We have no drugs yet proven to prevent or treat COVID-19, although some drugs appear promising, as do transfusions of blood donated by people who have recovered and are now immune. The virus is spread from one person to another; it has not been shown to be spread from animals or food. Until we have a safe and effective vaccine, the only way we have to slow down the pandemic is to keep infected people away from those who have not yet been infected. To do this, we need to develop antibody tests to find who has already been exposed to the virus and may be immune.
We Need Both Antibody Blood Tests and a Vaccine
Antibody blood tests tell if a person has antibodies in his bloodstream from having been infected with COVID-19. Many companies are working to develop these tests, and so far the FDA has approved four of the tests. After a person is infected with the virus, his immune system produces antibodies that help him kill the virus now and in the future. We don’t yet have studies to show that people with antibodies in their bloodstream are protected from getting the infection again, or how long that protection will last. However, based on our knowledge of other coronaviruses, the odds are very strong that having antibodies will prevent re-infection. When we are able to tell who has been infected and recovered and has the antibodies that may prevent re-infection, we will be able to send people who have recovered from COVID-19 back to work, to treat and help sick people, and be safely out in society.
However, we can’t wait for everyone to get COVID-19. Most of all, we need a vaccine to help people develop antibodies that will make them immune without getting sick and possibly dying from COVID-19. Normally it takes as long as five years to develop a new vaccine. Researchers have to spend months trying the vaccine in culture bottles to see if it harms and damages cells. Then they have to spend time trying the vaccine in animals to see if it harms them. Only after the vaccine has been shown to be safe in animals can the vaccine be tried in humans to see if it is safe in humans and effective in preventing the disease. The government is now in the process of speeding up research and relaxing restrictions so we can have a vaccine as soon as possible. Eleven companies have been approved by the FDA to start developing potential vaccines, and according to the World Health Organization, more than 70 different vaccines are already being tested.
Drugs Being Tested for Treatment of COVID-19
The U.S. federal government has approved more than 424 different clinical trials to find effective treatments for COVID-19. Treatments being investigated include blood pressure drugs, immune suppressants, immune stimulants, antiviral drugs, anti-malarial drugs, supplemental oxygen, nitric oxide to widen blood vessels, many different antibiotics, stem cells, anti-cancer drugs, nasal washes, steroids, vitamins C and D, zinc, honey, Chinese herbs, breathing machines, CPAP machines, anti-clotting medicines, anti-flu drugs, anti-HIV drugs, bone marrow transplants and many others.
So far, no controlled scientific studies have proven that any drug helps to prevent or treat COVID-19.
• Several recent papers show that the leading drug is Remdesivir made by Gilead in Israel. We still have no studies with placebo controls because the drug is being given on a compassionate basis and not compared to placebos. One recent study failed to show any advantage.
• Temple University has just started a clinical trial to evaluate gimsilumab, an artificially synthesized monoclonal antibody that suppresses an overactive immunity that causes cytokine storm in which a person’s own immunity destroys a person’s own body instead of just attacking invading germs.
• Hydroxychloroquine (Plaquenil), chloroquine and azithromycin: Studies from France and Brazil found that these anti-malarial drugs have not been effective in killing COVID-19 and they can cause deadly irregular heartbeats. Chloroquine has been shown in 62 patients to shorten the course of disease. Chloroquine and hydroxychloroquine both suppress immunity, so they may help a person who is at risk of dying of cytokine storm (Journal of Zhejiang University, March,2020 ). Some uncontrolled studies show that hydroxychloroquine and azithromycin reduced viral load in sick patients (International Journal of Antimicrobial Agents, preprint April 2020).
• Antiviral Lopinavir-Ritonavir has not been shown to be effective for COVID-19 (N Engl J Med, Mar 18, 2020).
What Can We Expect in the Next Two Years?
Social distancing and isolation strategies are likely to continue off and on until a significant percentage of the population has antibodies either from having had the disease or being immunized. Some of the habits we are learning in this traumatic period may become permanent as protection against future epidemics. For example, hand-shaking and cheek-kissing of strangers are likely to be replaced with other greeting gestures. Variations on working from home and remote schooling may become more popular options for people who have found that they prefer them.
We already have some blood tests, and will have many more, to see who has had COVID-19 and may be immune so they can most likely return safely to society. We could have a vaccine in a year because companies have been given permission to speed up the testing process, and the winners of this race are likely to make a lot of money.
