Coronavirus (COVID-19) Treatment: A Comprehensive Study

Since the first outbreak of the COVID-2019 coronavirus was reported in December, scientists have been working to find an effective treatment. But sadly to inform you that currently there is no specific COVID-19/ coronavirus treatment.

Currently, Coronavirus Treatment Is To Combat The Symptoms For The Time Being

The symptoms described mainly evoke an acute respiratory infection (fever, cough, shortness of breath), but also respiratory difficulties and pulmonary complications such as pneumonia are also described, as well as more severe forms. Digestive and eye symptoms (conjunctivitis) have also been observed in some confirmed cases.

The coronavirus treatments that can be administered are therefore those that help to control these symptoms. In the meantime, there is a worldwide race to find a specific drug.

Hydroxychloroquine And Azithromycin Authorized Against Coronavirus Treatment

The most talked-about drug in this epidemic is chloroquine. In a lecture given on February 25 in Marseille, Didier Raoult, director of the Institut Méditerranée Infection in Marseille, explained that chloroquine, an anti-malarial drug known for a very long time, was a promising avenue of research against COVID-19. “Just as it had been demonstrated for Sras at the time and forgotten, he regretted, chloroquine is active in vitro against coronaviruses”. 500 mg per day for ten days would have shown “a dramatic improvement for all clinically positive cases of infection with a Chinese coronavirus”. In particular, he cites research by Chinese scientists published in the journal BioScienceTrends carried out in a dozen Chinese hospitals since the start of the COVID-2019 epidemic. The results obtained on a hundred patients showed that chloroquine phosphate was more effective than other treatments, explain the scientists in the original study.

The antiviral drug Remdesivir is also cited, but chloroquine is said to be effective in several ways: “to contain the progression of pneumonia, to improve the condition of the lungs, to make the patient return to being virus-negative and to shorten the duration of the disease”. Another positive point for chloroquine, also underlined by Pr Didier Raoult, is that it is already available on the market. “It costs less and it is a drug that has been around for a long time and that has been proven to be safe in terms of the risk/benefit balance,” noted the scientists in the study.

Prof. Raoult is now proposing screening tests at the IHU Mediterranean University Hospital Infection and would treat “febrile” patients with a coronavirus treatment based on hydroxychloroquine, a molecule derived from chloroquine after launching his own study on 26 patients.

However, not everyone is so enthusiastic. The study has a number of biases according to certain scientific communities, who express their reservations about proclaiming so quickly the discovery of an almost “miracle” coronavirus treatment while reminding us not to go too fast. The lack of a large-scale study to assess the risks (side effects, overdose, interactions with other drugs) and judged of real effectiveness is deplored.

Sanofi is reportedly conducting trials.  “On the basis of these promising results, we very quickly mobilized and approached the health authorities to carry out a broader study and verify the effectiveness of the treatment,” said Olivier Bogillot, the company’s president for FranceInfo.

The Antiviral Drug Remdesevir: A Promising Treatment For Coronavirus?

Another drug that has been mentioned from the beginning: Remdesivir.  One of the cured French patients was reportedly treated with this antiviral manufactured by the Gilead laboratory. This treatment is “a small molecule capable of reaching all the compartments of the body and which we know that it diffuses perfectly into the lungs, the target organ of the disease”, said Professor Denis Malvy, head of the unit a tropical disease and traveller of the CHU Pellegrin (Bordeaux). The patient would have received the intravenous treatment for 10 days and would have “perfectly tolerated” it.   6 clinical trials have been launched worldwide and the “drug has shown its potential efficacy against COVID-19 in the laboratory”. On the other hand, the director of the laboratory explains that there are, to date, no data concerning its effectiveness and tolerance in humans.

At the end of March 2020, the laboratory caused controversy by obtaining the status of “orphan drug” in the United States. A ploy denounced in a letter from several NGOs. “Gilead has primary patents to redesign it in more than 70 countries, which could block the arrival of generics until 2031,” explain the authors, who ask the laboratory to “guarantee the rapid availability, at an affordable price, and accessibility of its experimental treatment to redesign COVID-19”.

Gilead would have given up the status of an orphan drug. In a press release dated 4 April 2020, Daniel O’Day, CEO of Gilead announced that it had set up “complementary access programmes” to make the experimental drug available to hospitals for seriously ill patients who cannot participate in ongoing clinical trials, before reminding that: “remdesivir remains an experimental drug that has not been approved by the authorities anywhere in the world. The safety and efficacy of the treatments are not yet known and even though we know the urgency, our responsibility and ethics require us to determine whether this drug is effective and safe”.

The laboratory claims to provide “the treatment, administered intravenously daily in hospital” free of charge for patients with severe symptoms and explains that it is doing its best to make sufficient stocks available if its effectiveness is officially confirmed, with “affordable access to the patients who need it most”.

Other Coronavirus Treatments In Europe

Since March 1, 2020, a European clinical trial called “Discovery” piloted at the University Hospital of Lyon was launched Sunday, March 15, 2020, in 7 European countries to test four experimental treatments, announced the Ministry of Health. It is planned to include 3,200 European patients including Belgium, the Netherlands, Luxembourg, the United Kingdom, Germany and Spain, and possibly other countries including at least 800 in France, hospitalized for a COVID-19 infection in a medical department or directly in intensive care,” said the French Institute of Medical Research.

The Coronavirus Treatments Evaluated by Discovery

  • Remdesivir, an antiviral used in particular against Ebola.
  • Lopinavir, a treatment used against HIV in combination or not with ritonavir.
  • Lopinavir in combination with beta interferon.
  • Hydroxychloroquine is still under study despite its authorisation in the context of the health emergency.

