Researchers have worked hard to identify and remedy to combat the new coronavirus that causes COVID-19.
Although there are still no definitive answers, the Food and Drug Administration recently legalized the emergency use of so-called convalescent blood plasma, an antibody-rich fluid donated through others who have survived an earlier infection with COVID-19. Authorization of Use (USA) will make it less difficult for physicians to donate plasma to patients with COVID-19 as a component of hospital treatment.
But some experts, adding to the New York Times, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), recently said more evidence was still needed to determine whether plasma is a safe and effective remedy and that the examination of the knowledge used to justify authorization was not solid enough.
“While knowledge to date shows some positive signs that convalescent plasma would possibly be useful in the remedy of others with COVID-19, especially if administered at the beginning of the disease, we lack the knowledge of randomized controlled trials that we want to improve perceive its usefulness in the COVID-19 remedy,” said Thomas FileArray, president of the Society of Infectious Diseases of America (IDSA) , in a statement.
This was not the first time that the evolving data on COVID-19 had provoked confusion and conflicting views.
In March, for example, the FDA legalized the emergency use of hydroxychloroquine and chloroquine antimalarial drugs, “perhaps out of desperation,” says Paul Goepfert, professor of medicine and microbiology and director of the Alabama Vaccine Research Clinic at the University of Alabama. Birmingham. Three months later, as studies indicated “known misdeeds and no evidence of benefits,” according to the American College of Physicians, this USA was revoked.
Researchers around the world continue to explore a number of other imaginable remedies, ranging from dexamethasone (a reasonable and widespread steroid) to repopulation (an expensive experimental antiviral). IDSA has published rules describing remedies that deserve to be proven as possible remedies for this new disease that many doctors still seek to understand.
“We inform ourselves much faster, much more than with any other virus,” Goepfert says.
But more rigorous studies will be needed before scientists perceive what will work best. Initially promising medications can be harmful or ineffective. Hundreds of trials are still ongoing, with thousands of patients in the United States and around the world.
Here’s a look at what we know so far about the COVID-19 remedy.
Most other people who get COVID-19 may receive treatment at home and begin to feel better after about a week, however, about one-fifth of patients delight in worsening symptoms, such as shortness of breath, according to the Centers for Disease Control and Prevention. It is other people with these more severe cases who may want to be treated in the hospital.
Hospital care is designed for patients when their bodies fight the virus, Goepfert said, which includes additional oxygen to help others breathe, intravenous fluids if they are dehydrated, and antibiotics to treat secondary bacterial infections, such as pneumonia. By being able to get enough in your bloodstream, doctors can place them on a respirator to help them breathe while their body fights the infection.
This experimental therapy, called convalescence plasma, collects blood plasma from others who have had COVID-19 and injects it into others battering the disease. health benefits more temporarily or can save the disease in high-risk people, such as frontline medical staff and those living with a COVID-19 patient.
The venerable remedy, dating back to the last 19th century, is a “great idea,” says Gregory Poland, an infectious disease expert and director of the organization of vaccine studies at the Mayo Clinic in Rochester, Minnesota. Therefore, there is an explanation as to why this would possibly be useful».
The first knowledge of promising Chinese studies. A national initiative to research treatment is still looking for plasma donors in the United States (read more on how to help). And in April, the FDA expanded the use of convalescent plasma to make it available to some patients with serious illnesses. outdoor disease from clinical trials.
Then, in August, the firm legalized convalescence plasma for emergency use. Some researchers, adding Frank Harrell, a professor of biostatistics at Vanderbilt University School of Medicine in Nashville, Tennessee, expressed fear that the benefits of plasma would be exaggerated when the U. S. announced Authorization was largely based on knowledge collected from 35,322 plasma patients under the FDA’s Expanded Access Program.
A Mayo Clinic test that analyzed this data, which has not yet been peer-reviewed, found that patients who gained plasma with higher antibody levels were more likely to do so than patients who gained plasma with low antibody levels. plasma within the first 3 days of diagnosis had better results than patients who obtained plasma on or after the fourth day after diagnosis.
All the evidence implies that plasma is safe, but it’s still not enough to say that we know plasma works, says Shmuel Shoham, associate professor of medicine and associate director of Johns University’s Center for Infectious Transplant Diseases and Oncology. Baltimore Medical School.
“What we don’t have are randomized essays aimed at, which are the popular gold to take home,” he says. These trials involve an organization that does not obtain plasma treatment, which the Mayo Clinic did not include (Shoham, who is a member of IDSA, is involved in two randomized LED plasma trials that are still looking to recruit patients).
Even if additional knowledge recommends that convalescence plasma is effective, it is not yet a cure or even an evolutionary remedy; it’s just a measure of transitoryness,” Poland says. The immunity granted regularly lasts only a few weeks. And because a patient’s plasma only treats two or three others, it’s not practical for widespread use. “As a crowdsourcing product, there may be problems of origin,” Shoham says.
