Challenge 4: What specific treatments are being used for COVID-19?

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• There has been a rush to develop new medicines. Developing a new medicine that is safe and effective can take years. Since we don’t have years to wait, doctors are looking to repurpose many existing medications (i.e., medicines that are already approved for use for other conditions) to see if they may help patients with COVID-19. This way they don’t need to start from scratch, which can save years in finding effective treatments. But there can be lots of problems with this approach if we are too quick to act - we risk forgetting sound scientific principles.
  

• “ Vitamin D Deficiency and COVID-19: Is There a Connection? ”

• Hydroxychloroquine is a medication used for malaria (a parasitic infection) and lupus (a disease of the immune system), that had been shown to work in vitro against another type of coronavirus (SARS) in the past, so doctors tried to use it early on against COVID-19. There was initial promise based on experiences in small groups of patients, but these early studies lacked the scientific rigor needed for approval and wide use of a medicine. Instead, they provided important hypotheses to drive larger studies that could do a more thorough job of seeing if hydroxychloroquine would help patients with COVID-19. Unfortunately, these larger, more scientifically rigorous trials were not encouraging - the science does not currently support using this medicine for treatment or prevention of COVID-19 unless the medicine is being used as part of a research study.

Reflect & Discuss

1. Why might vitamin D levels be lower in populations with higher rates of COVID-19?
2. How could a scientist test if taking vitamin D helps treat COVID-19?
3. Should doctors be allowed to prescribe medications that are not approved? Should patients be able to get an unapproved medicine without a prescription?

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• “Coronavirus Drug and Treatment Tracker”
• "Treatments for COVID-19"
  
• Anti-inflammatory medicines
  • We know that many people exposed to SARS-CoV-2 get mild or no symptoms at all. Others get so sick that they end up in the hospital or die. The differences in how sick people get may be because some people’s immune system overreacts to the infection. Our immune systems are designed to fight off infection. When the immune system reacts properly, we can get over an infection quickly, but if the system overreacts, it can cause us to get really sick. A lot of the medicines that are being studied and used for COVID-19 block the overactive response of the immune system. Dexamethasone is an example. However, the immune system is really important to fight infections including COVID-19 - we don’t want to block it in most people with COVID-19! So medicines like dexamethasone should only be used for people who get severely ill from COVID-19. We can measure levels of a patient’s immune response with some specialized blood tests called “inflammatory markers.” In some of the sickest patients with COVID-19, inflammatory markers are very elevated. There are some medicines that lower levels of inflammatory markers in COVID-19. Tocilizumab is one such medicine; it blocks the function of a specific molecule in the immune system called IL-6 (interleukin 6, which is in a family of compounds called cytokines). By blocking the function of IL-6, the thought is that an overreacting immune system won’t cause as much damage to the patient. Tocilizumab has been used in other immune disorders where the patient’s immune system is overreacting. In COVID-19 it has been shown to improve levels of inflammatory markers on blood tests in sick hospitalized patients, but the effect on the patient’s health directly is not so clear.
• Anti-virals
  • Many antiviral medications that have been developed for other diseases are being tried for COVID-19. One that has been used to treat COVID-19 is remdesivir, which was originally developed as a possible treatment for other viruses (hepatitis C, Ebola, Marburg) but was never approved for use for any of these. “Remdesivir is a molecule that is similar to the nucleotide building blocks the virus uses to copy its RNA genome. By imitating those building blocks, remdesivir blocks the enzyme that the coronavirus uses to replicate itself". A research study demonstrated that remdesivir reduced the time to recovery for hospitalized patients with severe COVID-19 infection, and it was granted FDA approval in October 2020. However, since it requires many doses through an IV, it is impractical for anyone other than the sickest patients.
• New Treatments
  • Many new treatments are being developed and studied. One group of medicines that shows promise is monoclonal antibodies. Antibodies are proteins the body makes to fight off specific infections. When someone is exposed to a virus, the body should make natural antibodies to fight the virus and help the person recover from illness. However, it can take time for natural antibodies to form, and during that time some people can get really sick. “Monoclonal antibodies” are medicines that work like natural antibodies but can be given right away, before natural antibodies have time to work. In COVID-19 infection, a patient can receive monoclonal antibodies through an injection or an IV as soon as possible after the infection starts. They help prevent patients from developing serious symptoms from their COVID-19 infection. There are many different types of monoclonal antibodies for COVID-19 being developed but all of them are reserved for people who are at high risk of getting seriously ill from COVID-19.
• Other Strategies
  • Sick patients with COVID-19 are doing better even though we don’t have effective medications yet because we are getting better at preventing and treating life-threatening complications of the disease. For example, prone positioning (having sick patients lie on their stomachs) of patients with COVID-19 in the hospital can help with oxygenation. Aggressive use of medications to prevent blood clots in hospitalized patients has also helped prevent life threatening complications.

Reflect & Discuss

1. Which treatments currently show the most promise for COVID-19?
2. What is the role of the immune system in COVID-19?
3. What is the role of antibodies in recovering from COVID-19?
4. Where can people get reliable and trustworthy information about medical treatments? Who should people ask if they have questions or confusion about medical treatments?

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Your answers with the class.

Explore

Using resources in the readings from this Challenge or other online sources, find out if there is any evidence to support the statements below. Find out by citing at least one source for each of these statements, either refuting or supporting the claims. Be prepared to present your answers and sources to class, including an explanation about why you thought your sources were trustworthy.

1. Sick patients with COVID-19 are doing better even though we don’t have effective medications yet because we are getting better at preventing and treating life-threatening complications of the disease.
   
   
2. Even though azithromycin is an antibiotic, some scientific studies have shown it may help treat COVID-19 because it reduces inflammation.
   
   
3. When there was a rush of excitement about using hydroxychloroquine to treat COVID-19, some patients who needed it for other reasons had difficulty getting it.
   
   
4. Medications that are used to treat HIV infection are being used to treat COVID-19.
   
   
5. Some people are taking advantage of the uncertainty around COVID-19 treatments to make money selling unproven (and sometimes dangerous) treatments.

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Your answers with the class.