If Priscila Medina had received COVID-19 a year earlier, she would have had no proven safe and successful therapies to pursue. Doctors knew just what to do when the 30-year-old nurse arrived at a Long Island hospital last month, so out of breath she couldn’t talk.
They soon arranged for her to get a novel treatment that provides virus-blocking antibodies, and she claims that “by the next day I was able to get up and walk around.” “I finally started turning the corner after two days. I was taking a shower, sleeping, and playing with my son.”
These types of treatments can help newly diagnosed patients prevent hospitalisation, but they are vastly underutilised due to the need for an IV. Other medications can hasten regeneration in sicker patients, although only a handful increase longevity.
While vaccinations are assisting in the containment of the pandemic, simpler and better therapies are required, particularly when virus variants spread.
“We’re seeing an increasing number of young people get into bad trouble… serious illness involving hospitalisation, and even unfortunate deaths,” Dr. Anthony Fauci, the US government’s top infectious disease specialist, recently told the National Press Club.
The greatest desire, he said, is for a convenient drug, such as a tablet, “that will keep patients with problems from feeling worse and needing hospitalisation.”
Here’s a look at what’s coming up and what you can do right now.
IS THERE A PILL ON THE WAY?
Developing medicines for respiratory conditions is difficult, partially because the doses must be high enough for the treatment to penetrate far into the lungs while not becoming poisonous.
Treatment research was also slowed because the US government originally prioritised vaccines. The first COVID-19 therapy did not demonstrate benefit in a large government-sponsored trial until the end of April 2020.
The medicine — remdesivir, marketed as Veklury by Gilead Sciences Inc. — is also the only one licenced in the United States for COVID-19, but several others, including the one Medina got, are allowed for emergency use.
Remdesivir is also the only antiviral COVID-19 drug — it inhibits virus replication — and “we really, really need a bunch more,” said National Institutes of Health Director Dr. Francis Collins at a recent seminar.
Pfizer, Roche, and AstraZeneca are among the firms researching antivirals in pill form. Molnupiravir, developed by Merck and Ridgeback Biotherapeutics, is the most advanced. It does not seem to benefit ill patients but shows potential in less ill ones, according to the firms, and a major analysis could yield results this fall.
If it works, it may be used at home as signs arise, close to how antiviral treatments for the flu are currently used. The NIH is still looking for a home-use solution in an analysis that is studying up to seven medications that are currently being used to treat other diseases.
Vaccines are now being tested as potential remedies. Any people with “long COVID” reported that their symptoms changed after vaccination.
OUTPATIENTS’ OPTIONS
There is only one choice now: antibody medications, which will reduce the need for hospitalisation by 70% if administered within 10 days of the onset of symptoms. Eli Lilly and Regeneron Pharmaceuticals are approved to provide their medications to people who are at high risk of serious illness, and the US government delivers them for free, though there may be a premium for the IV.
Antibodies are produced by the immune system to combat the virus, but they take weeks to develop following infection. The medications have lab-created copies that can help right away. Since certain virus strains can evade single antibodies, antibody combinations are still used.
Demand for these treatments has been surprisingly low: many people are unaware of them, physicians and clinics were not originally set up to have them, and IVs are cumbersome, though Regeneron has studied providing its medication as shots.
“This is truly life-saving treatment. “We believe it has a huge potential to be used more,” said Dr. Donald Yealy, director of emergency medicine at the University of Pittsburgh Medical Center.
“You don’t have to be very sick” to get it, he said, and several people are hesitant because they believe they can recover without it but then deteriorate.
Medina, a labour and childbirth nurse at Long Island Jewish Medical Center in New York, experienced this.
“When I felt I was getting better, things kept getting worse,” she said. “It was terrifying. I was feeling really out of breath. I couldn’t even speak.”
Her hospital paid for her to get the antibody therapy at nearby North Shore University Hospital, which had a surgical tent equipped with IV stations to handle a large number of patients at once, and she stabilised at home.
TREATMENT IN A HOSPITAL
The solutions are determined by the nature of the symptoms, and timing is critical — some medications can be life-saving at one stage but dangerous at another.
Remdesivir is prescribed for patients who need extra oxygen but do not need breathing equipment. According to tests, it reduced the time to rehabilitation by five days on average, from 15 to 10. However, since it has not been proven to increase longevity, a World Health Organization guidance commission condemns its application.
Dexamethasone and related steroids are the only medications that improve recovery of patients that need extra oxygen and intensive care. They can be harmful if used earlier, as people are still slightly ill.
“Early on, you want the immune system to combat the virus,” Fauci said, so therapy is directed at assisting in that process. If the disease progresses, the immune system can become overactive, and individuals may die as a result. For this later stage of disease, a variety of medications that suppress inflammation and other immune responses are being tested.
According to the National Institutes of Health, full doses of blood thinners such as heparin can help people who are moderately ill escape breathing machines or other organ support. To avoid blood clots, almost all hospitalised COVID-19 patients are now given low doses. According to research, higher doses can benefit patients who aren’t yet seriously ill but can hurt others who are.
LEARNED LESSONS
Doctors now realise that certain treatments, such as the malaria medication hydroxychloroquine, do not work. That can be almost as critical as understanding what to try, according to Dr. Adarsh Bhimraj of the Cleveland Clinic, who works with the Infectious Diseases Society of America to establish care recommendations.
“We still have misinformation about COVID-19 therapies,” he added, which misleads both patients and doctors.
Dr. Rajesh Gandhi, a Massachusetts General Hospital physician who is also involved in developing recommendations, said that “tremendous research progress” has been achieved in a year. Doctors no longer need to take a “kitchen sink solution,” or pursue a variety of treatments in the expectation that one will work, he says.
