We need to know if there any effective treatments for COVID-19

Because we lack testing and our healthcare system is overwhelmed, Americans with suspected COVID-19 are being told to self-treat at home rather than seek care. They are being instructed to take Tylenol for fever, drink plenty of Gatorade to stay hydrated and otherwise not leave their homes. No care packages are provided. Nothing other than palliative medications are typically being prescribed.

Although home is certainly more comfortable than a hospital, one downside of instructing sick Americans to self-care means that the American medical establishment can’t test anti-viral medications, supplements, or other medications on anyone in the beginning stages of the disease, and also can’t figure out how to improve treatment for cases who are not admitted to the hospital, many of whom still become very ill at home.

It means we can’t ask questions like, what causes mild disease to progress into a severe manifestation of COVID-19? What treatments work against COVID-19? When is the best time to administer these treatments, and in what combination?

The last question might be especially critical. Certain antivirals, like Tamiflu—a prescription medication for influenza, are only effective if given in the beginning window of virus infection. What if some antivirals are only effective against COVID-19 in that first asymptomatic yet contagious window? What if a different antiviral is only effective during a different part of the viral replication cycle? These could potentially be given as a cocktail to target the virus. Because they would be given in combination, there would also be an increased chance of evading viral resistance, which might develop to a single antiviral drug alone.

There are a number of antivirals that have shown some promise against COVID-19, including remdesivir and kaletra. When would be the optimal time for these to be given? And to whom should they be administered? Maybe a certain drug wouldn’t make enough of a difference for younger healthier patients, but could keep some high-risk groups out of hospital. Alternatively, maybe the side effect profile of many of these drugs would be too harsh for elderly patients with other underlying conditions but fine for those who are younger and healthier. These studies must be well-designed and systemic to tease apart the answers, and they should also be double-blinded. Our healthcare providers and clinical researchers must be provided all the support necessary to conduct these trials.

So far, the studies that have generated excitement have been too small to form a real basis for clinical care. Take the confusion around chloroquine, for example. Chloroquine is an anti-malarial that’s also been used to treat conditions like lupus and arthritis. However, President Trump touted it as a potential remedy for COVID-19 based on promising results from a very small study, and it immediately gained repute, even leading to hoarding by some with prescription pads. Could be that karma struck against those hoarders, because subsequent studies haven’t shown effectiveness for chloroquine against COVID-19, and some have even shown outcomes to be worse in the chloroquine than control groups. (Chloroquine’s side effect profile doesn’t look fun, either). But the hype still left desperate patients demanding chloroquine.

Another problem is that, right now, because there is not an FDA approved treatment for COVID-19, it is often the sickest patients who are granted ‘compassionate use exemptions’ and allowed to be treated with non-approved agents. This has emotional logic: we want to save the sickest among us, and when they appear to be failing, we want to do everything we can. There is also little risk of an experimental drug making things worse for someone who already seems to be dying. The problem with this approach is that, if you’re testing a drug on people who are already doing poorly, they may have worse outcomes regardless against the less sickly control group. This bias might lead us to throw out potentially useful drugs. Ideally, both groups of the study should be well-balanced in terms of factors like pre-existing conditions, disease progression, gender, and age. Given that no drug against COVID-19 seems to be emerging yet as a silver bullet, it seems time to move on from compassionate use to more clinically rigorous double-blinded trials including those testing potential combinations of therapies.

Right now, basically all we can definitively state regarding the treatment of COVID-19 is that President Trump’s suggestion to inhale or ingest Lysol or bleach is a bad idea. Sunlight is lovely but isn’t going to bring COVID patients back from the brink. Good lord. If we could cure disease by swallowing detergents and basking in sunlight, don’t you think we would have done so, maybe back around the year 1200 BC?  What exactly does Trump think biomedical researchers do all day?

Unfortunately, business and finance guys like Trump are running the country right now. They don’t seem to have a cohesive plan to fight COVID-19, and we need them to step things up, real quick. America needs its national agencies to get the funding and clinical trial infrastructure in place to figure out what (if any) existing treatments work, and how, when, and to whom they should be administered. I think it’s unlikely we’ll find a cure among existing treatments, but if they could decrease hospitalization rates, increase survival, or decrease viral shedding, it could be a huge component of our arsenal in the fight against COVID-19, buying us more time and saving more lives as we continue to work on a vaccine.

We need these answers sooner rather than later.