COVID-19: WHERE ARE WE WITH MEDICINES AND VACCINES?

When we looked at the ‘process’ of COVID-19 infection with a business-like eye, it was clear that the principal objective was to reduce new infections to zero or #NearZero.  This is especially given the LongCOVID problem that makes COVID-19 far worse than flu for anyone who becomes infected, be they young or old.

Whilst we can take precautions to avoid transmission, there are three potential preventative measures that would make living with COVID-19 far easier:

• Medicines that reduce chance of LongCOVID and/or hospitalisation, either to prevent contracting the disease or when have initial symptoms
• Medicines in hospital to improve survival rates and recovery times
• Vaccines to provide immunity from COVID-19

Any of these could dramatically change how we deal with COVID-19.  So let’s look at each one in turn.


MEDICINES FOR HOME USE

There is as yet no universal medicine that we can take to avoid catching COVID-19, or help us avoid serious symptoms.

There are many anti-viral medicines, but none for coronaviruses.  The SARS and MERS coronaviruses were extinguished too quickly for medicines or vaccines to be developed.

A new medicine needs to be both effective and ‘safe’.  To get a medicine quickly to those who need it in 2020 means short-cutting drug development by looking at anti-viral and oher medicines that are already in common use, where the level of safety is understood.  ‘Safe’ is that any adverse side-effects are acceptable by comparison to the adverse effects of the disease being treated.

Work is progressing around the world, but as yet no clearly effective and safe medicines.

Hydroxychloroquine and chloroquine

Hope was raised with hydroxychloroquine and chloroquine as a ‘treatment’ for COVID-19, which are used against malaria.  But initial trials in hospitals proved they are ineffective for use there.

Safety was also under question.  When self-administered, and even when prescribed.  In the USA in the first half of 2020 more than 2,441 reports of adverse effects due to these drugs were deemed “serious” because they included outcomes such as hospitalization, disability or death.  Of the 293 deaths, more than half listed COVID-19 as a reason for using the medication.

However, the COPCOV global double-blind clinical trial co-ordinated from Oxford hopes that hydroxychloroquine and/or chloroquine can be useful in a preventative role.  That would be at doses that minimise the risk of serious adverse side-effects.  Early days, but fingers crossed.



MEDICINES FOR HOSPITAL USE

Once someone is sufficiently ill to be taken to hospital, the first objective is to keep them out of the Intensive Care Unit (ICU), and get them back to good enough health to go home.  Once in intensive care, the objective is to get them to survive, but sadly around half who go into ICU have died.

The reasons for going to hospital are many and varied.  Pricipally people will be there because of breathing difficulties.  Others will have issues with damage to one or more organs such as heart, liver, kidneys, digestive system or brain as a result of LongCOVID.  I’m told nearly everyone has COVID-19 has to be put on blood thinners because of micro-clotting.  Otherwise the range of treatments are also many and various.

Nonetheless there is a global search for drugs that will help people in hospital recover.  As for medicines for home use, the focus of formal studies has been on drugs that have proved effective and safe before.

The “RECOVERY” (Randomised Evaluation of COVid-19 thERapY) trial was established as a set of randomised clinical trials to test a range of potential treatments for COVID-19.  Co-ordinated from Oxford, the trials have involved over 11,500 patients enrolled from over 175 NHS hospitals in the UK 

This set of trials has identified that the steroid Dexamethasone, which reduces inflammation, “reduced deaths by one-third in ventilated patients”, and “by one fifth in other patients receiving oxygen only”.

Update 2/9/20: Another steroid, Hydrocortisone, has been found t be as effective as Dexamethasone, potentially saving 8 lives out of 100.

 
Hydroxychloroquine and Chloroquine for use in hospitals

As noted above, Hydroxychloroquine and Chloroquine have been found to be ineffective for hospital use, but may be useful for preventative use in the community.



Remdesivir

The other drug widely mentioned is Remdesivir.  It is hoped that it will reduce the recovery time for hospitalised patients.

This drug was originally developed to treat hepatitis C  and found to have some effect with the SARS and MRS coronaviruses.  However there are significant side-effects and as yet Remdesivir is not fully licensed for treating any disease. 

It has been authorised for emergency use in various countries around the world, but as it has never been in commercial production, supplied are limited.  That includes in the UK.

A trial in the USA has shown a reduced recovery time for patients, and further results are expected from the Oxford RECOVERY trial.

Though an early study between Oxford University and China showed only minimal improvement in recover times.  Again fingers crossed for the current treials.



VACCINES

There are now nearly 200 vaccine initiatives being tracked by the World Health Organisation.

At 25 August.  Two phase 2 lost since 4 August

Update: 2/9/20:This article in the Guardian then discusses each of the leading initiatives.  An early leader was the “Oxford vaccine”, together with the “Imperial vaccine”.  They each use different techniques to construct the vaccine.

Other leaders are Moderna in the USA and Sinovac in China. There’s also a University of Melbourne initiative to use a tuberculosis vaccine to boost the body’s non-specific immune response.

It is clear that no vaccine will be available in 2020 proven effective and safe.  Nor will significant quantities become available for widespread vaccination until well into 2021, if at all.

Update: 12/8/20: Russia has just announced that they are going into production of their vaccine before the safety and effectiveness tests have been carried out.  Though to be fair so is production for the Oxford vaccine.  To be ready as soon as safety and effectiveness is confirmed.  If it is.  There is no guarantee. This article sets out what safety and effectiveness work is required.

UK Government ministers have been talking recently about “if” a vaccine.  There are considerable hurdles to overcome for each initiative, as that article sets out.  Having worked in the biotech industry trialling drugs, I well know that until the last hurdle has been jumped, nothing is guaranteed.  I’ve seen too many promising initiatives fail. The same has happened with other types of vaccines that have shown initial promise.

But as ever, fingers crossed while we focus on the other initiaves we need to do in 2020.

Update 16/8/20: The iNewspaper reports that the UK government has ordered six different vaccines, across four different types, in  the hope that one or more of them work.  These include:

• The 'Oxford vaccine', involving Oxford University, its spinout Vaccitech and AstraZeneca, an adenovirus type of vaccine
• From Belgian pharmaceutical company Janssen, another adenovirus vaccine
• From US biotech company Novavax, a protein adjuvant type

IN CONCLUSION

It is highly unlikely a vaccine will be available in any quantity until well into 2021, if at all. Indeed finding one or more vaccines that are both effective and adequately safe is not guaranteed.

Medicine trials with drugs that have been effective and safe for other viral infections promise quicker results.  In hospitals, Dexamethasone has already been proven to be effective in improvng recovery.  Remdesivir is also looking promising, although with significant adverse side-effects.

At home, there is as yet no treatment to stop infections nor to avoid people developing serious symptoms.  Hydroxychloroquine and Chloroquine have been found to be ineffective in hospitals, and have serious side-effects, especially if not used in accordance with instructions.  It remains to be seen if they will be of help in the home.

We know that the virus behind COVID-19 transmits more easily indoors than it does outdoors.  The concern is that infections will be prone to rise more strongly in winter than summer.  As we shortly enter autumn, it is extremely unlikely that vaccines or medicines will be available in the quantities needed before next spring.

On that basis, we have to assume that we need to prepare for winter and get through it using whatever other measures we have at our disposal.  That is primarily the behavioural measures of:

• Social distancing
• Masks and face coverings
• Washing hands and surfaces
• National or local lockdown as necessary to keep people apart