This post is taken from our new report Guarded Hope in the time of the Coronavirus…
As no effective treatment for covid-19 has yet been proven – as with the early years of the HIV outbreak – medical professionals have been forced to limit their interventions to supportive rather than curative care.
This aims to manage the lung damage and organ failure caused during the second phase of covid-19, assisting critically ill patients to survive while their own immune systems fight the infection. Tragically, as seen globally, this is not always successful and the mortality has been high in the older patients over 70.
By looking at a handful of existing drug options, our report Guarded hope in a time of coronavirus discusses some of the possible options.
As it is a new virus, we are limited by a lack of data from properly controlled trials. Many studies have been initiated recently, most looking at the treatment of moderate to severely ill patients. Remdesivir and Lopinavir, one of the HIV protease inhibitors, are undergoing extensive trials at the current time.
Two of the other most interesting options are a drug called Hydroxychloroquine and an antiviral drug called Favipiravir, both of which will be discussed in more detail. The importance of these drugs is that they are particularly focused on treating patients at the earliest stages of covid-19, meaning they might also have potential as protection for medical staff on the frontline, as well as other critical workers.
It is too early to speculate as to what the results will be and to run victory laps. Even the possibility of such treatments, however, means that the government must start thinking now about the implications of the availability of efficacious and safe treatments on it’s strategy for dealing with the epidemic and for gradually relaxing the lockdown rules.
No government was prepared for this epidemic, even when it was clear that the coronavirus was likely to spread fast from China through the rest of the world. The infectiousness and clinical severity of this virus in a non-immune world has been unprecedented.
The UK government cannot afford to be left behind at the next stage of the pandemic and so now needs detailed treatment preparedness plans for all eventualities, including the possibility of treatment of early cases, which might be available through the repurposing of existing drugs.
The current antivirals under review – remdesivir and favipiravir – although developed against other indications, do possess some broader-spectrum antiviral activity and may hold promise, certainly when given early in the disease. Neither of these were developed as a specific anticoronavirus agent, but it seems they have a measurable anti-coronavirus activity which needs full evaluation and then utilisation.
While we hope they may make a difference, this is unlikely to be a silver bullet but even limited responses from these treatments may change the profile of the pandemic. Such a plan needs to:
1. Support and monitor clinical trials of all compounds for which there is proper scientific rationale and initial evidence of their effectiveness.
2. Continue to improve the understanding of the spread of the virus.
3. Be ready to fast-track regulatory approvals for any such treatment for which clinical trial outcomes are positive.
4. For each of the more promising drugs, start preparing a protocol and logistics for their dispensing.
5. Review the epidemiological models if there is a positive outcome for some of these trials.
6. Establish international collaboration and make sure that there is sufficient manufacturing capacity.
7. Review the government’s overall epidemic management strategy.
With a properly conceived treatment preparedness plan, the government would be working on all of these aspects in parallel, so that, as soon as new information becomes available, all the above aspects of the epidemic strategy can be quickly adjusted and any proven treatment can be made immediately available.
This is turn will enable the government to move more rapidly towards a release of the lockdown, starting, potentially, within the next few weeks and concluding hopefully in the summer.