The National Institutes of Health are coordinating studies on how a more scalable remedy can be made from plasma, but the availability of such a product would still be a long way off.
Beyond supportive care such as oxygen, researchers are reading several treatments in addition to convalescence plasma that can simply relieve symptoms and, in all likelihood, avoid life-threatening complications. “Lately we have no known remedy to kill the virus or minimize its growth,” Says Goepfert. .
And with doctors controlling multiple medications in critically ill patients, when other people recover, it’s hard to know what’s helped, if any, or if a drug has caused harm. That’s why clinical trials are so important, goepfert says.
Here are some of the treatments researchers are studying lately.
Initial evidence of human experiments with the virus was mixed. In the end, larger trials warned that potential adverse effects would possibly outweigh the potential benefits. “This drug may not be effective in treating COVID-19,” the FDA concluded on June 15. (PDF) by revoking your emergency use authorization.
What you have to remember, goepfert says, is that “none of those drugs are harmless. “Hydroxychloroquine and azithromycin can cause abnormal and harmful heartbeats, and medications can be more harmful when given together.
First, intravenous antiviral gave the impression of helping to reduce the severity of COVID-19 in a Gilead-sponsored study of 53 hospitalized patients, but the study was small and did not directly compare those who won the drug with those who did. No.
Results from a NIAID trial of 1,063 patients, published May 22 in the New England Journal of Medicine, found that other people hospitalized with COVID-19 who gained the remedivir recovered enough to be discharged or resume activities. general in 11 days, to 15 days in those cases a placebo won.
Fauci, discussing the effects on April 29, said the mortality rate in the study, of 8% for other people taking re-ivir compared to 11% for other people taking placebo, “tended to be better” but not statistically important. “Knowledge wants to be further analyzed,” he said.
A study published in The Lancet on the same day the effects of NIAID were announced had other effects: it found that of 237 patients with severe COVID-19, those who gained reinfection did not remove the virus more temporarily or faster than those receiving placebo. Researchers wrote that they expected additional trials with remdesivir to “confirm or refute” its effects.
Gilead also sponsors studies to see if a shorter remdesivir remedy (five days instead of 10) takes effect.
In addition, studies on remdesivir are being conducted in others with milder symptoms. Like antiviral drugs used against influenza (such as Tamiflu), remdesivir may be more effective if given within a time after patients have developed the first symptoms, Goepfert explains.
A clinical trial involving thousands of patients, published on July 17 in the New England Journal of Medicine, found that a 10-day dexamethasone remedy particularly reduced death in patients with fans or oxygen. There was no evidence of gaining advantages in patients who were not. ventilated or oxygenated, and the study did not read about un hospitalized patients.
Based largely on this trial, IDSA rules propose steroids such as dexamethasone for patients hospitalized with severe COVID-19, but warn against their use in patients who do not require more oxygen, warning that they would possibly cause harm.
“Compared to other medicines we’ve been aware of so far, [dexamethasone] seems to have the greatest effect on patients, especially those who are seriously ill,” says Krutika Kuppalli, a doctor of infectious diseases in the Bay Region. However, he adds, doctors want more knowledge to better perceive possible side effects and long-term results, especially since previous experiments with other steroids to treat COVID-19 have had variable results.
The most promising way to return to pre-pandemic life is to vaccinate others from the virus that causes COVID-19, and researchers have made unprecedented progress toward immediate vaccine progression.
As of August 25, more than two dozen human vaccines were tested in clinical trials and more than 135 more were in the early stages of development, according to research by the New York Times.
“It’s vital to have a variety of approaches because it’s an absolutely new pathogen and we still don’t know what’s going to work,” says Ruth Karron, director of the Immunization Research Center at Johns Hopkins Bloomberg School of Public Health.
If all goes well, researchers could have at least one edition of the vaccine, if not more, in a position in the spring of 2021, according to Karron, or perhaps earlier. To put this in context, she says, “Historically, the progression of the vaccine has taken 10 or 20 years. “
However, even after a vaccine has undergone all the mandatory tests to make it effective, it still takes time to increase overall supply, he says. “At that moment we will know more about the teams in danger and who we are. “they want to prioritize to get the vaccine. “
Like the flu vaccine, a COVID-19 vaccine must provide comprehensive coverage against the virus.
“The genuine purpose is to protect yourself from serious illness,” Karron says, so even if he’s infected, he’s more likely to have a mild case and serious complications, such as pneumonia.
—Additional report via Lauren F. Friedman and Kevin Loria.
Teresa Carr is an award-winning journalist with a background in both science and writing, making her curious about how the world works and willing to tell you about it. She is a former Consumer Reports Editor-in-Chief and a Knight Science Journalism 2018 Fellow at from MIT and has more than two decades of experience in science, fitness, and customer reporting.