SALT LAKE CITY — A vaccine to stop the COVID-19 pandemic is at least a year away. As large segments of society are isolated at home, a scramble is on to find alternative ways to treat the novel coronavirus.
So far, there’s no proven treatment, beyond managing symptoms.
But a slew of approaches are being tried for a pandemic that has seen nearly 2.6 million lab-confirmed cases worldwide and killed more than 179,000, at least 45,000 in the United States.
Health care providers are repurposing drugs approved for other illnesses, searching for new drugs, and using blood transfusions from patients who survived the disease, among other treatments.
Here’s a sample of what we’ve learned so far.
Hydroxychloroquine
If you’re confused about the potential of hydroxychloroquine (Plaquenil) to treat COVID-19, you’re in good company. No potential treatment has sparked so many opposing views. It has been largely discounted as preventing infection, and early results on treating symptoms are mixed.
Utah’s Department of Health said information on the drug keeps changing, and it has altered some of its plans regarding it.
Hydroxychloroquine and its cousin chloroquine are oral prescriptions approved in the U.S. to treat malaria, lupus and rheumatoid arthritis. The Centers for Disease Control and Prevention said the drugs are now being studied as both a possible COVID-19 treatment and a preventive tool.
First approved in 1955, hydroxychloroquine is more popular than chloroquine because it has fewer side effects. Still, Goodrx.com reports negative effects — more common when the drug is used at high doses or long term — include permanent vision changes, abnormal heart rhythm, muscle weakness or nerve pain, low blood sugar and a worsening of psoriasis.
A panel of experts for the National Institutes of Health recently cited adverse reactions in recommending the drug not be used for COVID-19. And it warned against using the drug with the antibiotic azithromycin (the Z-pak), which some have touted as a paired punch against the virus, possibly because of some anti-inflammatory effects and because lung infection can contribute to bacterial pneumonia. But antibiotics treat bacteria, not viruses.
The CDC had hoped hydroxychloroquine would be an effective treatment for SARS in 2005, after tests showed antiviral effects on cell cultures, but that didn’t carry forward into mice studies.
The Washington Post reported that hydroxychloroquine and chloroquine gained interest as potential COVID-19 treatments in January. “According to Kate Starbird of the University of Washington’s Center for an Informed Public, tweets from media organizations — including Chinese state outlets — and investors highlighted past studies in which the medications were tested as cures for severe acute respiratory syndrome. ... They also pointed to statements from the coronavirus research center in Wuhan, China, suggesting the drugs could be used to fight COVID-19.”
Enthusiasm was also fanned by a French study in which the antibiotic and the antimalarial were combined. The study said the vast majority of patients treated with hydroxychloroquine and azithromycin cleared the virus, but there was no control group or way to tell if the study subjects would have cleared the virus anyway. The International Society for Antimicrobial Chemotherapy later said the trial, which was published in its journal, did not meet acceptable standards.
President Donald Trump has said hydroxychloroquine seems promising and people in dire condition from the virus appear to have little to lose. Public health officials and other health care providers are divided. Some believe hydroxychloroquine will help patients survive COVID-19 — or at least should be tried.
Poynter Institute noted that 30 million doses had been donated to the Strategic National Stockpile for disbursement to the states. And states are taking their own steps to secure access to the drug.
The Utah Department of Health earlier had planned to buy enough to treat 200,000 patients with a seven-day regimen. Utah pharmacies would receive doses so patients with active COVID-19 and a prescription could get the drug at no cost, as cost would be shared between state and federal governments.
Thursday, state health officials walked that back, announcing they hadn’t signed the contract yet and are “still researching FDA requirements concerning the compounding and distribution of hydroxychloroquine.”
“The most consistent element of COVID-19 has been that things are constantly changing,” the acting department director, Gen. Jefferson Burton, said. “We wanted to put ourselves in a position that if there were to be a shortage in the supply chain of hydroxychloroquine, we were well-positioned to be able to provide the medication to Utah residents who need it.”
That supply chain has “recently shown signs of stabilization,” he added.
