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Day 115: COVID-19 How Are Treatments Coming?
Ricochet member @dong challenged me to do a post on the status of various treatments for COVID-19. As @bitcoin has said, “I am not a doctor or a virologist, but I play one on Ricochet.” So I accept @dong ‘s challenge welcoming all amendments and corrections by more knowledgeable people in the comments (most of whom undoubtedly are more knowledgeable.)
My reading of the internet is that there are four treatment paths: (1) prevent the body from getting infected, (2) attack the virus directly, (3) attack the virus indirectly, or (4) keep the body from killing itself in response to detecting the viral infection. In addition to these strategies, there are a variety of supportive therapies that are employed depending upon which organ(s) the virus is attacking. Of important note, full-intubation high-pressure ventilators may be doing more harm than good.
So let’s talk about each of the paths:
Preventing the body from getting infected
This is the vaccine approach. Making you immune from the virus itself. Totally aside from the fact that no vaccine has ever successfully been developed for any coronavirus, there are several trying to do it:
Moderna
- Vaccine: mRNA
- Development: Phase 1 trial near complete, phase 2 trial set to start
Johnson & Johnson
- Vaccine: Modified adenovirus
- Development: Preclinical
Inovio Pharmaceutical
- Vaccine: INO-4800
- Development: Phase 1 trials
Oxford University
- Vaccine: ChAdOx1 nCoV-19
- Development: Phase 1 trials
Pfizer
- Vaccine: BNT162
- Development: Clinical trials
Sanofi and GSK
- Vaccine: Unnamed
- Development: Preclinical
Novavax
- Vaccine: NVX-CoV2373
- Development: Preclinical
Just the sheer number of organizations in the hunt should give us some hope, but it is important to understand as you read the details of each of the vaccine plans that they are not all pursuing the same design. This is not a contest for how to get a piston engine producing the most revolutions per minute. This is designing a whole new engine with potentially different energy sources and means of converting one form of energy (heat) into another form (mechanical).
Attacking the virus directly
Remdesivir (Gilead Sciences)
Originally developed for Ebola, Remdesivir attacks the virus’s capability of replicating. Clinical data shows that it may shorten the recovery time but is not demonstrated to have saved anyone from dying. Remdesivir was granted FDA approval on May 1 for emergency use, but there are still several ongoing clinical trials testing whether it’s effective.
This was initially developed to treat influenza but is being clinically trialed against COVID-19 in China, Italy, and the United Kingdom. Trials are slated to begin in Massachusetts as well. It attacks the virus by forcing mutations as it replicates neutralizing the viral effect in the body. It may be this mutation-inducing aspect that makes it not for use in pregnant women.
Attacking the virus indirectly
In addition, there are two different blood therapies: convalescent plasma and healthy donor plasma. Convalescent plasma involves extracting blood plasma from recovered COVID-19 patients and infusing that plasma into active COVID-19 patients. Healthy donor plasma recently tried in Lexington, KY, has also had good clinical results. The significance of the latter is that it may be that there is a large source of life-saving substances available that are not dependent on China or a limited population of COVID-19 survivors.
Keeping the body from killing itself
Hydroxychloroquine (HCQ)
A generic malarial drug also used for treating lupus and rheumatoid arthritis. Treating COVID-19 is an “off label” application of the drug. It suppresses the body’s response to infection which in many cases is how COVID-19 kills you. Clinicians worldwide are reporting good results with HCQ in combination with zinc and azithromycin. But the drug’s effectiveness in treating COVID-19 has not been determined through traditional double-blind studies. And some worries exist that at least in some patients with heart disease, the side effects can be fatal. Its most likely success is when given early after systems present and not when someone has progressed to intensive care.
Kevzara (Regeneron and Sanofi)
Baricitinib (Eli Lilly)
Kevzara and Baricitinib are drugs currently used to treat rheumatoid arthritis. Their strategy is suppressing the body’s immune response. Clinical trials will be starting soon. In contrast to HCQ, these manufacturers see their drugs as potentially effective for patients who have progressed to intensive care.
