Current Coronavirus Treatments and Vaccine Developments
By: Rushil Yerrabelli
As of Tuesday, March 31, the coronavirus has infected more than 800,000 and has killed 38,000 people worldwide. This unprecedented moment in history has changed our daily lives, consumed the global airwaves, and in many ways has brought the world together. As we hope for the end to come sooner, the search for treatments and the development of a vaccine has become increasingly pertinent. Information regarding the development of such vaccines and treatments remain scattered across the internet; the article below tries to present those details in one place.
There are three main ways to treat a disease: first, to treat the disease symptoms, second, to attack the virus through medication, and third, to provide immunity against the virus with a vaccine.
If an individual is infected with the coronavirus, a few measures are taken to help treat the patient. In moderate to severe cases, fluids are given to the patient to reduce the risk of dehydration, a common consequence of the coronavirus. Medication is also given to patients to reduce their fever. In severe cases of the virus, supplemental oxygen is provided to patients. Medical ventilators are given to those who are severely infected, where these machines are used as a means to assist someone who has trouble breathing sponstantelosy.
More recently, blood plasma transfusions from survivors of the coronavirus to those currently infected with COVID-19 is being tested across the nation. People who have recovered from the infection develop disease-specific antibodies to help neutralize the pathogen. Infusing the blood plasma of recovered patients to infected patients can help stimulate an immune response against the virus. This approach has been successful in treating other illnesses such as polio and measles. On March 24, the Food and Drug Administration approved this kind of treatment for experimental purposes, and New York Governor, Andrew Cuomo, stated that his state would begin testing this treatment.
Other treatments that have been used are high dosage Intravenous (IV) Vitamin C. While IV vitamin C has been used to treat severely ill patients, there is neither convincing evidence that this kind of treatment is effective, nor is the treatment commonly being used. High dosage IV vitamin C in past studies has helped treat sepsis and respiratory distress syndrome, both of which are severe complications that can arise from the coronavirus. Lastly, there is no evidence that consuming high amounts of vitamin C will prevent an individual from contracting the virus. Indeed, taking too much vitamin C has many side-effects including cramps, nausea, and increased risk of kidney stones.
Lastly, questions regarding the use of ibuprofen (Advil, Motrin, etc.) to treat coronavirus symptoms have come up. Some French doctors have advised against the use of ibuprofen as certain patients with COVID-19 have developed complications such as pneumonia. In a conflicting report, the World Health Organization has stated that ibuprofen and acetaminophen can be used to treat fevers and aches associated with the coronavirus. According to the Harvard Medical School, “If you suspect or know you have COVID-19 and cannot take acetaminophen, or have taken the maximum dose and still need symptom relief, taking over-the-counter ibuprofen does not need to be specifically avoided.”
Drugs and Medication
Other treatments include antiviral drugs, medicines specifically designed to target the virus rather than to reduce its symptoms. Many of these drugs are currently being clinically tested to prove their efficacy in treating the coronavirus.
Remdesivir is an antiviral drug that has recently caught the attention of scientists across the globe. This is because the coronavirus that causes COVID-19 is very similar to other viral diseases such as SARS and MERS. Laboratory and animal studies have suggested that remdesivir prevents the reproduction of such kinds of viruses in the body. The coronaviruses that cause SARS, MERS, and COVID-19 contain a near identical critical zone that produces an enzyme that is crucial in virus reproduction. Remdesivir targets this critical zone, and has been successful in SARS and MERS and is thought to have similar results with COVID-19.
Remdesivir has inhibited the reproduction of the coronaviruses that cause SARS and MERS in cells in a laboratory and animal studies. The drug seems also to be effective for COVID-19 in laboratory studies, but more research is underway to confirm such results.
Remdesivir is being used to treat patients with severe cases of COVID-19 in the United States. In China, two large clinical trials are underway to test remdesivir to confirm the drug’s effectiveness. The National Institutes of Health (NIH) is also conducting a similar trial for remdesivir.
