Quentin Marsman
2020 is the year of COVID-19. The disease caused by the new coronavirus has been a major health concern in the first months of this year and was declared a pandemic by the World Health Organization (WHO) in March [1]. The disease has led to lockdowns in multiple countries as a means to limit the spread of the virus. To touch upon the severity of the disease: on the 26th of May there were over 5.406.282 confirmed cases and 343.562 confirmed deaths [2]. In this brief message, the current perspectives on the treatment of the disease will be explored.
At this moment, no therapy has been officially approved in order to treat COVID-19 patients. Current clinical management consists of infection prevention, control measures, and supportive care [1]. The general public is hoping for life to back to normal as soon as possible. However, for this to happen we need a vaccine.Unfortunately, vaccine development takes a long time and a vaccine is not to be expected to be available before the end of the year. This does not mean that we have to just sit and wait for a vaccine. The focus of researchers has partly shifted to the use of existing medicines to quickly find an effective treatment for these patients.
China has started to treat their patients with Favilavir, an antiviral drug, which shows positive effects on the symptoms of COVID-19 [1]. Furthermore, in a recent trial, the antiviral drug Remdesivir was found to shorten the time to recovery [3]. Additionally, chloroquine and hydroxychloroquine, two malaria drugs, have been found to have in vitro activity against the virus [1]. In several countries, such as the United States, these two drugs are recommended for the treatment of COVID-19 patients. The anti-retroviral drug lopinavir/ritonavir was associated with improvement in patients in the 2003 SARS-CoV outbreak, suggesting a possible use against the new coronavirus. Interestingly, the WHO suggests that there may be benefits of these drugs, despite a 99 patient trial showing no benefit compared to standard care [4].
Furthermore, the WHO facilitates an international clinical trial called ‘Solidarity’ to help find a treatment for COVID-19 [5]. Over 400 hospitals in 35 countries are participating in this trial and around 3500 patients have been enrolled in the trial. The goal of the trial is to reduce the time to find a cure by 80 percent as compared to normal [5]. There are four treatment options included in the trial, namely remdesivir, lopinavir/ritonavir, lopinavir/ritonavir with interferon beta-1a, and hydroxychloroquine. No results are available yet.
In the long run, a vaccine will be the most ideal treatment to prevent people from getting the disease. There are several vaccines under development all around the world. First stage clinical trials to assess safety have already started, second stage clinical trials to assess effectiveness will start within around eight months and it is estimated that a vaccine will become available after around 12-18 months [1].
To conclude, no treatment for COVID-19 has been found yet. However, anti-viral drugs and malaria drugs showed promising effects in patients. The ‘Solidarity’-trial facilitated by the WHO researching the before mentioned drugs is a worldwide attempt to find a suitable treatment as soon as possible. Furthermore, multiple countries are also working towards a vaccine but this is not expected to be available soon. It is to be hoped that a cure will be found soon so we can all go back to the lives we once had.
References:
[1] Abd El-Aziz, T.M. & Stockand, J.D. Recent progress and challenges in drug development against COVID-19 coronavirus (SARS-CoV-2) – an update on the status. Infect Genet Evol 83, 104327-104327 (2020).
[2] World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. (2020). Retrieved from: https://covid19.who.int/ (Accessed: 27-05-2020)
[3] Beigel, J.H., et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. New England Journal of Medicine (2020).
[4] Cao, B., et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. New England Journal of Medicine 382, 1787-1799 (2020).
[5] World Health Organization. “Solidarity” clinical trial for COVID-19 treatments. (2020). Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments (Accessed: 27-05-2020)