Scientists are working around the clock all over the world to figure out ways to fight COVID-19.
“There is a truly impressive effort underway by governments, universities, pharmaceutical companies and nonprofits to tackle the COVID-19 challenge. The scale of the effort is gigantic,” says Bill Dreitlein, senior director of OptumRx Pipeline and Drug Surveillance.
While many are focused on developing a vaccine, there are plenty of teams trying to find treatments to slow down the disease and treat its symptoms.
“A treatment could be closer than a vaccine,” says Dreitlein, a pharmacist who watches the development pipeline.
Some scientists are looking at existing drugs to see if they can be used to treat COVID-19. There are more than 100 possible new drugs in the pipeline right now.
Here Dreitlein shares five things to know about the search for treatments:
Bill Dreitlein, Senior Director of OptumRx Pipeline and Drug Surveillance
1. Treating a viral infection is harder than treating bacterial ones
Remember the times your doctor sent you home without antibiotics because you had a virus, not a bacterial infection? That’s because different types of diseases need to be treated differently. COVID-19 is a virus.
Dreitlein say anti-viral drugs rarely deliver the knockout punch of antibiotics. Instead they work to slow or in some cases prevent the disease.
In the case of COVID-19, he says a treatment could resemble something like Tamiflu, which locks the virus inside the infected cell, preventing it from spreading and infecting other cells. Tamiflu can shorten the duration of the common flu by a day or two.
That might not sound very dramatic. But in the case of COVID-19, shortening the duration by a couple of days with reduced symptoms could mean earlier discharge from the hospital, or avoiding the progression to more extreme treatments, like needing a ventilator.
2. Anti-viral drugs aren’t a cure
One medication being tested to see if it can slow COVID-19, remdesivir, works by preventing the virus from replicating or making copies of itself.
“Remdesivir is not completely new. It was developed originally against the Ebola virus some years ago,” Dreitlein explains. “That’s good, since it means we know a lot more about how it works than if we had just started. We have a head start.”
With an existing drug, researchers know what effects it has on the body and how safe it is in various doses. What they don’t know is how it might work against the COVID-19 virus.
Early trial results suggest remdesivir helps COVID-19 patients recover more quickly. Also, it seems to be more effective when given earlier in the course of a patient’s illness.
A class of heart medications called ACE inhibitors (angiotensin-converting enzyme) may also help. ACE inhibitors help to lower blood pressure, which helps to lower your heart’s workload. In reviewing COVID-19 cases among Medicare Advantage patients, UnitedHealth Group and Yale School of Medicine found older patients who’d taken ACE inhibitors had an almost 40% lower risk of hospitalization.
This is an important observation, but we do not know these medications caused the lower hospitalization rate or if it was something else. The next step will be a large-scale trial to see if these common, inexpensive drugs can curb some of the most severe consequences of COVID-19.
Another treatment path is to develop a drug that can help block a disease in someone who hasn’t been exposed to it yet.
Efforts to prevent HIV/AIDS provide an example. There isn’t a vaccine, but doctors have had success preventing people from contracting the disease by using a pre-exposure prophylactic, or PrEP.
The value of the PrEP approach is that people at the highest risk of getting COVID-19 could receive preventative treatment. That could include health care workers. Several research trials are underway to explore the prevention idea.
The other way is to prevent disease in healthy people is to use a vaccine. This is a very active area of drug development with 10 different vaccines already being tested in humans and over 100 more being tested in the lab or animals. The first step will be to determine if the vaccine causes the body to produce antibodies, then to determine if those antibodies confer protection against the COVID-19 virus, and then finally to determine how long that protection lasts.
3. Prioritizing approvals of COVID-19 treatments
Given the threat posed by the virus, the FDA has taken several steps to speed up the drug approval process. The agency is giving COVID-19 treatments priority treatment; it’s also teaming up with other government groups to prioritize drug/vaccine candidates, streamline clinical trials and coordinate regulatory processes.
“These actions show that the FDA is demonstrating a willingness to do what it can. I think that any new treatment that demonstrates some benefit will get fair and swift regulatory action,” Dreitlein says.
It’s not easy to get a drug to market; clinical trials take time. “There is only one way to determine whether a drug is safe and effective for a given condition,” says Dreitlein. “That is a double-blind placebo-controlled study. In these trials, neither the patients nor the doctors know whether a participant has been given the drug or a placebo. These are complicated to do, and they take a long time to arrange and execute.”
Check out this infographic. It shows how long the FDA drug approval process usually takes.
The good news is that, while the FDA prides itself on having the “safest and most advanced pharmaceutical system in the world,” a study published earlier this year in the Journal of the American Medical Association found that drugs are getting through the FDA review process faster than ever.
4. Making plans for production
For drug makers, getting FDA approval is only part of the journey. The next steps are manufacturing and distributing the treatment.
Some companies are already working to ramp up production to support more clinical trials and a possible launch. They are partnering with other pharmaceutical companies and countries for help.
If demand is greater than supply, distribution may work like COVID-19 test kits — figure out the areas of greatest need and supply those first.
5. Plasma potential: Tom Hanks, other survivors to the rescue
Besides drugs, other therapies are showing promise. Researchers have found antibodies in the blood of survivors might have the power to beat COVID-19. Antibodies are proteins our immune systems create to fight against disease.
There’s a nationwide effort to collect “convalescent plasma” — blood from people who’ve recovered from COVID-19. Thanks to an FDA ruling in late March, doctors all over the country can quickly get permission to use plasma from survivors to treat patients with severe or immediately life-threatening cases of the disease.
UnitedHealth Group recently donated $5 million to support the convalescent plasma study, which is being led by Mayo Clinic. “Treating patients with convalescent plasma has the potential to save many lives,” says Dr. Richard Migliori, UnitedHealth Group chief medical officer.
Tom Hanks, possibly the most famous person to recover from COVID-19, recently tweeted a picture of the plasma he donated to UCLA for vaccine research.
— Tom Hanks (@tomhanks) April 29, 2020
In the end, there may not be one overarching solution. Multiple treatments may be key to controlling the spread of the virus and effectively treating symptoms.
“We have many ‘shots-on-goal’ to try and stop this disease,” says Dreitlein.