When a U.S. health authority issued its first warning a year ago that COVID-19 would “cause serious disruption in everyday life,” doctors had no effective treatments to further support it.
There is still no cure, but thanks to an unprecedented global research effort, several treatments are helping patients survive COVID-19 and stay completely out of the hospital.
COVID-19 treatments target two broad problems: the ability of the coronavirus to spread through the body and the damage caused by the immune system’s response. When the virus enters the body, it takes over cells and uses them to repeat itself. In response, the body sends inflammatory signals and immune cells to fight the virus. In some patients, the inflammatory response may persist even after the virus is under control, leading to damage to the lungs and other organs.
The best tool is prevention, including the use of face masks and vaccines. Vaccines train the immune system to ward off attackers. With less risk of an uncontrolled infection, they can reduce the risk of COVID-19 death to almost zero. But vaccine supply is limited, even with a third vaccine now allowed for US use, and therefore treatments for infected patients remain crucial.
As physicians working with COVID-19 patients, we followed the drug trials and success stories. Here are six treatments commonly used for COVID-19 today. As you will see, timing is important.
Treatments that can keep you out of the hospital
Two promising types of treatment involve the injection of antiviral antibodies into high-risk COVID-19 patients before the person becomes seriously ill.
Our bodies naturally create antibodies to recognize foreign invaders and help combat them. But the production of natural antibodies takes several days and SARS-CoV-2 – the coronavirus that causes COVID-19 – repeats rapidly. Studies show that the injection of antibodies to patients just after the symptoms start can protect patients from serious infections.
Monoclonal antibodies: These laboratory antibodies can bind to SARS-CoV-2 and prevent the virus from entering and infecting cells. These include Bamlanivimab and the combination therapy casirivimab / imdevimab developed by Regeneron. The U.S. Food and Drug Administration has granted emergency permission for these treatments because it has been found to protect high-risk patients from hospitalization and death. However, once patients are sick enough to be admitted to the hospital, there is no evidence that studies show it.
Recovery plasma: Another way to deliver antibodies is blood from patients recovering from COVID-19. Recovery plasma is mainly given in research institutions because the clinical evidence so far has been mixed. Some trials show benefits early in the disease. Other studies have shown no benefit in patients admitted to the hospital.
There may be a role for recovery plasma as adjunctive therapy for some patients due to the increasing threat of mutated SARS-CoV-2 variants, which may evade monoclonal antibody treatment. However, careful research is needed.
Treatments for hospitalized patients
Once patients become so ill that they have to be admitted to the hospital, treatments change.
Most patients admitted to the hospital have difficulty breathing and have low oxygen levels. Low oxygen occurs when the virus and the corresponding immune response injure the lungs, leading to swelling in air sacs that limits the amount of oxygen in the blood. Patients hospitalized with COVID-19 usually need supplemental medical oxygen to breathe. Doctors regularly treat patients with oxygen with the antiviral drug remdesivir and anti-inflammatory corticosteroids.
Remdesivir: Remdesivir, originally designed for the treatment of hepatitis C, prevents the coronavirus from replicating itself by interfering with its genetic building blocks. It has been shown to shorten the duration of hospital stay, and doctors may prescribe it to oxygen patients shortly after arrival at the hospital.
Corticosteroids: Steroids calm the body’s immune response and have been used for decades to treat inflammatory disorders. It is also widely available, inexpensive and well-studied medicine, so they were one of the first therapies to introduce clinical trials for COVID-19. Several studies have shown that low-dose steroids reduce mortality in patients admitted to the hospital, including the sickest patients in the intensive care unit, or ICU. Following the findings of the rural studies RECOVERY and REMAP-CAP COVID-19, steroids are now the standard of care for patients hospitalized with COVID-19 and treated with oxygen.
Blood thinner: Inflammation during COVID-19 and other viral infections can also increase the risk of blood clots, which can cause heart attacks, strokes and dangerous blood clots in the lungs. Many patients with COVID-19 receive the blood thinner heparin or enoxaparin to prevent blood clots before they occur. Early data from a large trial of COVID-19 patients suggest that patients in hospital benefit from higher doses of blood thinners.
Some patients with COVID-19 become so ill that they need an ICU for high levels of oxygen support or a ventilator to help them breathe. There are various therapies available for ICU patients, but ICU patients have not been found to benefit from high-dose blood thinners.
The treatment of the sickest patients
Studies have found that ICU patients with COVID-19 survive longer if they receive steroids. However, low dose steroids alone may not be enough to combat excessive inflammation.
Tocilizumab: Tocilizumab is a laboratory-generated antibody that blocks the interleukin-6 pathway, which can cause inflammation during COVID-19 and other diseases. New results from the REMAP-CAP trial not yet peer-reviewed suggest that a single dose of tocilizumab taken within one to two days after being placed on respiratory support reduced the risk of dying in patients who already received low dose steroids. Tocilizumab has also been shown to benefit patients with high levels of inflammation in the early results of another trial.
These innovative therapies can help, but careful support in the ICU is also crucial. Decades of extensive research have defined core management principles to help patients with severe lung infections who need ventilators. These include avoiding underinflation and over-inflation of the lung by the ventilator, treating pain and anxiety with low levels of sedatives, and regularly placing certain patients with low oxygen levels on their abdomen, among many other interventions. The same key principles are likely to apply to patients with COVID-19 to help them survive and recover from a critical illness that can last weeks or months.
Medical progress since the beginning of the pandemic has been alarming. Doctors now have vaccinations, antiviral antibodies for outpatients at high risk, and various treatments for patients admitted to the hospital. Continued research will be crucial in improving our ability to fight a disease that has claimed more than 2.5 million lives worldwide.
This article was published from The Conversation, a non-profit news site dedicated to sharing ideas from academic experts. It was written by: William G. Bain, University of Pittsburgh; Georgios D. Kitsios, University of Pittsburgh, and Tomeka L. Suber, University of Pittsburgh.
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William G. Bain receives research funding from the U.S. Department of Veterans Affairs; the National Institutes of Health; the University of Pittsburgh Institute for Vascular Medicine, the Hemophilia Center of Western Pennsylvania; and the Institute of Transfusion Medicine.
Georgios D. Kitsios received research funding from the National Institutes of Health, the Clinical and Translational Science Institute at the University of Pittsburgh, and Karius, Inc.
Tomeka L. Suber receives research funding from the National Institutes of Health, Burroughs Wellcome Fund and the Samuel and Emma Winters Foundation.