This is the landscape at the moment. No doubt more news is to come.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
Nice summary, Rodin. As a former virologist I could add quite a bit here, but I don’t have enough time.
However, there is one development that’s not getting anywhere near enough reporting: a Chinese company has developed and starting testing a SARS-CoV vaccine based on the exact same principle and manufacturing process as the Salk polio vaccine. They’ve already tested the vaccine in monkeys (which is a fairly big deal and more than most competitors have done), and the monkeys are 100% protected with no side effects, including antibody-dependent enhancement.
Several reasons why this is important. First, the Salk vaccine is a proven technology that we know can work. None of the other first-tier candidates have ever been proven to work for any infectious disease. In fact, many of them have been in development for decades and failed (even multiple times) in other settings.
Second, the Salk vaccine is one of the best-known vaccines in the world, so we can be quite certain of its safety (both the vaccine itself and the manufacturing process) without exhaustive testing. Finally, millions of doses of Salk vaccine are still produced every year. Those facilities could be very rapidly retooled to produce the SARS-CoV-2 vaccine, as the process would be nearly identical, and humanity would definitely survive one year of slightly fewer polio vaccinations. Since all of the other vaccines have never left the experimental phase, there are no large-scale production facilities for any of them, nor have their manufacturing methods been validated by the FDA. In summary, a Salk-like vaccine could probably reach the level of 100 million doses 6 months to 1 year faster than these experimental vaccines.
The problem is that “Big Vaccine” is no longer interested in 1950s technology. This includes both the Western pharmaceutical industry as well as major NGOs (and Bill Gates) and the WHO. Big Pharma can’t make much money off this, and Gates and the NGO jet set crowd don’t find it sexy enough (no joke). It’s true that most vaccines produced by a Salk-style vaccine are somewhat less potent than those using more modern technologies. But even a somewhat weak vaccine could probably do wonders, since transmission of the virus doesn’t appear to be as aggressive as originally believed.
In summary, it’s ridiculous that mainstream science is poo-pooing a tried-and-true method that a) has been proven for decades, b) is very reliable, and c) could be ramped up months or years more quickly. And it’s embarrassing that the Chinese did it first. In my opinion, US-based rhesus macaque laboratories should be repeating these experiments right now to confirm the Chinese research. If the results prove reproducible, let’s beat the Chinese at their own game by confiscating their intellectual property to manufacture the virus ourselves.
Link to the study: https://science.sciencemag.org/content/early/2020/05/06/science.abc1932
Heres a treatment protocol from Eastern Virginia Medical School.
Early on it appears HCQ may be effective. The theory is it blocks viral replication if used early. As the disease progresses it , and other antivirals loose efficacy. Then treatment shifts to treating the cytokine storm and subsequent microvascular inflammation and clotting disorder.
Summary of EVMS Treatment Protocol.
Link to the entire EVMS Treatment Protocol
Aren’t safe and effective vaccines the most difficult and time-consuming, albeit absolute (relatively speaking) solutions? While we are waiting the several years, if at all, for a vaccine, which of the treatments are the most effective? Whatever happened with the hydroxychloroquine studies?
There are several short talks and a discussion of vaccines and therapeutics in this UCSF Grand Rounds video from a week ago:
I cued it at the relevant spot, but there’s interesting stuff before that as well, just not as on point.
Note the mention of HCQ studies as being dropped in favor of therapeutics with similar mechanisms, due to the know heart damage risk.
@mendel ‘s info about a Salk approach is very interesting.
I am confused about the known heart damage risk of Hydroxy… Hasn’t the drug been used extensively for 6 or 7 decades? Is the heart damage risk higher because it is “off-label” ?
The formal studies are still under way. Clinical anecdotes for success were referenced in the OP. An “observational study” was published in the JAMA Open Network that discounted the efficacy of the treatment, but
There are also critics of this observational study that think it was just way too convenient to publicize criticism of a therapy that President Trump was telling people about.
Early on it appears HCQ may be effective. The theory is it blocks viral replication if used early. As the disease progresses it , and other antivirals loose efficacy.