Hydroxychloroquine and Chloroquine
More recently, discussions on whether or not hydroxychloroquine and chloroquine, two drugs that have been around for nearly 70 years, are effective in treating COVID-19 are underway. In the past, both of these drugs have been used to treat malaria and other inflammatory diseases such as lupus and rheumatoid arthritis. Hydroxychloroquine and chloroquine are considered safe, cheap and readily available drugs that have virtually no side effects in treating diseases like malaria and arthritis.
With regards to COVID-19, hydroxychloroquine and chloroquine seems to work in two ways. First, these drugs prevent the virus from attaching and entering a cell, and secondly, if the virus enters the cell, the drugs kill the cell before the virus can multiply and spread.
Hydroxychloroquine and chloroquine have been effective in laboratory settings, however, their effectiveness in humans remains uncertain. Many clinical studies are ongoing to test these two drugs, but two preliminary studies have shown promising results.
One report published in February of 2020, tested 100 COVID-19 patients in China with chloroquine, in which chloroquine was effective in eliminating the virus from the body and shortening the duration of the disease. These results seem promising, however, the study failed to include any evidence to support its claims. Moreover, the study was neither randomized nor a double-blind controlled experiment.
A second study was done by a group of scientists in southern France, where 26 COVID-19 patients who were treated with hydroxychloroquine were compared to 16 patients who were not. After approximately a week, 70% of patients treated with hydroxychloroquine were reported to show no signs of the virus in their bodies. The drug was effective across patients who exhibited both mild and severe incidences of coronavirus. While this study is again promising, it is too small to draw conclusive results.
China has recently approved the use of a Favilarvir, another antiviral drug. Favilarvir was first used to treat inflammation of the nose and throat during coronavirus but has recently been observed to attack the virus itself. A clinical trial of 70 patients is underway in China to test Favilarvir in treating coronavirus.
Coronavirus Vaccine Developments
Nearly 35 companies across the world are in the works to develop a vaccine, of which 4 of these companies have vaccines being tested in animals. One of these companies is a Boston based biotech group called Moderna, whose vaccine will soon enter human trials. Oxford scientists also have called for 510 healthy volunteers to test their vaccine candidates.
Many of these companies have designed their vaccines around the MERS and SARS coronaviruses, as COVID-19 shares 80 to 90 percent of its genes with SARS. Vaccines were in the works for development for SARS and MERS, however, they were halted once the virus had been contained. Developing vaccine candidates and animal testing is often considered the easy part, but human clinical trials are where challenges arise.
Clinical trials are usually done in three phases, first among a dozen healthy volunteers, then a group of a couple of hundred people, and lastly among several thousand individuals. Challenges occur within these trials as the vaccine might be effective only within a certain age group, and success rates fluctuate within patients. Approval for testing is challenging especially when creating a vaccine for a new illness. With diseases like the flu, approval is easier since the vaccine is only marginally modified. Vaccines for COVID-19 are using DNA and RNA to generate parts of the pathogen in the body. No vaccine made from DNA and RNA has ever been approved to date, and therefore vaccines for the coronavirus must be treated as brand new. In the past vaccine candidates can take up to a decade for approval, and therefore having a vaccine by November is unrealistic.
Even if a vaccine is approved, the distribution of the vaccine can be challenging. Making sure the vaccine reaches to all people who need it is difficult. The UK has said it would prioritize healthcare workers and vulnerable individuals if a vaccine is developed. Moreover, nations would have to compete with each other to gain access to the vaccine. Pandemics hit nations the hardest with weakened and poor-funded healthcare systems. Since developed nations such as the United States and France are hit hard by the virus, it is likely these nations would use the vaccine for their people instead of exporting it to poorer nations. India is another major supplier of vaccines to the developing world, and it would most likely use the vaccine for its 1.3 billion people before distributing it to other nations.
Despite these challenges, vaccine development is extremely important as it can save many lives in future outbreaks. But for now, our best bet is to contain the virus as much as possible, by washing our hands and practicing social distancing.