New treatments target different stages of COVID-19, even before patients get sick enough to need a hospital. Juan Monino via Getty Images
A year ago, when US health authorities issued their first warning that COVID-19 would cause serious “disruptions in everyday life,” doctors had no effective treatments to offer beyond supportive care.
There is no cure yet, but thanks to an unprecedented global research effort, various treatments are helping patients survive COVID-19 and stay out of the hospital entirely.
COVID-19 treatments target two general problems: the ability of the coronavirus to spread through the body, and the damage caused by the body’s immune system response. When the virus enters the body, it takes over cells and uses them to replicate. In response, the body sends inflammatory signals and immune cells to fight the virus. In some patients, that inflammatory response can continue even after the virus is under control, leading to damage to the lungs and other organs.
The best tool is prevention, including the use of masks and vaccines. Vaccines train the immune system to fight off attackers. With less risk of uncontrolled infection, they can reduce the risk of death from COVID-19 to almost zero. But vaccine supplies are limited, even with a third vaccine now licensed for use in the US, so treatments for infected patients remain crucial.
As physicians working with COVID-19 patients, we have been following drug trials and success stories. Here are six treatments that are commonly used today for COVID-19. As you will see, time matters.
Treatments that can keep you out of the hospital.
Two promising types of treatments involve injecting antiviral antibodies into high-risk COVID-19 patients before the person becomes seriously ill.
Our bodies naturally create antibodies to recognize foreign invaders and help fight them. But the production of natural antibodies takes several days, and SARS-CoV-2, the coronavirus that causes COVID-19, replicates rapidly. Studies show that injecting patients with antibodies soon after symptoms begin can help protect against serious infections.
Monoclonal antibodies: These laboratory-engineered antibodies can bind to SARS-CoV-2 and prevent the virus from entering and infecting cells. They include Bamlanivimab and the combination therapy casirivimab / imdevimab developed by Regeneron. The US Food and Drug Administration granted emergency use authorization for these therapies because they have been found to protect high-risk patients from hospitalization and death. However, once patients are sick enough to need hospitalization, studies have found no proven benefit from them.
Convalescent plasma: Another way of administering antibodies involves drawing blood from patients who have recovered from COVID-19. Convalescent plasma is administered primarily in research settings because the clinical evidence so far is mixed. Some trials show benefits early in the disease. Other studies have shown no benefit in hospitalized patients.
Convalescent plasma may have a role as an adjunct therapy for some patients due to the growing threat of mutated variants of SARS-CoV-2, which can evade monoclonal antibody therapy. However, careful research is necessary.
Once patients get so sick they have to be hospitalized, treatments change.
Most hospitalized patients have shortness of breath and low oxygen levels. Lack of oxygen occurs when the virus and the corresponding immune response injure the lungs, causing inflammation of the pulmonary alveoli that restrict the amount of oxygen entering the blood. Hospitalized COVID-19 patients generally need supplemental medical oxygen to help them breathe. Doctors usually treat patients on oxygen with the antiviral agent remdesivir and anti-inflammatory corticosteroids.
Remdesivir: Remdesivir, originally designed to treat hepatitis C, prevents the coronavirus from replicating by interfering with its genetic components. It has been shown to shorten the length of hospital stays and may be prescribed by doctors to patients receiving oxygen shortly after arrival at the hospital.
Corticosteroids: Steroids quell the body’s immune response and have been used for decades to treat inflammatory disorders. They are also widely available, inexpensive, and well-studied drugs, which is why they were among the first therapies to enter clinical trials for COVID-19. Several studies have shown that low-dose steroids reduce deaths in hospitalized patients receiving oxygen, including the sickest patients in the intensive care unit or ICU. Following the findings of the landmark RECOVERY and REMAP-CAP COVID-19 studies, steroids are now the standard of care for hospitalized COVID-19 patients who are treated with oxygen.
Anticoagulants: Inflammation during COVID-19 and other viral infections can also increase the risk of blood clots, which can cause heart attacks, strokes, and dangerous clots in the lungs. Many COVID-19 patients are given anticoagulants heparin or enoxaparin to prevent clots from forming before they occur. Early data from a large trial of COVID-19 patients suggests that hospitalized patients benefit from higher doses of blood thinners.
Some COVID-19 patients get so sick that they need an ICU to receive high levels of oxygen or a ventilator to help them breathe. There are several therapies available for ICU patients, but ICU patients have not been found to benefit from high doses of anticoagulants.
Treating the sickest patients
ICU patients with COVID-19 are more likely to survive on steroids, according to studies. However, low-dose steroids alone may not be enough to curb excessive inflammation.
Tocilizumab: Tocilizumab is a laboratory-generated antibody that blocks the interleukin-6 pathway, which can cause inflammation during COVID-19 and other illnesses. New results from the REMAP-CAP trial that have not yet been peer-reviewed suggest that a single dose of tocilizumab given within one to two days after receiving ventilation reduced the risk of death in patients already receiving steroids in doses. low. Tocilizumab has also been shown to benefit patients with high levels of inflammation in early results from another trial.
These innovative therapies can help, but careful supportive care in the ICU is also crucial. Decades of extensive research have defined basic management principles to help patients with severe lung infections who need ventilators. These include avoiding under-inflation and over-inflation of the lung by the ventilator, treating pain and anxiety with low levels of sedative medications, and periodic placement of certain patients with low oxygen levels in the abdomen, among many other interventions. The same key principles likely apply to COVID-19 patients to help them survive and recover from a critical illness that can last for weeks or months.
Medical progress since the beginning of the pandemic has been impressive. Doctors now have vaccines, high-risk outpatient antiviral antibodies, and various inpatient treatments. Continued research will be crucial to improve our ability to fight a disease that has already claimed more than 2.5 million lives worldwide.
This article is republished on The Conversation, a non-profit news site dedicated to sharing ideas from academic experts. It was written by: William G. Bain, University of Pittsburgh; Georgios D. Kitsios, University of Pittsburghand Tomeka L. Suber, University of Pittsburgh.
William G. Bain Receives Research Funds from the US Department of Veterans Affairs; the National Institutes of Health; the University of Pittsburgh Institute of Vascular Medicine, the Western Pennsylvania Hemophilia Center; and the Institute of Transfusion Medicine.
Georgios D. Kitsios has received research funding from the National Institutes of Health, the Institute for Clinical and Translational Sciences at the University of Pittsburgh, and Karius, Inc.
Tomeka L. Suber receives research funding from the National Institutes of Health, Burroughs Wellcome Fund, and the Samuel and Emma Winters Foundation.