If the Viral load has progressed too far HCQ will lose it’s effectiveness. But if used in the early stages it has been proven worldwide to be very effective. HCQ has been used since 1955 and has been used by millions. It is safe. That said HCQ should be used with AZITHROMYCIN only in those patients without heart issues. Doctors have used HCQ with Zinc with good success for those patients with heart issues. The Dr Fauci/Big Pharma/Big Media Cabal has effectively promulgated the lie that HCQ is dangerous when at this time it is far and away the best remedy out there in the early stages against the virus. It’s use has saved thousands of lives.
Remdesivir attacks the virus’ capability of replicating. Clinical data shows that it may shorten the recovery time but is not demonstrated to have saved anyone from dying. Remdesivir was granted FDA approval on May 1 for emergency use-
The phrase “is not demonstrated to have saved anyone from dying” should be repeated load and clear, over and over. Remdesirvir has not been shown to save lives and the study used for it’s approval was abruptly corruptly reconfigured midstream to show at least some effectiveness in reducing symptoms but it was shown that Remdesirvir was failing to save lives, so why has the FDA granted it approval for emergency use and not HCQ? This fact shows the blatant corruption of Fauci ,the FDA and the NIH. Remdesirvir so far has not been shown to work.
The heart risk is not because it is “off-label.” If you have a patient with both lupus and arrhythmia or rheumatoid arthritis and arrhythmia the treating physician would be monitoring the use of HCQ closely or not prescribing it. The potential heart issues is a known side effect and have to be weighed by the physician when considering the health history of the specific patient. That does not make HCQ a bad therapy. It just means that the potential side effect has to be considered in deciding a course of therapy. That is true for all drugs.
I am still confused about how after 8 weeks of HCQ talk in the news and 1,000,000+ patients, that we still don’t have definitive data on treatments. I appreciate the EVMS protocol and I suspect many locales have developed something similar, despite not having good studies on HCQ and other treatments. I can’t help but think that some powerful entity is stopping the research at the national level.
I find it interesting that EVMS recommends Vitamin-D. I came across another study about Vitamin-D and Covid19 out of Ireland. Every state should require every nursing home to begin prophylactic vitamin-D/C/Zinc supplements. Every nursing home should do it without a government telling them to. Every nursing home resident should get a care package from their family today. This is from the study:
This is a situation, where knowledgeable people are ahead of the experts. @ronin thank you for the informative summary.
The HCQ topic still remains an absolute dumpster fire.
The side effects of HCQ alone appear to be mostly overblown. In the studies that claim to show HCQ toxicity, it is usually because a) the treatment was not randomly assigned, meaning the patients who get HCQ tend to be sicker and were already predestined to have worse outcomes, b) it was given at very high doses, or c) it was given in combination with azithromycin. That last factor does seem to be problematic.
Every single study on the benefits of HCQ so far has had major methodological flaws. Without exception (I’ve read almost all of them). This includes both studies purporting to show benefit, and studies purporting to show no benefit.
There are ongoing randomized clinical trials that administer the drug in different settings/time points/patients that have yet to report their results. Hopefully these will be forthcoming.
Also, the “lupus patients taking HCQ for years don’t get severe disease” claim seems to have been clearly refuted.
All in all, we still don’t know much more about this topic than we did a month ago. Frustrating.
Anyone who has ever listened to an advertisement for any medication, even aspirin, on TV is well aware that ALL drugs can have negative side effects. A person with any number of immune compromising issues must always be careful of the medications they take under any circumstance. I was surprised to hear a week or so ago about this new and now, newly approved drug called Remdesirvir. It seems to have popped up out of nowhere. I have seen no actual results, even anecdotal, mentioned. Yet with the Chloroquine medication, it seems that thousands of anecdotal success stories have been documented and I have heard of very minimal if any, negative reactions. It is cheap and completely and thoroughly observed. What am I missing?
You’re not missing anything. It’s the fact that those success stories are anecdotal. Anecdotal stories are very good to know but don’t provide enough confidence that the result isn’t a fluke. And that is doubly the case for an infection that the vast majority of patients will survive just fine without any treatment at all.