An emergency authorization from the Food and Drug Administration has cleared the way for physicians to prescribe hydroxychloroquine to hospitalized adults and adolescents who have COVID-19 but can’t participate in one of many ongoing clinical trials — including studies being conducted in Utah by Intermountain Healthcare and University of Utah Health. The prescription provider must report whether the drug helps, as well as any serious adverse events.
Practitioners and researchers emphasize that the drug must be legally prescribed and its use carefully monitored.
Forbes reported recently that abuse of hydroxychloroquine doubled from March 18 to April 6, based on year-over-year data from the American Association of Poison Control Centers. The number of cases was small, growing from 35 to 76. They didn’t include an Arizona man who died after ingesting a nonpharmaceutical chloroquine normally used to clean fish tanks.
A preliminary study from China that has not been peer-reviewed found that hydroxychloroquine did not eradicate COVID-19, but relieved some symptoms. Conversely, the Veterans Administration just completed a study involving 368 patients who had received normal care, hydroxychloroquine or the combination including azithromycin. The study, not yet peer reviewed, saw somewhat higher death rates among patients who received the anti-malarial drug alone. Experts say more study is needed.
As far as preventing infection, a group of rheumatologists who prescribe the drug to treat rheumatoid arthritis and lupus told The Wall Street Journal that a number of those patients contracted COVID-19 despite being on the drug. The group, the Global Rheumatology Alliance, didn’t look at whether the drug treats COVID-19, just whether it prevents infection.
It’s still thought that hand-washing, not touching one’s face and social distancing are the best prevention strategies.
Convalescent plasma therapy
This novel coronavirus has hit particularly hard because people had not experienced it or built up any resistance against it. The idea behind convalescent plasma therapy is that people who have recovered from COVID-19 have some antibodies and it’s possible that transfusing some of their blood to patients who are battling the illness can bolster their immune systems to fight it.
Plasma makes up just over half of blood and is a yellowish liquid that carries blood cells and proteins. Several early studies suggest patients thus treated see symptoms improve within a few days.
Cynthia Lemus, 24, recently became the first Utahn to receive convalescent plasma therapy at Intermountain Medical Center, after Intermountain Healthcare announced it would try the treatment to help certain COVID-19 patients.
According to the Deseret News, “The effort is part of a national investigative treatment protocol launched by the U.S. Food and Drug Administration. The Mayo Clinic and American Red Cross are part of the collaboration.”
Many doctors are trying the treatment to see if they can help patients who are not responding well to other therapies.
Remdesivir
The CDC describes remdesivir as an investigational intravenous drug that has been shown to have “broad” antiviral activity, stopping replication by ending RNA transcription. The drug has helped somewhat against other coronaviruses and is now being tested against SARS-CoV-2, the coronavirus responsible for COVID-19. It has been made available to some people through drug trials and a “compassionate use” program allows pregnant women and children who have severe symptoms of lab-confirmed COVID-19 to access it.
Goodrx.com said remdesivir demand has exceeded supply.
More clinical trials
Clinicaltrials.gov lists more than 750 studies worldwide underway or planned related to COVID-19. Not all of them are looking for treatments: Some, for instance, study symptoms or lack of treatment. But most hope to find an effective therapy. And 475 feature an intervention that can be compared to standard care or another measure. In the United States, there are 113 COVID-19 studies, including eight in Utah. Four of those involve hydroxychloroquine and two look at remdesivir.
Pharmacist Jennifer Tram recently analyzed some of the target drugs for Goodrx.com. Among them:
Actemra (tocilizumab), used to treat rheumatoid arthritis, is being tested because it can calm down a hyped-up immune system, which can cause an infected person’s body to fight itself in unhelpful ways. COVID-19 can kick off what experts call a “cytokine storm,” leading to even more inflammation. That complication is fairly common with serious respiratory infections, including severe cases of influenza.
Tamiflu (oseltamivir) is an antiviral medication approved to reduce symptoms and shorten the duration of influenza. Several studies are ongoing to gauge effectiveness against COVID-19, but so far, nothing stellar has been reported.
Kaletra is a combination of two antivirals normally prescribed to those with HIV. So far, studies have not shown the drugs make much difference to COVID-19 outcomes.
Many of the drugs being studied worldwide are approved to treat specific conditions in other countries, but are not approved medications in the United States. Avigan is used against flu in China and Japan, for example.