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If Priscila Medina had gotten COVID-19 a year ago, she would not have shown any safe and effective treatment. But when the 30-year-old nurse arrived at Long Island Hospital last month, with so little breathing that she could barely speak, the doctors knew what to do.
They quickly arranged for me to get a new drug that provides antivirus antibodies and “the next day I was able to get up and move,” he said. Two days later, “I started turning the corner. I was showering, eating, playing with my son.”
Treatments like these can help newly diagnosed patients avoid hospital admission, but they are severely underused because they require an IV. Other medications for patients with disease can speed recovery, but only a few improve survival.
While vaccines help curb the pandemic, easier and better treatments are needed, especially as virus variants spread.
“There are more and more young people who have serious problems … serious illnesses that require hospitalization and even tragic deaths,” Dr. Anthony Fauci, a leading expert on infectious diseases from the United States government, at the National Press Club.
The biggest need is a convenient medicine, such as a pill “that can prevent people with symptoms from getting worse and need hospitalization,” he said.
Here’s a look at what’s on the horizon and the options available now.
A pill on the way?
Developing drugs for respiratory diseases is difficult, in part because the doses need to be high enough for the drug to reach the lungs, but not so high that it is toxic.
Treatment research was also slower because the U.S. government initially gave priority to vaccines. It was not until the end of April 2020 that the first treatment with COVID-19 showed benefits in a large government-sponsored study.
This drug – remdesivir, sold as Veklury by Gilead Sciences Inc. – remains the only one approved by COVID-19 in the US, although some others, such as the one Medina received, are authorized for emergency use.
Remdesivir is also the only antiviral drug COVID-19, which interferes with the reproduction of the virus, and “we really need a lot more,” said Dr. Francis Collins, director of the National Institutes of Health, at a recent seminar.
Several companies, including Pfizer, Roche and AstraZeneca, are testing antivirals in pill form. The furthest is molnupiravir, from Merck and Ridgeback Biotherapeutics. It doesn’t seem to help inpatients, but it proves to be promising in the less ill, and a comprehensive study is expected to yield results this fall, the companies said.
If extinguished, it could be taken at home when symptoms appear, similar to how antiviral medications work. grip are used now. The NIH is also looking for a home use option in a study that tests up to seven medications that are already used for other diseases.
Vaccines are even being tested as treatments. Some people with “long COVID” said their persistent symptoms improved after vaccination.
Options for outpatients
There is now an option: antibody drugs, which can reduce the chances of having to be hospitalized by 70% if given within 10 days of the onset of symptoms. Eli Lilly and Regeneron Pharmaceuticals are authorized to provide their treatments to patients at high risk for serious illness and the U.S. government provides them for free, although there is sometimes a fee for IV.
The immune system makes antibodies to fight the virus, but it takes weeks after infection for them to form. Medications come with lab versions that can help you right away. Combinations of antibodies are now used because some virus variants can bypass them on their own.
Demand for these drugs has been surprisingly low: many patients are unaware of them, initially doctors and hospitals were not prepared to administer them and IVs are not convenient, although Regeneron has also tried treatment as a trait.
“This is a really life-saving therapy. We think it has a great opportunity to use it more,” said Dr. Donald Yealy, chief of emergency medicine at the University of Pittsburgh Medical Center.
“You don’t have to be really sick” to get it and many patients doubt it because they believe they will recover without it, but they will suddenly get worse, ”he said.
It happened to Medina, a part-time nurse at the Long Island Jewish Medical Center in New York.
“When I thought it would get better, things started to get worse,” he said. “I was very scared. I felt very short of breath. I could barely speak.”
His hospital arranged for him to have antibody treatment at the university hospital near North Shore, which had a medical store with intravenous stations to care for many people at once, and he recovered at home.
The severity of the symptoms determines the choices and important issues: certain medications can save lives at one time and harmful at another.
Remdesivir is used in patients who need extra oxygen but not respiratory machines. In the studies, the time to recovery was reduced by 5 days on average, from 15 to 10. But it has not been shown to improve survival, so a panel of World Health Organization guidelines opposes the use of the precious medicine.
The only drugs that increase survival are dexamethasone and similar steroids for patients sick enough to need additional oxygen and intensive care. If used before, when patients are only slightly ill, they can hurt.
“In the beginning, you want the immune system to fight the virus,” so the treatment aims to help make that happen, Fauci explained. As the disease progresses, the immune system can become hyperactive and people can die from it. A number of drugs that influence inflammation and other immune responses are being tried for this later stage of the disease.
The NIH says full doses of blood thinners, such as heparin it can help people who are moderately ill to avoid breathing machines or other organ supports. Almost all hospitalized COVID-19 patients receive low doses now to prevent blood clots. Research suggests that higher doses may help people who are not yet seriously ill, but may harm very sick people.
Now doctors know that some things don’t work, including the malaria hydroxychloroquine drug. This can be as important as knowing what to try, said Dr. Adarsh Bhimraj of the Cleveland Clinic, which helps develop treatment guidelines for the Infectious Diseases Society of America.
“We still have misinformation about COVID-19 therapies” that misleads both patients and doctors, he said.
Dr. Rajesh Gandhi, a Massachusetts General Hospital doctor who also helps with the guidelines, said “tremendous scientific progress” has been made in a year. Doctors no longer need to take “a kitchen sink approach,” trying many things in the hopes that someone will help, he said.
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.