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As scientists scramble to find a coronavirus vaccine, citizens are anxious for treatments for the highly contagious virus — in some cases anxious, or ill-informed, enough to fall for “nano silver” or essential-oil scams. Though the Food and Drug Administration warns that there “are no FDA-approved therapeutics or drugs to treat, cure or prevent COVID-19,” researchers are searching for potential remedies to help lessen the symptoms of the virus. To help sort through the possible treatments (and inevitable misinformation), here are the solutions as they stand on March 19 for the first-ever pandemic to be caused by a novel coronavirus.
In his Thursday press conference, President Trump promised that this common derivative of the anti-malarial drug chloroquine would be available to coronavirus patients with a prescription “almost immediately.” He said that it had “very encouraging early results” in tests on the coronavirus and that people could have access to the drug “literally within a few days.” But like so many bits of COVID-19 misinformation, Trump’s understanding was off the mark: Shortly after the president’s announcement, an FDA spokesperson told Bloomberg that hydroxychloroquine had not yet been approved for use by coronavirus patients.
FDA head Stephen Hahn told the Daily Beast that because the drug has been approved to treat other ailments (in addition to malaria, it can, alongside other drugs, treat autoimmune disease like lupus and rheumatoid arthritis) researchers are already aware of possible side effects. While the testing phase is under way, Hahn said the drug would first be implemented under “compassionate use,” allowing doctors to ask for patients’ consent to take the drug, at which point the FDA would analyze the data to determine if a full approval would be beneficial. “We want to do that in the setting of a clinical trial — a large, pragmatic clinical trial to actually gather that information and answer the question that needs to be asked and answered,” Hahn added.
Studies currently in-process also suggest that chloroquine and its derivatives could be effective in treating the coronavirus. One study published in Nature on Tuesday found that hydroxychloroquine — considered less toxic than chloroquine — and a drug called remdesivir were effective in stopping COVID-19 spread in vitro. “[Hydroxychloroquine] appears to be the drug of choice for large-scale use due to its availability, proven safety record, and a relatively low cost,” according to the study. And while doctors in China, South Korea, and France report that chloroquine regimens appear to help patients, they still need extensive and controlled studies to determine if they would work at scale.
Already, there are serious concerns about chloroquine as part of a treatment regimen, as Australian National University geneticist Gaetan Burgio notes:
And after Trump boasted of the drug’s potential in his Thursday press conference, lupus patients are now having difficulties accessing chloroquine, which prevents the immune system of a lupus patient from attacking the body’s tissues.
The other drug included in the Nature study, remdesivir, has already “improved the clinical condition of the first patient” infected by the coronavirus in the U.S. Though the FDA has already allowed 250 patients to access the drug, the study states that “remdesivir is not expected to be largely available for treating a very large number of patients in a timely manner” because of its status as an experimental drug. According to the FDA, the data collected from the expanded access program could help the agency understand the drug, though “controlled clinical trials are needed to determine if it is safe and effective for the treatment of COVID-19 infection.
For years, the compound has been touted as a potential cure for infectious disease, according to STAT News, which describes its function:
Remdesivir does not go after the virus directly. Instead, it targets the system the virus uses to replicate itself, hijacking it like you would your office’s copy machine as part of a company-wide prank.
These viruses have a genome that consists of a strand of RNA. To make copies of themselves, they rely on a molecule called a polymerase to string together the individual building blocks of the viral genome. These are like the “letters” that we think of composing DNA.
Remdesivir is an “analog,” designed to mimic the appearance of one of the RNA letters, adenosine. It looks so similar that the polymerase can unknowingly pick it up instead of the real adenosine and insert it into the strand of viral genome that’s being constructed, like bringing home the wrong twin from summer camp. Once in place, the analog acts as a cap, preventing any additional pieces from being strung on. This leaves the strand short of the full genome. The virus can’t go on to replicate or infect other cells.
Because of this cunning strategy, researchers have tested the drug against other coronaviruses — like SARS and MERS — as well as other virus families, like Ebola. Though it’s a long way off from proved success and public implementation, hopes in the medical community are high: “There’s only one drug right now that we think may have real efficacy,” Bruce Aylward of the World Health Organization said in February. “And that’s remdesivir.”
Convalescent plasma and hyperimmune globulin
Let’s break that down. Convalescent plasma is the liquid portion of the blood that carries cells and proteins; convalescent means it is taken from patients recovering from the virus. Hyperimmune globulins are a group of infection-fighting proteins taken from that plasma that are high in antibodies to a specific pathogen, in this case the coronavirus. According to the FDA, researchers are interested in determining if these “antibody-rich blood products … could shorten the length, or lessen the severity, of the illness.” In a study published in The Lancet in late February, the authors noted that convalescent plasma appeared to have some success in treating cases of past epidemics, like Ebola, and the H1N1 flu. “Evidence shows that convalescent plasma from patients who have recovered from viral infections can be used as a treatment without the occurrence of severe adverse events.” Therefore, the authors suggest it is “worthwhile to test the safety and efficacy of convalescent plasma transfusion.”
Read treatment studies with a grain of salt
If there’s any use for the tired phrase “abundance of caution,” it’s for the public unfamiliar with medical journals picking up the new material. In an interview with New York’s Irin Carmon, STAT News journalist Helen Branswell explains the double-edged sword of “preprint servers”:
Historically, when scientists or researchers wrote a paper and submitted it to a journal for publication, they couldn’t talk about it publicly except at medical conventions before publication or it wouldn’t get published. Typically things never reached journalists until they had been truly peer-reviewed and had the imprimatur of whatever journal was publishing them.
In recent years there’s been a movement to share data more quickly because that process can be quite slow and data can be locked up for quite a long time. Some of the journals have allowed people to post studies before they’ve been vetted to preprint servers and other scientists can look at them and comment on them. Those are being used very widely now. Anybody who has a paper on this is posting it on a preprint server, more or less, and they are being reported on effectively as maybe not much different than a published peer-review paper. I would say probably in the main it’s been useful because you need to be able to share information quickly in a circumstance like this, but sometimes the papers are just obviously wrong or controversial or whatever. And there have been several instances where people put up papers that garnered a lot of attention and were major distractions, and in the end not particularly helpful.
This post has been updated.