Combating COVID-19
Some of the best weapons to fight the coronavirus are still washing our hands, wearing masks and social distancing. But today we look at other things that are used in the fight as well as immunizations, which could be the ultimate weapon to win the war.
Pre-exposure
Are there drugs that can prevent coronavirus infections? The COVID-19 Treatment Guidelines Panel of the National Institutes of Health recommends against the use of any agents for coronavirus pre-exposure prophylaxis, except in a clinical trial.
At present, no known agent that is administered before exposure can prevent coronavirus infection. Clinical trials are investigating several agents, including emtricitabine plus tenofovir alafenamide or tenofovir disoproxil fumarate, hydroxychloroquine, and supplements such as zinc, vitamin C and vitamin D.
Studies of monoclonal antibodies that target the coronavirus are in development. There is a list of ongoing tests on ClinicalTrials.gov.
Click the image below to see a list of the clinical trials and their status.
Post-exposure
The guidelines panel also does not recommend the use of any agents for coronavirus post-exposure prophylaxis, except in a clinical trial.
Potential options that are under investigation include chloroquine, hydroxychloroquine, lopinavir/ritonavir, nitazoxanide, vitamin super B-complex and vitamin D. Other strategies that are in development include the use of coronavirus monoclonal antibodies and convalescent plasma.
In June, two large clinical studies suggested that the antimalarial drugs chloroquine and hydroxychloroquine do not help treat or prevent COVID-19.
Hydroxychloroquine, also known by the brand name Plaquenil, is an anti-malaria drug that has been around since the 1930s. It has also been used to treat patients with lupus. Chloroquine is derived from quinine, which French chemists in 1820 isolated from the bark of the cinchona tree.
Dr. Patrice Harris, president of the American Medical Association, says she would not prescribe hydroxychloroquine, saying there is no evidence the drug is effective and safe for preventing or treating the coronavirus.
U.S. Surgeon General Jerome Adams said, “The drug should be used as a last resort for extremely ill patients after they are able to have a conversation with their health care provider about everything that they could possibly do to save their lives.”
Success with other diseases
These charts show how immunization from polio and the measles stopped the diseases in their tracks. The first outbreaks of polio in the U.S. were discovered in the 1890s, and vaccinations were not available until the 1950s.
The first accounts of measles were in the 9th century in Persia. The first vaccine became available in 1963, and the one in use today was introduced in 1968. Before the vaccine, nearly all children got measles by the time they were 15. It is estimated that 400 to 500 people died each year with hundreds of thousands infected.
Help is on the way
Researchers around the world are developing more than 165 vaccines against the coronavirus, and 31 vaccines are in human trials. Some are hopeful of a breakthrough as early as October, others estimate 2021.
Two companies are in Phase 3 trials, treating large numbers of people. In May, the U.S. government awarded British-Swedish company AstraZeneca $1.2 billion as it began Phase 3 trials on a vaccine. The company hopes to have two billion doses available in the fall.
On Aug. 11, the government awarded Moderna, also in a Phase 3 trial, $1.5 billion in exchange for 100 million doses if the vaccine proves safe and effective.
Some new approaches are being investigated, including DNA-based and RNA-based strategies and replicating and non-replicating vector strategies, with the hope of identifying a safe and effective vaccine that can be used in the near future.
Russian vaccine?
This week Russia announced it had a vaccine for COVID-19 as coronavirus cases surpassed 20 million worldwide. U.S. scientists were quick to point out that Russia’s claim was overstated as the Russian Ministry of Health merely issued what’s called a registration certificate for a vaccine candidate that has been tested in just 76 people.
According to a report in ScienceInsider, the certificate allows the vaccine, developed by the Gamaleya Research Institute of Epidemiology and Microbiology in Moscow, to be given to a small number of citizens from vulnerable groups, including medical staff and the elderly. But the certificate stipulates that the vaccine cannot be used widely until January 2021.
In the U.S., about 5.2 million people have tested positive for the coronavirus, or about 1.6% of the population. Most recover, and the latest Centers for Disease Control and Prevention surveillance reports show hospitalizations are leveling off.
The CDC’s data on mortality rates shows the percentage of deaths attributed to pneumonia, influenza or COVID-19 increased from June 27–July 18 for the first time since mid-April. The mortality rate for the following week was 7.8% versus the previous week’s 12.6%. The percentage remains above the epidemic threshold.
On the front lines
How ventilators and ECMO help sick patients.
Sources: University of Washington, idsmed.com and The Seattle Times, University of California San Francisco, sciencedirect.com, National Institutes of Health, Centers for Disease Control and Prevention, Ourworldindata.com, Historyofvaccines.org
Source: Orange County Register
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