Co-authored by Jonah Liss and Daniella Ghafari
Since the commencement of the ongoing “Great Lockdown,” negative implications have surfaced in nearly every regard. With the well being of political, social, educational, religious, and economic systems at jeopardy, the premature termination of quarantine is increasingly tempting. In spite of your perceived stance on the lockdown dilemma, remaining diligent in our social distancing efforts seems to be imperative as to not overwhelm our health care systems and to avoid a worse, second wave. Social distancing is, however, not the only way to combat COVID-19. While remedies or even a cure for the novel coronavirus may not be as simple as injecting disinfectants, medical researchers around the world have achieved many promising breakthroughs.
The FDA recently granted American biopharmaceutical company Gilead Sciences emergency authorization to use its investigational antiviral drug Remdesivir for hospitalized patients with severe COVID-19 cases. Remdesivir showed promising results after demonstrating activity in animal models that had MERS and SARS, which have similar structures to the novel coronavirus. Remdesivir has been authorized for usage in both adults and children, but specifically for confirmed COVID-19 diagnoses where patients have severely low blood oxygen levels or require ventilator support. Information pertaining to safety and effectiveness are currently limited, however, considering the shortened recovery time in some patients throughout clinical trials, Gilead's 50,000 vials ready to ship is certainly an assuring sign.
The FDA announced in a press release, that "given there are no adequate, approved, or available alternative treatments, the known and potential benefits… [of Remdesivir] currently outweigh the known and potential risks of the drug's use." The FDA's expedited authorization will increase access to Remdesivir for doctors considerably, in contrast to earlier where usage was limited to clinical trials. While Remdesivir may not be a cure to COVID-19, it is certainly a step in the right direction and appears to be a viable remedy for extreme cases. As such, Remdesivir has the potential to help many patients, all while alleviating hospital strains existing from an influx of cases and a lack of resources.
2. Hydroxychloroquine + zPak
The novel coronavirus is a single-stranded RNA virus, that works by injecting its genetic material into vulnerable cells, and using its resources to produce the proteins that COVID-19 needs to spread through your body. Essentially, the coronavirus is not trying to kill you, it's trying to use your body as a host and then infect others so it can keep living. Hydroxychloroquine is not a new drug; it has been around for a while to help treat malaria as well as autoimmune diseases that cause painful inflammation like lupus and rheumatoid arthritis. Anytime a foreign substance, or an antigen, enters someone's body, white blood cells trigger a reaction from your immune system, which can be seen physically as a fever, sneezing, and coughing among other reactions in order to expel the virus. We know that for COVID-19 cases, there is an average incubation period of two days to two weeks, meaning that your immune system takes that long to react and show symptoms. Although not enough research has been completed yet, Yale doctors are researching Hydroxychloroquine since it has been suspected to increase the recovery time of COVID-19 patients, by increasing the speed of one's immune system.
A zPak, or azithromycin, has been used with hydroxychloroquine to combat the virus. Azithromycin is known to treat many respiratory tract infections, as well as STDs and urinary tract infections because it can combat inflammation. Azithromycin is actually an antibiotic, and using it alone may not be effective in combating the virus, though it was found effective in treating the Zika and Ebola viruses. We know the COVID-19 affects a patient's respiratory tract, so in junction with hydroxychloroquine, some studies have found that patients recover much faster than they would on no medication alone.
Despite these promising signs, a study conducted by the U.S. Veterans Health Administration found an increase in mortality rates upon hydroxychloroquine usage. They further suggested that doctors considering its usage "should monitor the patient for adverse effects, especially prolonged QTc interval." The QTc interval is a measurement used to assess the health of one's heart, which was not consistently in a safe zone among many patients tested in the study. Although the study had many limitations, there were an alarming 70 deaths among the 368 patients that were evaluated. The VHA did not rule out the usage of hydroxychloroquine, but noted that their studies "highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs."
Baricitinib is a drug commonly used to treat rheumatoid arthritis, which American pharmaceutical company Eli Lilly and Company has the exclusive right to further develop and commercialize. Benevolent AI, an artificial intelligence company in the UK, discovered that Baricitinib has treatment potentials despite previous unknowingness by rheumatologists and even Eli Lilly and Company. The drug acts as an immunosuppressant, which is why it has also been used for treatment in other viruses like H.I.V. The exact usage Baricitinib will have is still largely unknown, but similarly to Remdesivir, the discovery of its potential usage should give us all a sense of hope. Not only does Baricitinib show that a COVID-19 cure may be closer than initially expected, but also that through international cooperation, we can accomplish amazing things. Baricitinib was developed by an American company, discovered to be further useful by a company based in the UK which was partially funded by Singaporean firms, and will be studied in accelerated clinical trials by the US, Italy, and Canada. As Secretary-General of the United Nations António Guterres stated, “the fury of the virus illustrates the folly of war.” Our best chance of defeating COVID-19 is through cooperation on a local, domestic, and international level.
