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.

Favipiravir

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

Eli Lilly, AstraZeneca and Regeneron, among other companies, are working on so-called antibody treatments, which are made to act like immune cells and may provide protection after exposure to the virus. Earlier this month, Regeneron said its treatment could be available for use by the end of this summer or fall.

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.]