A Close Look at Potential Drug Remedies for COVID-19
Given the remarks regarding potential COVID-19 treatment options by President Trump, Vice President Pence and other federal officials during a White House press conference on March 19, 2020, below is a brief analysis of the status of agents for treatment and prevention of COVID-19 (sources are provided at the end of the article):
Remdesivir is a novel antiviral drug in the class of nucleotide analogs that has been found to inhibit several coronoviruses. It has not been tested on COVID 19 except for a single patient. That patient had a reduction in virus levels and has since recovered. The Food and Drug Administration requires that all new drugs need to be clinically tested for both efficacy (whether it really works) and safety (causing unrelated sickness or even death). This is a 5- step process (discovery/concept, preclinical research, clinical research, FDA review, and FDA post-market safety monitoring). Remdesivir is only at step 1 or 2 of this process. Most new drugs take 10 years for approval. Some of this time can be reduced by emergency relaxing the requirements and shortening the review process, but this drug is clearly not the answer for the current crisis.
A different drug approach is to find a compound or compounds that are already being used to treat other conditions in humans. Such drugs include chloroquine and hydroxychloroquine (a slightly less toxic form that seems to work similarly). These drugs were originally found and used to treat malaria. More recently they also have been used for rheumatoid arthritis and Lupus treatment. Thus, they are already cleared to use in humans, although doses must be carefully controlled (a child died from taking an unused adult malaria pill). There are currently 23 clinical trials in progress in China to test chloroquine/hydroxychloroquine effectiveness against COVID 19. The Chinese have not shared any information from these trials. The president and FDA have promised fast track approval if they prove to be effective. If they even slow the lung inflammation that occurs with COVID 19, the looming critical need for ventilators will be mitigated as the number of infected individuals peaks. It should be noted that even if the effectiveness is found to be real, ramping up industrial production of these compounds to meet a short-term timetable may be difficult.
A third approach with promise is using plasma from individuals who have recovered from a COVID 19 infection. This method has been used successfully in the past, even as far back as the 1918 Spanish flu. People with the COVID-19 infection will develop antibodies against the virus. Blood plasma could be collected and injected in another person either before or during an active infection. This approach has been found to work with SARS and Ebola virus infected individuals. The method could be given fast track for FDA approval. The difficulty would be plasma collection and testing for safety, and again this does not appear to be feasible to affect the current US outbreak.
This information was compiled from scientific journal publications obtained from PubMed, the free National Institutes of Health (NIH) search engine that covers all health related publications, including links to some articles that are available pre-publication through March 20, 2020.