Another Treatment Prospect

The concrete company Hemarina received authorization from the ANSM on March 27 to start a clinical trial which consisted of administering a solution derived from the blood of a sea worm to patients with COVID-19. Its haemoglobin – a molecule present in red blood cells and whose role is to transport oxygen in the body – is capable of carrying 40 times more oxygen than human haemoglobin.

But the Medicines Agency decided on 9 April to finally suspend the biotech company’s “Monaco” trial. The reason for this was the inclusion of data from a 2011 pre-clinical study on pigs, which resulted in “100% lethality” in these animals. As a result, AP-HP has “decided to no longer be a promoter” of this work, the foundation told AFP. “A re-evaluation (…) is necessary to assess the risks incurred in relation to the expected benefit for patients,” the hospital group explains. “The trial had not started and no patient has therefore received this experimental product.

COVID-19 Treatment Program By The Bordeaux University Hospital

The Bordeaux University Hospital launched the first outpatient clinical trial since the start of the pandemic. Four treatments are being tested on 1000 participants aged over 65 years (a particularly concerned population) who are COVID-19 positive. Among the treatments being evaluated are the famous hydroxychloroquine but also an antihypertensive and an antiviral. In practice, the participants are visited by a doctor and a nurse. The latter decide on the appropriate treatment, which must be started within three days of the positive test, and give them a monitoring kit. Strict follow-up is then put in place. Three new visits take place in the first ten days and regular monitoring is carried out by telephone or via online tools.

“The aim is to treat the disease as early as possible to avoid any deterioration and to keep patients on an outpatient basis. Four treatments, three of which are new, will be tested on nearly 1,000 people. The study will continue as long as the epidemic is there and an effective drug has not been found. This will be our base here,” explained Professor Denis Malvy, member of the scientific council and principal investigator of the clinical trial, to 20 Minutes.

Coronavirus Treatments Outside Europe

Other avenues of treatment are still being explored. A report bringing together all the data validated to date in scientific journals by Coreb (Coordination Opérationnelle Risque Epidémique et Biologique) explains that in China there are currently 80 potential treatments being tested to treat COVID-2019. Fifteen clinical studies have been registered, involving more than 2,000 patients. Among them, Coreb presents the study summary of the drugs tested for two series of studies, one on 99 patients and the other on 138 hospitalized patients.

Antiviral treatments studied: 90% (124) of the volunteer patients received oseltamivir (Tamiflu), mainly indicated for influenza. 76% (75) took ritonavir, indicated for HIV in particular;

Antibiotic treatments studied: Moxifloxacin (bacterial ENT infections) on 89 patients and ceftriaxone (treatment of bacterial meningitis) on 34;

Support treatments: Oxygen therapy, mechanical ventilation.

Japan’ Coronavirus Treatment

In Japan, the Fujifilm group is currently testing the efficacy of its Avigan anti-influenza drug (favipiravir). The first clinical trials had already been carried out by the Chinese authorities with this compound. Encouraging results have been observed.

Several vaccines are also being tested, including one in the USA, where clinical trials will begin in April 2020, and one in France (Institut Pasteur) which should be tested in September 2020.

The Path To Passive Antibody Therapy And Plasma Transfusion

Researchers at the Johns Hopkins University in Maryland, USA, have advanced a new therapeutic approach known as passive antibody therapy. It involves taking blood from infected but recovered patients to extract viral antibodies, which are particularly high when the body has had to make them fight the virus. These antibodies are isolated, treated and then can be injected into other patients.

This technique had already proved its effectiveness during the H1N1 pandemic and the Ebola virus by reducing the viral load, which improved the survival rate.

Its advantage lies in the speed of its implementation, which is much shorter than that of a vaccine. In addition, the growing number of patients also means an increasing number of potential donors.

However, it requires the coordination of many members of the medical profession: infectious disease specialists, haematologists, blood bank specialists and hospital administrators.

Plasma Treatment

On this principle, in the United States, the FDA (Food and Drug Administration) has been studying for several weeks of treatment to treat people suffering from coronavirus. This consists of transfusing sick people with a serum obtained from blood plasma collected from cured patients. 

Plasma is the liquid part of the blood, once the cells and platelets have been removed. The plasma of infected and convalescent patients contains antibodies to fight the virus, offering the possibility of a serum, hope for treatment.

The benefits of this transfusion would be numerous. Not only would it increase the chances of a cure, thus saving lives, but it would also be a way to boost immunity.

While clinical trials are still underway, the FDA wants to facilitate access to this treatment for the most severely affected people. Before wider use, studies are still needed and researchers are investigating the possibility of transfusing this serum to people potentially exposed to the virus in order to develop their immune response. It is important not to rush into this, further research is needed, particularly to identify the potential risks of such a method.

Plasma transfusion has already been studied and used in China. The authorities had called on cured people to donate blood to help other patients.

Note: For further study, read The Risk Factors Of Coronavirus and 11 Ways To Prevent Coronavirus Spreading.

References:

  • Q & A on coronaviruses (COVID-19), World Health Organization (WHO)
  • 2 – Breakthrough: Chloroquine phosphate has shown apparent efficacy in the treatment of COVID-19 associated pneumonia in clinical studies, Bioscience Trends, February 4, 2020
  • Nanshan Chen et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet– Jan 29, 2020 
  • Wang D et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. 2020 Feb
  • Arturo Casadevall and Liise-Anne Pirofski; The convalescent sera option for containing COVID-19, The Journal of Clinical Investigation  1172 / JCI138003
  • Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Science direct, March 20, 2020