquine and chloroquine can cause serious side effects—including cardiac arrest, warns Dr. Desruisseaux.
Another caution: On April 1, the International Society of Antimicrobial Chemotherapy announced concerns over a March 2020 study published in the International Journal of Antimicrobial Agents on the efficacy of hydroxychloroquine and azithromycin for Covid-19. The society’s statement questioned whether the study met standards ensuring patient safety.
Remdesivir is an experimental antiviral drug originally developed to combat Ebola, says the World Health Organization (WHO). Although it failed against that vicious infection, it has shown effectiveness against MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome) in laboratory and animal tests. Both MERS and SERS are related to the current Covid-19 virus, leading experts to hypothesize that remdesivir might also work against Covid-19.
The drug works by interfering with the virus’s ability to replicate, explains Dr. Desruisseaux, who is also an associate professor of internal medicine in the section of infectious diseases at Yale University School of Medicine in New Haven, Connecticut. Remdesivir interfered with the virus’s ability to replicate in cell cultures. “We should have the results soon on whether or not it is effective in patients with Covid-19,” says Dr. Desruisseaux.
Remdesivir is now in Phase 3 clinical trials with the results expected in April or May. Even if those results are positive, however, the drug still needs to go through an approval process. Right now, patients can have access to remdesivir through a clinical trial or on a “compassionate use” basis, says the CDC.
Other antiviral medications
Various existing antiviral drugs are also being tested for use in Covid-19. This includes the combination of lopinavir and ritonavir formed into one drug under the brand name Kaletra, which is a licensed treatment for HIV.
In a March 2020 study published in The New England Journal of Medicine, researchers in China looked at 199 patients and found that the combination didn’t show any benefit. However, it’s now being investigated in a WHO trial called SOLIDARITY. The European-based DISCOVERY trial is also looking at lopinavir and ritonavir in patients who are ill with Covid-19.
Azithromycin is a broad-spectrum antibiotic that is used to treat bacterial infections including pneumonia, bronchitis, sexually transmitted diseases, and sinus infections, among other conditions. Antibiotics are not effective against viral diseases, but azithromycin has been mentioned in the context of Covid-19 as possibly being effective if a patient also develops bacterial pneumonia, says Dr. Poland. While people who have the flu sometimes also develop bacterial pneumonia, this has not been the case in Covid-19 patients.
“It is not like pneumonia with influenza, which is a complicating bacterial infection,” says Dr. Schaffner. “This looks primarily like a viral pneumonia due to Covid-19, along with an overly exuberant inflammatory response.” Which means azithromycin (and other antibiotics) would not be helpful. Learn about the people at the highest risk for Covid-19.
Many other drugs, as well as supplements and vitamins, have been bandied about as possible solutions to Covid-19. For instance, some patients have tried high doses of vitamin C. There’s no good evidence that this works, but there are studies underway. For example, Chinese researchers have registered a clinical trial to probe further into the effectiveness of IV vitamin C in hospitalized patients with Covid-19.
“What you’re seeing in a lot of these cases is we don’t have anything else to offer, so in the context of a clinical trial it’s worth testing most anything for which there would be a theoretical basis,” says Dr. Poland.
That doesn’t mean you should reach for anything on the shelves, particularly nutrients and supplements, which claim to treat Covid-19. “Anything that pretends to be approved is automatically a scam at this point because nothing is approved,” says Dr. Poland. “The multibillion-dollar business of nutraceuticals, herbs, and supplements haven’t been able to demonstrate any efficacy with this particular infection.”
The potential dangers
Given that Covid-19 is already killing so many people, it’s tempting to cling on to any therapy showing any promise whatsoever. This approach is dangerous. “People out of fear and anxiety reach out to these things and that’s almost never a good way to make good decisions,” says Dr. Poland. “Many feel fear but how we act on that can impact our health for the better or the worse.”
Hydroxychloroquine and chloroquine, for instance, can be safe if they’re used at the right dosage and monitored carefully, but they can also cause cardiac arrest. A man in Arizona died and his wife was hospitalized after they took chloroquine phosphate for Covid-19. Chloroquine potassium is not the same as the drug chloroquine. It is a compound used to clean fish aquariums.
“No treatment is free of adverse side effects,” says Dr. Schaffner. “It’s very important to assess that. Nobody wants to give a drug to a patient who’s already sick that’s of no benefit, but there’s a larger risk of getting an adverse reaction. The average layperson usually doesn’t consider the safety side of the equation.”
Find out whether certain high blood pressure drugs are harmful if you have Covid-19.
The importance of clinical trials
Research is being sped up due to the severity of Covid-19. As of April 8, the virus had infected more than 1.4 million people and killed over 83,000 worldwide. In the U.S., more than 400,000 people have been infected and almost 13,000 have died.
Even though experts are racing against time, clinical trials are still “absolutely essential and are the only way to find new therapies,” says Andre Kalil, MD, professor of internal medicine at the University of Nebraska Medical Center in a recorded statement. “There are many, many examples in the past in different outbreaks of people getting hurt and even dying from the side effects of drugs that were not properly tested. The only way to find a new treatment is going to be by doing a controlled trial and as many trials as possible.” Dr. Kalil is leading the remdesivir trial at the University of Nebraska. Want to read more? Here’s what you need to know about at-home Covid-19 tests.
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- Gregory Poland, MD, spokesperson, Infectious Diseases Society of America and professor of medicine and infectious diseases, Mayo Clinic, Rochester, Minnesota
- Journal of the American Medical Association: "Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma"
- Food and Drug Administration: "Coronavirus (COVID-19) Update: Daily Roundup, March 24, 2020"
- Expanded Access to Convalescent Plasma for the Treatment of Patients with COVID-19
- National COVID-19 Convalescent Plasma Project
- Mahalia S. Desruisseaux, MD, associate professor of internal medicine, section of infectious diseases, Yale University School of Medicine
- OneBlood: "COVID-19 Convalescent Plasma"
- Centers for Disease Control and Prevention: "Information for Clinicians on Therapeutic Options for COVID-19 Patients." Elsevier: "COVID-19 Drug Therapy." William Schaffner, MD, infectious diseases specialist, Vanderbilt University Medical Center, Nashville FDA: "Coronavirus (COVID-19) Update: Daily Roundup March 30, 2020."
- International Society of Antimicrobial Chemotherapy: “Statement on IJAA paper”
- International Journal of Antimicrobial Agents: “Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma”
- NEJM Journal Watch: "Remdesivir: A Promising Antiviral Against Coronaviruses"
- ClinicalTrials.gov: "Severe 2019-nCoV Remdesivir RCT"
- Centers for Disease Control and Prevention: "Information for Clinicians on Therapeutic Options for COVID-19 Patients"
- AidsInfo: "Lopinavir / Ritonavir"
- The New England Journal of Medicine: “A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19”
- World Health Organization: "'Solidarity' clinical trial for COVID-19 treatments" ClinicalTrials.gov: "Trial of Treatments for COVID-19 in Hospitalized Adults (DisCoVeRy)" National Library of Medicine: "Azithromycin"
- ClinicalTrials.gov: "Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia" CNN: "Fearing coronavirus, Arizona man dies after taking a form of chloroquine used to treat aquariums" Johns Hopkins University: "Coronavirus COVID-19 Global Cases" Andre Kalil, MD, professor of internal medicine, Nebraska University Medical Center, Omaha