by Dr. Anis Ansari Board Certified in Internal Medicine and Nephrology Clinton, IA
Coronavirus is a newly discovered enemy which continues to ravage many countries. It has killed more than 128,000 people worldwide and 26,000 people in the United States to date April 15, 2020.
Healthcare providers are frustrated due to the rapidly worsening conditions without any set of definitive guidelines for treatment to combat this pandemic. It is time to review medications that are on the horizon which can be utilized and their current status.
Fortunately, 80 percent of infected patients with COVID-19 will experience mild to moderate symptoms. They do not need admission to the hospital and their symptoms can be controlled at home.
Patients admitted to the hospital when presenting with a high-grade fever, low pulse oximetry (oxygenation level) and worsening shortness of breath who have other comorbid conditions like heart disease, diabetes, and hypertension. They are also likely to rapidly deteriorate requiring ventilator support.
Realistically, time is not on our side. Some of these experiments in randomized controlled trials will take a year or more to finish. Of all the research in process, 52 percent of studies are vaccine-based, 33 percent are antibodies based, 16 percent antiviral and 25 percent concentrate on other areas like cell-based therapy. In general, many experiments are being done on mice or in Petri dishes but not on human beings.
Some experiments are being conducted on humans, but they are too small to be useful. The Center for Disease Control (CDC) https://www.cdc.gov/ reports that in February 2020, 100 patients were treated with Chloroquine (antimalarial) in China. The Scientist demonstrated that Chloroquine was superior to control treatment in inhibiting the worsening of pneumonia, improving lung imaging, eliminating the virus from the body and shortening the duration of the disease.
In Southern France, a case study involving 26 patients received Hydroxychloroquine (used in Rheumatoid Arthritis and Lupus) compared to 16 patients who did not. After 6 days, the virus was not detected in 70 percent of those given the drug compared to only 12.5 percent who were not treated. Zithromax, a common antibiotic also has been used at times. Ultimately depending on each situation, physicians can decide what is best for their patients.
Next up; a new solution discussed is convalescent plasma. When people recover from COVID-19 their blood contains antibodies produced by their cells to fight coronavirus. This is a trusted process where plasma products can be separated from a recovered patient and transfused to a COVID-19 patient. Unfortunately, there is not much experience with this treatment except some from China where it was able to help fight infection by reducing the duration and severity of the disease.
Remdesivir is an antiviral medication that has been successful in treating coronaviruses in animals causing a reduction in the virus and lung disease. Interleukin-6 inhibitors like Actemra or Sarilumab have limited data and are not available for use. Corticosteroids are not recommended unless the benefits exceed the risk.
There are a lot of anecdotal reports that Ivermectin (antiparasitic medication) was able to kill the virus in Petri dishes within 48 hours along with reports of high dose Vitamin C etc. Predictions are that a COVID-19 vaccine will take some time. Unfortunately, the next Flu season is only 6 months away.
Again, currently, there is no official treatment available which makes things very frustrating. Physicians can make a judgment about the use of any one or more of the above medications depending on the situation. You can be sure that scientists are working feverously to find a cure to save lives.