The Road to Find COVID-19 Treatment
Apr 17, 2020
The Road to Find COVID-19 Treatment

Scientists around the world are racing to find the treatment to cure the novel coronavirus, which has now become a pandemic. But how long until the vaccine will become available?

It?s been more than three months since we heard about a new viral infection that emerged in China. Eventually, it has now become a concern around the world and is declared a pandemic by WHO. Social distancing and nation-wide lockdown may help us reduce the spread of COVID-19 but the only way to prevent being infected by this deadly virus is with a vaccine.

Concerned with the health of the public worldwide, the scientific community is working at its highest pace to find a treatment option for novel coronavirus spread. In mid-January, Chinese researchers have online posted the genetic sequence of the virus, making it easier for researchers to work towards finding a vaccine. More than 70 companies and institutions across the globe have already focused themselves on finding a vaccine against COVID-19. Five of the possible vaccines have been tested on humans. Moderna Therapeutics, a company based in Boston started clinical trials on March 16.

Even with the current pace, the vaccine is expected to be in the market after 18 months. To manage the spread healthcare workers are trying to treat the symptoms with a combination of existing drugs, experimental antiviral drugs, and antibody-rich plasma from the patients who recovered from this viral infection.

Existing Drug Treatment

Some researchers are working on modifying the existing treatment of other diseases to combat COVID-19. WHO has also launched a major clinical trial, named Solidarity, across the globe to test different theories for the treatment of COVID-19 with existing drugs: Remdesivir; an experimental antiviral drug, chloroquine or hydroxychloroquine; antimalarial drug, combination of two HIV drugs (lopinavir and ritonavir), and anti-inflammatory interferon-beta (an immune system messenger that can inhibit the virus) in addition to the HIV drugs. Let?s read about how these drugs were chosen by WHO.

  1. Remdesivir
    Prior to COVID-19, coronavirus was the cause of two other pandemics (Severe Acute Respiratory Syndrome (SARS) between 2002-2004 in China, and Middle East Respiratory Syndrome (MERS) in 2012). The virus for the cause of COVID-19, SARS-CoV-19 shares 80-91% of its genetic material with SARS.
    The drug, Remdesivir was developed by Gilead Sciences to treat Ebola but was later proved effective against SARS and MERS according to researchers who tested it in animal studies.

    Like most drugs, it would be more potent if given at earlier stage. The major challenge would be you can?t give this drug to anyone who walks in the hospital with mild symptoms- it is intravenous, expensive and not everyone with mild symptoms will develop severe illness. In some patients infected with COVID-19 it helped to inhibit the virus in cells. Although, it can?t be used as a definite treatment option until further studies.
  2. Chloroquine or Hydroxychloroquine
    Chloroquine and hydroxychloroquine have recently received strong attention following positive results in patients infected with COVID-19. The drugs work by decreasing acidity in endosomes and later cripple the virus. Endosomes are the cell compartments that are used to ingest foreign material and is used by some viruses to co-opt. Although, SARS-CoV-2 enters the human body by attaching it?s spike protein to the receptors of human cells. The drug would be needed in large quantity in the patient?s body to fight this virus, which may be harmful.
    There are not prominent results published on the use of hydroxychloroquine to treat COVID-19 patients. It is also stated that the use of hydroxychloroquine could cause more harm than good. There are reports suggesting chloroquine poisoning in people who self-medicated.
  3. Lopinavir-Ritonavir Combination
    These drugs were developed by Abbott Laboratories to inhibit the protease of HIV. The combination has worked effectively in some cases of SARS and MERS. Although the first trial by Chinese researchers in 199 severely ill patients didn?t yield any result. In February, doctors in Taiwan noticed an improvement in COVID-19 patients who were treated with the combination of Lopinavir-Ritonavir. Researchers believe that if treatment starts early, it might be effective.
  4. Lopinavir-Ritonavir Combination with Anti-inflammatory Interferon Beta
    The fourth theory of treatment option combines Lopinavir-Ritonavir with interferon-beta, a molecule involved in regulating inflammation. The use of interferon-beta in marmosets infected with MERS has reduced the disease severity. It might be too risky for patients with severe COVID-19 infection. If given at a late stage, it could worsen the tissue damage.

There are several other research work going on to find a cure for this virus. It would be more effective if drugs are tested on early-stage COVID-19 patients. The more clinical data is available, the better for the doctors to treat the patients.

Antibodies Treatment
When a patient is infected with a virus, the immune system of the person will send white blood cells to fight against it. These cells will produce antibodies that will prevent the virus from replicating or entering the human body. If a patient survives the virus attack, they will have antibodies in their blood plasma against it.

The convalescent plasma therapy works on the idea that if we take a small portion of antibodies from a recovered patient and infuse it in the severely ill patient with the same virus, it will stimulate the patient?s immune system to fight and cripple the virus. In China, the therapy showed noticeable results.

This therapy has been used since the 1918 influenza pandemic to treat patients. It was also used at the time of other pandemic like SARS, MERS, and H1N1.

RNA Vaccines
A vaccine is essentially a pure preparation of one or more key components of the virus ? such as the envelope, spike or a membrane protein ? that is injected in the body to train the immune system to detect the virus. If the virus is detected, the immune system attacks it and protects the body from infection.

Developing protein-based vaccines takes years. Check the below image for the process of typical vaccine development.

Rather than focusing on protein-based vaccines, researchers are working on a new type of vaccine called mRNA vaccines. The idea is that the mRNA (the vaccine) will allow the human body to produce vaccine proteins itself. mRNA vaccines will be safer as they do not carry the risk of protein contamination or the injected virus to become active, like other types of vaccine. The biggest advantage is that it can be mass-produced.
Moderna Inc. has already announced the experimental COVID-19 mRNA vaccine- mRNA-1273 is ready for clinical trials in humans. Sanofi Pasteur also announced two projects working on a vaccine for COVID-19.

Several companies are working to find a vaccine to cure or prevent further infection from SARS-CoV-19. It might become available in the market within 12-18 months. Many foundations, companies and individuals are coming forward to fund coronavirus related projects. Bill Gates announced that he will support seven companies who are working on coronavirus vaccines. In his 2015 TED talk soon after the 2012 pandemic, he talked about if we were ready for another pandemic. He predicted that in recent years if there would be a death of over 10 million people, the cause could be a microbe rather than a war. The question still exists about how ready we would be if there is another such outbreak? Will industries be ready to identify and produce drugs? Will our healthcare facilities be able to treat patients? What would we learn from this pandemic and how would we prepare ourselves better for the next one?

Until a vaccine becomes available, doctors are treating their patients based on symptoms with the combination of drugs. There are several approaches to treat COVID-19. Although, the best way to protect yourself until the vaccine becomes available is to maintain social distancing and staying home. So stay at home, wash your hands, and hope that a cure becomes available soon.