So statistically speaking, it would not be unusual for a single clinic that sees only 25 Covid patients to have only a small number if not no severe cases or deaths at all. Now that same clinic decides to test their bright new therapeutic idea on some or all of their patients. And what do they see? 100% success!
Does that mean the drug worked, or were they just fooled by randomness? There’s no way to know without large-scale, uniform trials. And those trials take time.
Thank you @mendel. Yes, this is very frustrating for me as well. I am trying to avoid theories, but it is difficult to not notice the negative effect of Trump saying, “What have you got to lose?” on the perception of this drug. I hear people talk about it with such venom and disdain that it feels like it is poison.
Those of us who have been vax injured or who have family members who suffered that fate, are never going to take a vax for this. Given that it will be RNA based, and will also, as Fauci has bragged, need to have nano bot technology to somehow ensure that it is effective, I do not consent to being a guinea pig.
If hydroxycloroquine was an item that Bill Gates held the patent to, and if it cost at least 1100 bucks per treatment, rather than the 20 bucks a month it now costs, it would already be mandated. As it is, its use has been suppressed.
Also Bill Gates and/or his proxies in New York are now doing the research and studies. This would have been a major conflict of interest, such that had this been happening 60 years ago,e very other critter in Congress would have been screaming about the inappropriateness of having this billionaire being in charge of the HCQ research.
Here are two different takes on Zev Zelenko and his use of hydroxychloroquine:
https://www.nytimes.com/2020/04/02/technology/doctor-zelenko-coronavirus-drugs.html
How Zev went from a country doctor to a man who had the President’s attention:
By Kevin Roose and Matthew Rosenberg
April 2, 2020
Last month, residents of Kiryas Joel, a New York village of 35,000 Hasidic Jews roughly an hour’s drive from Manhattan, began hearing about a promising treatment for the coronavirus that had been rippling through their community.
The source was Dr. Vladimir Zelenko, 46, a mild-mannered family doctor with offices near the village. Since early March, his clinics had treated people with coronavirus-like symptoms, and he had developed an experimental treatment consisting of an antimalarial medication called hydroxychloroquine, the antibiotic azithromycin and zinc sulfate.
Full article at link above.
Here is another article on how the simple inexpensive cocktail brought forward by Zev Zelenko has helped his patients:
https://www.vanguardngr.com/2020/03/coronavirus-new-york-doctor-successfully-treats-patients-with-drug-cocktail/
Hillary Clinton killed off the vaccine”industry” by taking over the vaccine production.
https://nypost.com/2015/10/18/hillarys-vaccine-price-plan-didnt-work-the-first-time-for-a-reason/
The WSJ story is behind a pay wall.
As first lady and in charge of the Bill Clinton administration’s health-care reform effort, Hillary accused “greedy” drug companies of exorbitant price increases for vaccines. In 1993, she first proposed nationalizing the vaccine industry. She settled for a Vaccines for Children Program that saw the federal government buy up over half of all available vaccines at government-set prices.
The result? Companies stopped producing and investing in vaccines. The United States started experiencing vaccine shortages.
In 1994, the Health Security Act called for the federal government to deny coverage for Medicare patients using drugs deemed “excessively priced” by a public commission. Under the Clinton plan, physicians or pharmacists had to obtain prior approval from the government before prescribing or dispensing to Medicare patients a drug deemed not cost-effective.
Back then, Hillary’s advisers — doctors pretending to be economists — told biotech startups to focus on big targets like heart attacks instead of on rare illnesses like cystic fibrosis and
Gaucher’s disease. You see, these “experts” were confident that the government and insurers could come up with “reasonable” prices for new medicines and determine which ones were really necessary.
The biotechnology industry took years to recover.
Thank you, Hillary.
The first week of March my wife and I returned from a few weeks in Mexico. The scare was beginning to take hold. I heard Ingraham discuss Hydroxy… on her show. I was able to get a dose for my wife and myself, just in case. The two doses together cost me $1.50 out of pocket. A dose means to me 14 pills, four the first day and two each day for five days thereafter.
