Hi, this is Dr. Hurst.  In this video, I am going to discuss the most talked about treatments for COVID-19 so far and give an important warning about these promising therapies.

As of today, March 24, 2020, The number of people with COVID-19 in the US is rising exponentially, even in the setting of minimal testing.  Healthcare systems in New York are already under strain, and the rest of the country’s health care systems and providers are doing their best to prepare for what appears to be an unprecedented tidal wave of seriously ill patients.

With all the bad news, it’s understandable why information on potential treatments, even when very preliminary, has attracted a lot of interest.  At no other time can I remember when a 36-patient case-control study was called very promising in a presidential news conference.

Today, there are 125 studies listed on clinicaltrials.gov under COVID-19.  I have seen estimates that at more than 60 different therapies for COVID-19 are being investigated.  Here are a few of the most discussed.

  • Hydroxychloroquine/chloroquine

These are older medications used to treat malaria and other inflammatory conditions, such as rheumatoid arthritis.  These medications have been shown in vitro (meaning in a laboratory setting) to inhibit the SARS-CoV-2 virus, which causes COVID-19.  Early information from China suggests promising results with one paper reporting “that chloroquine phosphate is superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course…”  

Another paper from France followed.  The study was a case-control study of 20 treated patients compared to 16 untreated controls (that were not randomized).   (an antibiotic that has been shown to be active in a laboratory against other viruses such as Ebola and Zika).  

While it would be very fortunate if an older, inexpensive medication were found to be effective against COVID-19, it should be emphasized that the information available so far is very preliminary.  Several studies are ongoing or planned, and we will hopefully have more data in weeks to months.

  • Remdesivir

Remdesivir is an investigational antiviral medication that is being evaluated in several trials to assess its effect on COVID-19.  It is also being used currently in COVID-19 patients on a “compassionate use” basis. Remdesivir was used under compassionate use protocol on the first patient in the US with COVID-19 when he was showing signs of clinical deterioration on the 6th day of hospitalization.  By day 8, he improved, his chest x-ray improved, and he no longer needed oxygen

Remdesivir has been around for some time.  Touted as a treatment for Ebola (although it didn’t perform as well as others in a clinical trial), it has shown to inhibit the SARS-CoV-2 virus in a laboratory setting.

It’s too early to tell if Remdesivir has a role to play in stemming the COVID-19 pandemic, although initial anecdotal reports show promise.

  • Lopinavir/ritonavir

This is a combination antiviral medication that has been used to treat and prevent HIV since 2000.  The first randomized, controlled trial of lopinavir/ritonavir for the treatment of seriously ill patients of COVID-19 was recently published in the New England Journal of Medicine. This trial showed trends towards improved outcomes but did not meet statistical significance.  Further studies will be needed in different populations (for example, as a preventive agent or in less sick patients with COVID-19) to learn if this medication can be useful in COVID-19.

  • Favipiravir

Favipiravir is another antiviral being tested in Japan and China.  This agent recently had a randomized trial released that shows some promise.  In this trial, 240 hospitalized individuals with COVID-19 were randomized to the antiviral medication Favipiravir or another antiviral Arbidol.  The study found that those given Favipiravir had a higher seven day′s clinical recovery rate (71.4% Vs. 55.9%) and more effectively reduced the incidence of fever and cough.  Further studies are ongoing, but media reports from China quote a Chinese official as calling the medication “clearly effective in treatment.”

  • Convalescent serum

A short-term therapy that is already well-established as a technique (it was used during the Spanish Flu in 1918) is using convalescent serum.  Basically, this is taking the blood of recovered COVID-19 patients, separating the antibodies to the virus, and then injecting them into those who are at high risk or have early-stage COVID-19.  This technique has been suggested as an effective strategy to help protect our healthcare workers. While promising, there are no clinical trial data reported on convalescent serum use with COVID-19.

I want to make an important point about these treatments. They are unproven at this point. They should not be taken without a doctor’s supervision, and certainly should not be hoarded. Like all medications, they have potential side effects, and there are already reports of people treated for chloroquine toxicity and in fact, yesterday a man died from chloroquine toxicity. In the interest of your best health and for the rest of us, please don’t pursue any treatments for COVID-19 that are not under a physician’s supervision.

The fight against COVID-19 is just beginning, but we already have many promising leads. Time will tell if any of these can live up to the initial promise, or will there be a new discovery?  Healthcare has an impressive history of rising to the challenge of new health threats. I believe COVID-19 will be no different.

Stay well.

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