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April 15, 2020

COVID-19: Are we closing in on a cure?

Islamabad

April 15, 2020

The turn of the decade brought forth the beginning of a modern World War of sorts. In contrast with the known human history, however, the enemy has proved to be elusive thus far. This time around, the entire human race is up against a minute particle made of protein and nucleic acid called the Human Coronavirus.

In late December 2019, a novel strain of coronavirus that was subsequently named as SARS cov2 was reported as the cause of multiple cases of mysteriously treatment resistant pneumonia in Wuhan in Hubei province of China. Owing to its rapid transmission by respiratory droplets released during sneezing or coughing and probable feco-oral route, as well as the ability of the virus to survive on nonliving surfaces for extended periods of time, the cases skyrocketed in a matter of days. WHO declared the disease nCOVID-19 (novel Coronavirus Infectious Disease 2019) a global pandemic on March 11, 2020. Currently, it has spread to 209 countries worldwide with over 1.7 million confirmed cases and more than 100,000 deaths. A seemingly tiny organism has unmasked the unpreparedness of the human race, thereby crippling the entire human population socially, psychologically, and in the most debilitating manner-economically.

The virus can go unnoticed in as many as 50% of infected cases where it may show no symptoms at all. The remaining patients present with fever, dry cough, shortness of breath, sore throat and/or diarrhea. The worse affected group consists of a smaller fraction of patients comprising the older age group and patients with comorbidities such as hypertension, diabetes, chronic respiratory disease or compromised immunity. In this population, the disease can manifest as severe pneumonia, sepsis and respiratory failure worse enough to require mechanical support, all of which can result in death within a matter of days. Keeping in view the worldwide spread and rapidly increasing death toll of this disease, the need for an effective drug or vaccine is imperative.

The desperation is palpable as new studies are being published every day and new trials being approved in several countries to test possibly efficacious drugs.

Hydroxychloroquine, widely used as an antimalarial drug has garnered the most attention as a possible treatment for nCOVID-19. It was approved by FDA as Emergency Use Authorization on March 29, 2020. It has been tested in China and France showing assuring results in patients infected with coronavirus. Combination of Hydroxychloroquine with Azithromycin has also shown promising results but limitations to these studies are the small number of patients experimented, limited follow up and side effects of Hydroxychloroquine on heart rhythm. However, multiple clinical trials to test the efficacy of this drug have already been approved and are underway in many countries including US and Pakistan.

Remdesivir, which is an approved antiviral for the treatment of Ebola virus, showed encouraging results in animal models against the strains of Coronavirus that caused the previous two epidemics. Owing to the structural similarities between SARS-cov2 which is the causative agent for nCOVID-19, and previously known Coronaviruses, this drug has also been under experimentation in China and US. Very recently, a collaborative study done in US, Canada, Europe and Japan published its results after using this drug in severely ill patients. The outcome was remarkable as 68% of patients treated with Remdesivir had either improved or recovered from the disease. Several trails on other antiviral drugs like Lopinavir, Ritonavir, drugs for Influenza are also making progress.

Tocilizumab, a drug currently used against autoimmune disorders, was shown to improve symptoms by decreasing oxygen requirement and counteracting inflammatory products in the lungs in a group of 20 patients.

The use of antibody rich plasma from nCOVID-19 survivors has been the center of debate recently. Similar practices had been a popular choice of treatment for Influenza, Spanish Flu and other viral infections in the past. Building on the remarkable results from certain recent clinical trials, health care workers in Pakistan are also going to implement this mode of treatment as per recent Drug Regulatory Authority Pakistan recommendations.

A blood pressure-lowering drug Losartan, which targets the same receptor (ACE-2) on human cells as the inflammatory proteins manufactured by the virus, has been hypothesized to reduce lung injury in nCOVID-19 patients. However this hypothesis is currently under scrutiny before it can be approved for testing.

Is a vaccine for nCOVID-19 on the horizon? Two vaccines have entered human trials in China and US, and several are still undergoing laboratory trials. However, no approved vaccine for nCOVID-19 is available till date.

Our understanding of this virus and the disease it causes is still in the budding stages. The next few months are critical in the discovery of a treatment for nCOVID-19. Any option that can keep a patient stable enough to stay at home is welcome at this moment, because our healthcare system is not equipped to deal with the staggering number of patients that we are seeing right now. The developments in the academic and clinical endeavors being pursued by scientists and doctors worldwide are reassuring. An operative treatment option may be available in next 3-5 months, leading us out of this long tunnel.

Dr. Rabia Ashraf

Graduate of King Edward Medical University Lahore, ECFMG certified USA

[email protected]