Since the early days of the pandemic, we have all wanted to know when and how it will end.
Many of us assumed that COVID-19 vaccines were the answer, and the U.S. government poured more than $ 18 billion into Operation Warp Speed to develop and test them. This research has yielded three approved vaccines – so far – which are extremely effective not only against the original virus, but also against its many variants, including the highly transferable Delta variant.
And yet the pandemic lingers.
Fortunately, vaccination is not the only tool in our arsenal. Researchers are also experimenting with a wide range of drugs that can help reduce hospitalizations and deaths due to COVID-19. That, too, could put an end to the pandemic.
But it will not be easy.
“Viruses mutate easily, so they are usually very quick to escape any therapeutic intervention,” he said. Juliet Morrison, a microbiologist at UC Riverside. “Any antiviral should target multiple aspects of the viral life cycle so that you do not choose resistance.”
That means finding a single pill that can not only disrupt how the coronavirus enters cells, but also how it copies itself. It must also be able to mess with the shell the virus produces to protect its precious genetic code.
“There are about 30 different proteins that SARS COV-2 encodes, and all of these are potential targets,” she said.
When it comes to the most severe cases of COVID-19, it is important to know that it is not the virus itself that places people in the ICU, but rather the immune system’s response to the virus, Morrison added.
This means that the most effective treatment would stop the coronavirus before it causes the immune system to become haywire. But it had to happen early – in many cases, before people even knew they were infected.
“It’s a big problem,” she said.
Researchers are determined to succeed despite these obstacles. In June, the Biden administration announced a $ 3 billion investment to accelerate the discovery, development and manufacture of antiviral drugs for COVID-19 patients. The ultimate goal is to create a pill that can be prescribed immediately after a patient receives a positive coronavirus test result.
It may sound like a high order, but experts say this could happen by the end of the year.
“I am very hopeful,” he said Dr. Aneesh Mehta, Head of Infectious Diseases at Emory University Hospital. “We have some very good candidates.”
Until then, doctors will have to rely on therapeutic agents that were created to treat other diseases.
Mehta spoke to The Times about what drugs are currently available to COVID-19 patients, how the disease will be treated in the future, and how efforts to create an antiviral drug capable of stopping coronavirus can also help prevent – or at least shorten – other pandemics in the coming years.
How do doctors treat people with mild cases of COVID-19 now?
If you have COVID-19 and are slightly ill, using monoclonal antibodies [proteins that mimic the body’s own immune defenders] is a good option.
These have reduced the number of patients who need to go to the hospital and the good news is that one dose should be enough to cover your treatment during COVID.
But not everyone can get them, right?
One of the important limitations is that they almost always have to be given through an IV, so in general we only use them for patients with risk factors such as cardiovascular disease, diabetes, lung disease and in the elderly.
If they continue to work on the road, we can expand their use.
What about treating very ill patients?
For patients who are sick enough to be in the hospital and on oxygen, there are two types of treatments recommended by the National Institutes of Health.
One is anti-inflammatory, which dampens the immune response. The other is an antiviral that works by directly stopping the virus from replicating.
Let’s start with the anti-inflammatory approach. What substances are these?
The main anti-inflammatory we use is dexamethasone, a steroid used for many other conditions. It has been shown to reduce the risk of dying from COVID if you are in the hospital and have oxygen.
Baricitinib, used for rheumatoid arthritis and other autoimmune diseases, is more expensive, but we use it for some patients who cannot use dexamethasone. These are the two main anti-inflammatory drugs used in the United States.
What antiviral drugs are you using?
Remdesivir is approved for patients who are in the hospital and on conventional oxygen through nasal pins. For sicker patients, it may not be as effective.
Do you ever combine these two approaches?
Yes. We generally use them together so that we attack both the virus and the inflammation that the virus creates. For most people, the combination reduces the risk of death and the time they are in the hospital.
Tocilizumab, which blocks a chemical system in the body that leads to inflammation, can reduce the risk of death in patients who are rapidly developing into being in the ICU.
The World Health Organization recently said that drugs like tocilizumab reduce the odds of death by 13% compared to standard care. Honestly, it does not sound like much.
The risk reduction is moderate, but for some patients it can be a very useful tool.
Like everything else in COVID treatment, there are no magic bullets. It requires medical teams to use every tool in the arsenal to help patients, and that includes supportive care.
So far, COVID-19 drugs have mostly been tested on inpatients. Can they also help patients with milder illness?
At the onset of the epidemic, the vast majority of clinical trials were of patients who were ill enough to be in the hospital. But as we know, it was only the tip of the iceberg for patients.
There has been a big push recently – here in the US and globally – to study treatments for those who are not sick enough to be in the hospital. Antiviral agents and monoclonal antibodies may be more effective early in the disease; this is really an important area for us to explore.
We are also investigating how to get these drugs so that patients can use them at home and not use vital hospital.
How difficult is it to convert an IV medication into pill form?
That is a question many of us have. Doctors would rather give patients things that are easier for them to take. However, there are difficulties in getting some of the biochemicals into a form that is stable enough to get through the digestive tract and throughout the body.
We have antiviral pills in clinical trials now. However, the monoclonal antibodies are difficult to deliver as pills because they are a protein that can become unstable under the wrong conditions.
Government researchers have said they hope to see an antiviral pill by the end of the fall. Does it seem possible?
I am very hopeful that we will have an oral antiviral medicine for people with COVID before the end of the year. We have very good candidates, including Molnupiravir, which was developed at Emory.
We would love to be in a situation like we are with the flu where patients are diagnosed at a clinic or emergency care and then given a prescription for a pill that they can take at home that prevents them from getting sicker.
It seems that many people assume that the next pandemic will also be caused by a virus. Why?
The next pandemic can come through bacteria or fungi, but most likely it comes from a virus. It is easy for them to spread. They are small, they are difficult to detect, and there are various ways they can infect the body and run through the body.
Therefore, it is important that we have a basic plan for pandemic preparedness that includes monitoring of new viruses and good platforms for developing treatment of these viruses and the ability to test them very quickly.
We need to learn from each pandemic how we can be better prepared for the next.
This interview was edited for length and clarity.
This story originally appeared in the Los Angeles Times.