COVID-19 has affected our way of life and everyone has the same high-level questions, how long will this continue and why aren’t there medications to treat this virus? As a health care provider and researcher, I cannot answer the first question other than to say that the longer we cheat and do not practice true social distancing, the longer this virus will be around. I would like to spend some time on the second ques- tion. COVID-19 was first identified in December 2019. We are in April.
It takes time to develop, test and implement new treatments. It is for this reason that we are seeing the utilization and testing of previously available medications. These drugs are being used and tested because they make sense that they could be effective. This is the hope. We, the medical community, and only the medical community, need to ensure that we offer hope, not false hope or false promises.
To start the discussion, there is no standard of care or medical consensus on the treatment of COVID-19 other than to treat the symptoms of fever and cough with drinking plenty of fluids, rest, acetaminophen and cough syrups.
There is a feeling that the use of hydroxychloroquine, an outdated anti-malarial drug now used to treat rheumatoid arthritis may be effective and this “sense” has led to its widespread use. But what is the data supporting its use? A single, non-randomized study of 36 patients in France suggested that hydroxychlo- roquine lowered coronavirus levels in the blood as compared to untreated controls. Just the other day, another small but randomized study out of China reported that hydroxychloro- quine showed no benefit in treating COVID-19 infection. With limited data, and one large clinical study just starting in the US to determine if this drug will be safe and effective, the FDA approved its use for COVID-19 infection. I hope they are right in this decision and not offering false hope.
We need more data. Similarly, there are scattered reports on the use of the combi- nation of hydroxychloroquine and azithromycin, tocilizumab (an IL-6 receptor antibody), vitamin C and even famotidine to treat COVID-19 infection. Once again, there is no ev- idence-based data to support the use of these products and the concept that they may be effective is speculative at best at this point. We need more data.
It appears that there are two phases of COVID-19 infection, an early phase and a later phase characterized by a surge in pro-inflammatory cytokines, a part of our immune system, which leads to severe lung inflammation and poor outcomes in a small minority of COVID infected patients. Research to develop treatments for COVID-19 is therefore based on intervening both early and late. The good news is that there are well conceived, randomized, double-blind, placebo control trials currently underway which are rapidly enrolling patients with COVID-19 infection.
The medications being tested fall into two broad categories, drugs that are directly anti-viral and drugs that suppress this cytokine storm overreac- tion to COVID-19. The direct anti-viral currently be tested, Remdesivir, works by preventing the virus from replicating. The immune modulator, sarilumab, is an IL-6 receptor inhibitor that theoretically decreases the inflammatory response in the lungs which is triggered by the virus. There is tremendous hope that these therapies will be effective but since they randomized, placebo-controlled trials, we will not know if they are effective for several months. While they are being given with the intention of helping, only time will tell if they are effective, ineffective and most importantly, safe.
Medical science is feverishly working to develop and test treatments for COVID-19, but these treatments need to be assessed through well-designed clinical trials that will provide answers as to their effectiveness and safety.
We must rely on evidence-based medicine to give us these answers, not speculation or emotions or non-scientifically backed statements which may provide false hope and potentially do more harm than good. We will get through this together, but we need to remain vigilant in our social distancing, wash our hands frequently and use common sense to flatten to curve and contain the virus. Please stay safe and act smart.