On 2 October 2020, about seventeen hours after his diagnosis was first made public, a masked and Covid-positive President Donald Trump walked from the White House to a waiting helicopter on the South Lawn, and was then flown the short distance to the Walter Reed National Military Medical Center in the DC suburb of Bethesda, Maryland. As he now undergoes treatment at the nation’s most prestigious military hospital, the “state-of-the art”, albeit experimental, treatment he receives will be closely watched across the world with special interest, given that there is no proven and universally accepted treatment for the novel coronavirus. We already know that a five-day course of intravenous Remdesivir, an antiviral antibiotic, is underway, and that he has also received a single dose of REGN-COV2, an antibody cocktail, as part of of his multi-pronged treatment.
Medical researchers have mounted a massive onslaught against Covid-19 , driven by the devastating effects of the global pandemic. Thousands of clinical trials are now being conducted across the world, including the ongoing RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial in 176 UK hospitals. But the blockbuster “silver bullet” treatment has yet to be identified, and the US Federal Drug Administration has yet to approve any particular drug for the prevention or treatment of Covid-19. However, the prospects of survival from severe Covid-19 infection continue to improve, mainly as a result of high-quality intensive care, over and above any drugs that may have been used in any given patient. It is worth reviewing the treatments that are currently available, especially in view of the confusion being caused by a simultaneous “infodemic” of confusing and conflicting “information”, in which fact can no longer be differentiated from fiction.
Most people infected with Covid-19 will either display no symptoms at all and fully recover, or go on to develop mild and self-limiting symptoms, not requiring hospitalisation. Once deemed to be Covid-positive, strict self-isolation at home, for at least ten days from the onset of symptoms, or from the day when first tested positive for Covid-19, is essential. Any self-administered treatment is then purely aimed at relieving symptoms, such as rest, plenty of oral fluids, and either paracetamol or ibuprofen for fever, lying on one’s side or sitting upright, and trying a teaspoon of honey for cough, and keeping the room cool, as well as sitting upright, if breathless. Worsening breathlessness, despite self-treatment, indicates that medical help is required.
Many victims of severe Covid-19 infection, admitted to hospital, will require some form of intensive care, which refers to the intensive monitoring and support of the body’s vital organs, including the lungs, heart, brain, kidneys, and liver. The processes and procedures involved are proven and effective part of standard medical care. Drugs, where effective, only hasten recovery by either killing or inhibiting the virus, thereby reducing the so-called “viral load”, and allowing victims to develop natural immunity by producing their own protective antiviral antibodies.
All currently available drug treatments, some apparently more successful than others, should be considered to be experimental at present. These drug treatments can be classed as either antiviral, which either kill the virus or prevent further viral multiplication, or as immune modulators, which help the body’s own immune system to fight off the virus.
Covid-19 is a newly identified coronavirus, with no known effective drug treatment. Normally, any new drugs will have undergone clinical trials, which may take years to complete before it can be concluded that they are both effective and safe for human use. The urgency created by Covid-19, however, means that time is not on our side and doctors have had to resort to the so-called “off-label” use of existing antiviral drugs with a known safety profile. Broad-spectrum antiviral antibiotics are known to be effective in treating other viral infections. Thus Remdesivir, which was originally developed to treat hepatitis C and then used against the Ebola virus, and anti-HIV (anti-retroviral) drug combinations, such as lopinavir/ritonavir, are currently being tested in trials of Covid-19 therapy. Remdesivir incidentally happens to be the first drug to be licensed to treat Covid-19 in the UK, outside of a clinical trial.
In addition to the antibiotics mentioned above, other drugs have also been tested for their potential antiviral actions. For example, the much-touted antimalarial hydroxychloroquine, an aminoquinoline, with demonstrable antiviral action on laboratory testing, has proved to be ineffective when tried out as part of clinical trials, and has not been used for further testing in the UK since June 2020.
Immune modulators do not directly attack Covid-19, but alter the body’s immune response to the virus. These drugs are useful for treating the hyper-inflammatory response, also known as a cytokine storm, seen in hospitalised patients with severe Covid-19 infections, which can lead to adult respiratory distress syndrome and multiple organ failure. Cheap and widely available steroids, such as low doses of dexamethasone, suppress inflammation by inhibiting the cells responsible for inflammation and by suppressing the chemical mediators of inflammation that these cells produce-also known as cytokines. Monoclonal antibodies, which can be recognised by the suffix -mab in their names, provide a more targeted response by inhibiting specific cytokines that are overproduced in severe Covid-19 infections. Other modulators of the immune response to viruses, such as proteins known as interferons, are also being considered as potential treatments for Covid-19. Furthermore, the body’s immunity may be boosted by treatment with so-called short-term “passive immunity” through preformed antibodies, obtained from the pooled blood plasma provided by donors who have recovered from Covid-19 infection. The benefits of such “convalescent sera” appear promising, although not fully proven.
While scientists around the world labour away in search of a potential cure, people who have little faith in established science have turned to a range of unproven and even potentially dangerous remedies. On top of that, some fame-hungry scientists are also guilty of premature and over-optimistic claims for the treatments they are developing. During this pandemic, whatever the temptations, it is important not to get distracted and then stray away from reliable providers of up-to-date information, such as the NHS, the CDC, or the WHO. Social media may be excellent for socialising, but unfortunately cannot be relied upon when it comes to the more pressing matters of life and death.
Ashis Banerjee