The Search for Covid-19 Treatment

man in face mask during covid19 epidemicThe hunt is on for effective treatment for COVID-19 (SAR-CoV-2). The New York Times reports that there are over 254 therapies being explored. Medical professionals have, even in these few months, been adapting their treatments as they learn more about the nature of the virus. The fact that COVID-19 can affect people in a wide variety of ways requires almost individually tailored treatments.  Furthermore, the symptoms of COVID-19 vary widely, sometimes limited to red eyes (conjunctivitis), painful toes, slight fever, mild cough, or general aches and pains, depending on where in the body the virus lodges or begins its attack, how strong the existing immune system is, and how healthy the individual is before being exposed.

Treatment of Active Cases

In the case of viral infections, such as COVID-19, the driving force for severely ill patients is a terrible overreaction of the immune system’s response.  It is known as a cytokine storm because levels of cytokines, the molecules that stimulate the immune system, increase drastically, and the immune system over-reacts catastrophically.

COVID-19 is characterized by low blood levels of oxygen, signaling that the body is not getting enough oxygen. Because it was first identified as a pneumonia-type condition, in severe cases the treatment procedure was use of a ventilator to force air into the lungs. Outcomes are not always good and doctors have been shifting to other methologies and using high-pressure forced ventilation (intubation) only as a last effort.

Many doctors now agree that the low oxygen status is more like high-altitude sickness and the better treatment is to provide oxygen at as low-pressure as possible. The protocol is to support lung capacity by having the patient reclining or sitting up rather than lying down. If that is insufficient, then the patient is provided extra oxygen at as low pressure as is possible, as with a CPAP machine of the type used for sleep apnea.

Remdesivir Somewhat Effective

The FDA has given emergency approval to the drug Remdesivir for treatment against COVID-19.  It failed as a treatment for Ebola and hepatitis but effective against MERS and SARS in vivo and in vitro and against a number of other coronaviruses. It inhibits viral RNA polymerases that control RNA growth and has shown in vitro activity against SARS-CoV-2. A revival of a previously explored drug, it had already been tested for safety in animals and humans.

There have been several trials. At least one dose was provided to 61 patients on a compassionate use basis. Compassionate use means that no when the patients conditions reaches severity, and the drug is being tried as a last resort. Data from 53 of those patients was examined, 68% of whom showed an improvement in blood oxygen levels.  This percentage included 57% of patients on a ventilator. 13% of the patients died, but of the survivors, the duration of illness decreased from 15 to 11 days. 1 On average, the drug reduced recovery time by four days.

In another trial with 1000 hospitalized patients, this time controlled with a placebo, patients improved more quickly in an average of 11 days rather than 15 days for recovery.  Again, the drug did not markedly improve mortality rates (the most severe cases). The New York Times reported that scientists, noticing that coronavirus appear to weaken as they mutate, thought it could be possible to ‘trick’ the virus.  Looking at past failed experiences they found that GS-5734, Remdesivir might be effective.  Remdesivir works by terminating the chain of growing covid-19 RNA, thus killing it.

You can read about other Remdesivir (GS-5734) at clinicaltrials.gov.

Clinical Trials for Treatment

  • Hyperbaric oxygen therapy, a treatment for decompression sickness, bubbles of air in the blood, and infections. It involves inhaling pure oxygen in a pressurized room with air pressure three times the normal level.
  • There are a number of studies underway or being planned for plasma therapy in which the blood plasma of COVID-19 survivors, teeming with antibodies, is given the patients via an IV drip.
  • In China, researchers are investigating use of a device that generates a combination of hydrogen and oxygen (hydroxyl generator) which is inhaled by the patient (as opposed to inhaling pure oxygen).
  • Drug trials for potential drug treatments are wide-ranging. They include:
    • FT516, an off-the-shelf stem-cell product used to treat cancer patients
    • Pinen.hydronoplacton.ribonucleic acid spray used in pulmonary problems
    • Deferoxamine (Desferal) used treat iron overdoses or aluminum toxicity.
    • Hydroxycholorquine (Dimard).  This is the infamous drug used to treat malaria, but which has serious side-effects for some patients.  Some trials have been discontinued for that reason. The FDA has cautioned against use of hydroxycholorquine outside of supervised hospital use due to the risk of heart rhythem problems.
    • Lopinavir/Ritonavir (Keletra). This drug is used to treat HIV and AIDS.
    • Azithromcin (Zitromax),  currently used to treat susceptible microorganisms, including respiratory tract infections.
    • DAS181, a drug for immunocompromised patients with lower respiratory tract viral infections. It has already been in clinical trials for parainfluenza infection. It blocks virus entry into respiratory epithelial cells, preventing its spread.
    • Clevudine used for hepatitis B
    • Huaier grancule, china. TCM extract of a mushroom (trametes robiniophila murr) which inhibits cancer
    • Methylprednisolone (corticosteroid that reduces inflammation) versus tocilizumab (immunosuppressive drug, blocks immune system from over-reacting).
    • Isotretinoin. retinoid used in severe acne and skin cancers; it inhibits ACE2 cells which can act as home cells for COVID-19 infection.
    • And many more!  You can read about these clinical trials at clinicaltrials.gov.

Until a Vaccine is Found

Until an effective vaccine is found, we urge you to continue to practice social distancing, wash your hands and keep your hands away from your face. Wearing a mask is important if you are around others who are sick, or if you are sick (to protect others).  At the very least, it reminds you to keep your unwashed hands away from your eyes, nose, mouth, and face.

Remember to do those things that help to maintain your immune health:

If you want nutritional support to boost your immune system, you can try one of these:

Stay well out there!

nutrients Up Next: Itchy eyes = spring allergies + eye fatigue.

  1.   Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, et al. (2020). Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med. Apr 10.