How true, and on both sides. I find it very frustrating, as well.
Personally, I encounter more people who are insistent that HCQ has been proven effective, and seem impervious to evidence that this is not the case. I occasionally see reports of people who insist that HCQ cannot possibly be effective, apparently because if it was, they would have to admit that the President was right about something.
Thanks for your update, frustrating as it is to have no answer to this question.
It doesn’t cause heart damage.
It causes “QT prolongation”. It affects the way the heart muscle repolarizes after a beat. It takes longer to do so.
This allows the possibility of developing a sudden cardiac arrhythmia called Torsades de Pointe, a form of ventricular tachycardia that can be fatal. A lot of drugs can do this. It’s also something that is cumulative, the more QT prolonging drugs you take the, the more at risk you are. The risk is small, but real. What I have not been able to determine is “how small”? One in a thousand? One in a million?
The problem has been recognized in Rheumatologic patients who have been taking HCQ for long periods of time, it just has not had a major study. My best guess is that it’s a minor if real risk.
Here’s a study looking at this from a Rheumatology journal.
Personally, if I need to take it, or prescribe it, the answer is to monitor the EKG on a daily basis for changes.
Without the professional detail that you, @kozak , infused into your answer, I had read and been told by my own Doctor about the known side effect you described. Thanks for the deeper explanation. If you contracted this disease, would you take Hydroxy…?
Re: Therapeutics
So-called high dose vitamin C is being trialed in China and is in use in NYC area hospitals, where 1600 mg 3-4 times/d is given. This dosage has been found safe in Phase I trials in adjunctive regimens in sepsis though much higher doses are used by some doctors. There are numerous case/anecdodal reports are using doses at least 25 times higher with few problems other than easily managed hypoglycemia. See also the “well tolerated” doses mentioned below for burns:
Dr. Zelenko is working on a publication describing his work with HCQ; he said that he is trying to make it absolutely “bulletproof.” Here’s a recent interview. It is clearly not a good treatment for advanced disease, though many medical personnel in the COVID trenches are reportedly taking it prophylactically and/or keep it on hand for possible therapeutic need for themselves and their families.
I’m hearing that the body temperature tracking feature of the Oura ring is an early warning sign of an infection brewing, though that obviously isn’t pathognomonic for SARS-CoV-2. A study involving 30,000 ring bearers is underway; more specific patterns might emerge. Or not.
Hydrogen (the gas, not hydrogen peroxide) is also being investigated.
What about the other polio vaccine?
Well, you may want to read the recommendations of the doctor who helped convince the Shanghai, China government to make it an official recommendation. 1,600 mg twice a day? I’ve taken 25 grams (25,000 mg) in a mixed IV and consumed it in one hour less than 4 weeks ago. Much to the chagrin of many, I’m still alive here to talk about it. That dose was low because of shortages. I actually wanted 50 grams.
fixed typo in link
FDA approved in 1955
Chloroquine Is a Zinc Ionophore
Layman’s summary: It opens up a dedicated channel for zinc into the cell. This is much more difficult to achieve under normal conditions, hence the elevated zinc consumption protocol of roughly 200 mg for up to 5 days.
the combination of zine and chloroquine induces apoptosis in a human cancer cell model system?
zinc + chloroquine = kill cancer cells?
That’s the claim. I’m more familiar with Vitamin C being used as adjunctive therapy in that model (the Riordan Clinic uses it as a mainstay) both with and without Ozone preceding it and glutathione as an additional ingredient along with Magnesium Chloride so I don’t know how you sequence this on an actual patient under continuing long term care. The more important thing I wanted to highlight was the well known mechanism that its proven under imaging that it opens up a dedicated zinc channel. That’s no small accomplishment, and the channel is well documented.
The challenge under cancer care is not inducing such a toxin release that you overwhelm the patient in a single treatment but manage the cancer cell kill and what it releases (I’m thinking of iron) properly.
Yes, but probably not in a way relevant to virus treatment.
However, in a study that