4. Plasma Treatment
One way that doctors are attempting to help their patients recover is by using blood plasma therapy and transfusions. When a person recovers from a virus, it's because their bodies have produced antibodies that helped combat the virus, which remains in the blood for some time so that they do not relapse. According to Harvard University, "Convalescent plasma - literally plasma from recovered patients - has been used for more than 100 years to treat a variety of illnesses" so it looks promising for helping patients recover from COVID-19.
However, the requirements are long and a blood transfusion for patients can be exhausting, and it is still unknown if blood transfusion is actually effective in treating coronavirus. Additionally, experts do not know the best time to administer a blood transfusion to ensure recovery. Because of this, the FDA has approved of plasma treatment in cases that are the most severe or life-threatening.
There are specific requirements for someone who would like to donate blood, and they vary from source to source, so if you have recovered from COVID-19 and would like to help other people recover, please call a hospital to find out how you can help.
5. mRNA-1273 Vaccine
The experimental vaccine mRNA-1273, which uses synthetic messenger RNA to help immunize humans against viruses, will have a slightly different path to potential consumers than other treatments like Remdesivir. Moderna CEO Stephane Bancel announced plans to partner with Swiss drugmaker Lonza to manufacture a Billion Doses of the unproven vaccine. Despite mRNA-1273 still being in a phase 1 trial state, Bancel announced that Moderna and Lonza will be prepared “to start dosing as soon as [they] get the green light.” While this approach to vaccine manufacturing is certainly a risky investment and untraditional, we are living in unprecedented times.
6. Quantum Computing (Future Outlook)
Classical computers perform calculations in binary, where transistors act as on-and-off switches to create two states that makeup “bits” of information: zeros and ones. However, through quantum physics concepts such as superposition and entanglement, quantum computers store information as “qubits,” which can exist as both zeros and ones at the same time. What this means is that, in application, quantum computers “make even the world’s most powerful supercomputers — capable of performing a giddying 20,000 trillion calculations per second — look like an early-2000s flip-phone” according to Agence France-Presse. Companies such as IBM and Google already have early-stage quantum computers, which in the coming decades have the potential to help the pharmaceutical industry. Although quantum computers are not currently a viable tool for pharmaceutical research, it is expected that in the future they will be able to discover new drugs through biological simulations, as to drastically decrease what can typically take companies a decade and billions of dollars to accomplish. Many experts expect a cure for the novel coronavirus to take upwards of 18 months. While quantum computers may not be of much help right now, they have the potential to be momentous in avoiding a future pandemic.
ABC - Coronavirus: What does COVID-19 do to your body and why does it spread so easily?
Accenture - The Future of Pharmaceutical R&D is Now
American Society for Microbiology - A Contemporary View of Coronavirus Transcription
Bloomberg - Gilead CEO Says Over 50,000 Remdesivir Courses Ready to Ship
CNN - FDA issues emergency-use authorization for remdesivir to treat hospitalized patients with severe Covid-19
CNN- Remdesivir drug shows promise -- but it is far from a coronavirus cure
FDA - Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment
FDA - Recommendations for Investigational COVID-19 Convalescent Plasma
Fortune - Gilead’s remdesivir won’t be a COVID-19 miracle cure, but it’s still an important first step
Harvard Medical School - Treatments for COVID-19
Medscape - Hydroxychloroquine Ineffective for COVID-19, VA Study Suggests
NBC - FDA grants remdesivir emergency use authorization for COVID-19
NCBI - Cell Biology of Infection
NCBI - Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial
NCBI - Mechanism of action of hydroxychloroquine as an antirheumatic drug
NCBI - RNA Viruses: RNA Roles in Pathogenesis, Coreplication and Viral Load
News Medical - Functions of MHC in the Immune System
NIH - NIH clinical trial of investigational vaccine for COVID-19 begins
Physician's Weekly - Covid-19: VA Study Points to Increased Mortality with Hydroxychloroquine
Tech Crunch - Potential new treatment for COVID-19 uncovered by BenevolentAI enters trials
The Motley Fool - FDA Authorizes Gilead's Remdesivir for COVID-19
The Motley Fool - Moderna Prepares to Manufacture a Billion Doses of Coronavirus Vaccine
The New York Times - How A.I. Steered Doctors Toward a Possible Coronavirus Treatment
United Nations - "The fury of the virus illustrates the folly of war"
Yale Medicine - Can Hydroxychloroquine Treat COVID-19? We Don’t Know Yet