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From the early days of the pandemic, we’ve all wanted to know when and how it would end.
Many of us have assumed COVID-19 vaccines were the answer, and the U.S. government has invested more than $ 18 billion in Operation Warp Speed to develop and test them. This research has produced three licensed vaccines – so far – that are highly effective not only against the original virus, but also against its many variants, including the highly transmissible Delta variant.
And yet, the pandemic persists.
Fortunately, vaccination is not the only tool in our arsenal. Researchers are also experimenting with a wide variety of drugs that can help reduce hospitalizations and deaths from COVID-19. That too could end the pandemic.
But it won’t be easy.
“Viruses mutate easily, so they are usually very quick to evade therapeutic intervention,” said Juliette Morrison, a microbiologist at UC Riverside. “Any antiviral must target several aspects of the viral life cycle so as not to select for resistance. “
It means finding a single pill that can disrupt not only the way the coronavirus enters cells, but also the way it copies itself. He should also be able to play with the shell the virus makes to protect its precious genetic code.
“There are about 30 different proteins that SARS COV-2 codes for and all of them are potential targets,” she said.
When it comes to the more severe cases of COVID-19, it is important to know that it is not the virus itself that puts people in intensive care, but rather the immune system’s response to the virus, a added Morrison.
This means that the most effective treatment would stop the coronavirus before it disrupts the immune system. But it should happen early – in many cases, before people even know they are infected.
“It’s a big deal,” she said.
Scientists are determined to succeed despite these obstacles. In June, the Biden administration announced a $ 3 billion investment to accelerate the discovery, development and manufacture of antiviral drugs for COVID-19 patients. The ultimate goal is to create a pill that could be prescribed immediately after a patient tests positive for the coronavirus.
It might seem like a tall order, but experts say it could happen by the end of the year.
“I am very optimistic,” said Dr. Aneesh Mehta, Chief of Infectious Disease Services at Emory Teaching Hospital. “We have very good candidates.
Until then, doctors will have to rely on therapies that have been created to treat other diseases.
Mehta told The Times about the drugs currently available for COVID-19 patients, how the disease will be treated in the future, and how the effort to create an antiviral drug capable of stopping the coronavirus could also help. prevent – or at least shorten – other pandemics in the years to come.
How are doctors now treating people with mild cases of COVID-19?
If you have COVID-19 and are mildly ill, use monoclonal antibodies [proteins that mimic the body’s own immune defenders] is a great option.
These have reduced the number of patients needing to go to hospital, and the good news is that one dose should be enough to cover your treatment during COVID.
But not everyone can get them, can they?
One of the important limitations is that they almost always have to be administered intravenously. Therefore, we generally only use them for patients with risk factors such as cardiovascular disease, diabetes, lung disease and in the elderly.
If they continue to work on the road, we can expand their use.
What about the treatment of very sick patients?
For patients sick enough to be hospitalized and on oxygen, there are two types of treatments recommended by the National Institutes of Health.
One is anti-inflammatory, which dampens the immune response. The other is an antiviral, which works by directly preventing the virus from replicating itself.
Let’s start with the anti-inflammatory approach. What drugs are these?
The main anti-inflammatory drug we use is dexamethasone, a steroid that is used for many other conditions. It has been shown to decrease the risk of dying from COVID if you are in the hospital and on oxygen.
Baricitinib, which is used for rheumatoid arthritis and other autoimmune diseases, is more expensive, but we use it in some patients who cannot use dexamethasone. These are the two main anti-inflammatory drugs used in the United States.
What antiviral drugs are you using?
Remdesivir is approved for inpatients and on conventional oxygen through nasal clips. For sicker patients, it may not be as effective.
Do you already combine these two approaches?
Yes. We usually use them together, so we attack both the virus and the inflammation that the virus creates. For the majority of people, the combination decreases the risk of death and the length of hospital stay.
Other treatments?
Tocilizumab, which blocks a chemical system in the body that leads to inflammation, may reduce the risk of death in patients who progress quickly to the intensive care unit.
The World Health Organization recently said drugs like tocilizumab reduced the risk of death by 13% compared to standard care. Honestly, that doesn’t sound like much.
Risk reduction is moderate, but for some patients it can be a very useful tool.
Like everything else in COVID treatment, there is no quick fix. It forces medical teams to use every tool in the arsenal to help patients, and that includes supportive care.
So far, COVID-19 drugs have mainly been tested on hospitalized patients. Can they also help patients with milder disease?
At the start of the epidemic, the vast majority of clinical trials involved patients sick enough to be hospitalized. But as we know, that was just the tip of the patient iceberg.
There has been a big push recently – here in the United States and around the world – to study treatments for those who are not sick enough to be hospitalized. Antivirals and monoclonal antibodies may be more effective early in the disease; this is really an important area that we need to explore.
We are also exploring how to obtain these drugs so that patients can use them at home and not use up the living space of the hospital.
Is it difficult to convert an IV drug to pill form?
This is a question that many of us ask ourselves. Doctors prefer to give patients things that are easier for them to take. But it is difficult to put some of the biochemicals in a form stable enough to pass through the digestive tract and the whole body.
We currently have antiviral pills in clinical trials. But monoclonal antibodies are difficult to deliver in pill form because it is a protein that can become unstable under bad conditions.
Government scientists have said they hope to see an antiviral pill by the end of fall. Does it seem possible?
I am optimistic that we will have an oral antiviral drug for people with COVID by the end of the year. We have some very good candidates, including Molnupiravir, which was developed at Emory.
We would love to be in a situation like the flu, where patients are diagnosed in a clinic or emergency care and then given a prescription for a pill they can take at home that will keep them from getting sicker.
It seems a lot of people are speculating that the next pandemic will be caused by a virus as well. Why is that?
The next pandemic could come from bacteria or fungi, but it will most likely come from a virus. It’s easy for them to spread. They are small, difficult to detect, and there are different ways of infecting the body and passing through the body.
That’s why it’s important that we have a fundamental pandemic preparedness plan that includes monitoring for new viruses and good platforms to develop a treatment for these viruses, and the ability to test them very quickly.
We must learn from each pandemic how to be better prepared for the next.
This interview has been edited for length and clarity.
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