Sunday, August 2, 2020

Some suggestions for finding effective treatments for COVID-19.

Copyright 2020 Robert Clark

 There is a present push to reopen the economies and the schools. Unfortunately, there has been a present surge in COVID-19 cases. Some countries particularly the Asian countries have COVID-19 death rates at 1/100th those in Western countries. I suggest an international conference on the treatments being used that have been found effective through out the world. Such a conference could even be conducted online.

 It is a well-known fact that antiviral therapies are best applied soon after infection, for example, for influenza and HIV. Oddly, this lesson seems to have been forgotten for COVID-19.

 This article argues for going back to that well-known principal of antiviral therapies:

Rethinking antiviral effects for COVID-19 in clinical studies: early initiation is key to successful treatment.
Shoya Iwanami,et. al.

 There have been many antivirals that have been shown effective against the coronavirus in vitro, but have been disappointing in vivo. But almost all such studies have been looking at patients at advanced disease. But key would be to do the treatment soon after symptoms first appear. Because testing sometimes takes days for the results to come back, the treatment should be applied immediately even before a positive test confirmation.

 Because there are sometimes false negatives, the medication should continue to be taken during the time symptoms are apparent. And even if after repeated testing it is likely the person is negative for COVID-19, if the medication is effective than it should be protective during the period the medication is taken. This in fact will be another method of testing its effectiveness, by determining if it has a protective effect.

 Since such treatments are taking place before serious disease develops it necessarily would be on an outpatient basis. Then for those antivirals being taken among the teams administering the medications there should be experts on the possible side effects.

 To be able to find which medications are most effective, clinical practices and hospitals within the same general vicinity could be using different medications. That would be able to make it easier to compare their effectiveness, without various confounding factors coming into play. And the effectiveness of the medications should be shared in real time.

 A difficulty with respect to COVID-19 though is that most subjects recover on their own making it difficult to see if a medication is having a real effect or not. However, the experience of some doctors in Italy with hydroxychloroquine shows a key and important method by which the effectiveness could be detected: cut in hospitalizations.

Success in Italy reported in early treatment of COVID-19 using hydroxychloroquine.

 Since most deaths come after hospitalizations a dramatic cut in hospitalizations would result in a dramatic cut in the death rates. And the experience of those doctors in Italy using it was of a dramatic cut in the hospitalizations.

 The importance of this is not just for the cut in the hospitalizations but also the speed at which this drop will become apparent. If you are only judging by death counts, then that can take weeks to months to determine the medications effectiveness because patients can remain hospitalized for weeks to months, before it is determined if they recover or not from the disease.

 But because for COVID-19 whether the disease progresses to the serious stage requiring hospitalization is determined within a matter of days, doctors using the medication would know within days if it is effective in cutting the hospitalizations they observed.

 If an antiviral is effective against COVID-19 then the same should be true also for that antiviral, a cut in hospitalizations that becomes apparent within days.

 Given the success those doctors in Italy using it have found in cutting hospitalizations, hydroxychloroquine should be among the antivirals being tried. However, the FDA has a policy in place that is interpreted as banning it in general for treating COVID-19. But actually the policy allows it within clinical trials against COVID-19. But any doctor can apply for a clinical trial. So the doctors wanting to use it should apply to conduct a clinical trial. Such trials don't have to be paid for by government grants or pharmaceutical companies. And the medication itself is quite cheap. Only, those doctors wanting to use it should have doctors on their teams or be in consultation with doctors who are experts in their use and possible side effects such as those specializing in rheumatic diseases.

Anti-inflammatories for serious disease.
 Some anti-inflammatories have shown to be effective for patients that need oxygen such as those on ventilators, including dexamethasone and tocilizumab. But the reduction in lung inflammation can be measured in real time by detecting markers such as IL-6 and CRP and even in CAT scans. Then the effectiveness of these anti-inflammatories can also be observed on short time scales. See the discussion in the update dated from 6/26/2020 here:

About the article, “Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19”. UPDATED, 6/26/2020.

 As with the antivirals, nearby hospitals should be testing different medications so the comparisons can be made to their effectiveness without confounding factors. And as with the antivirals the comparisons among the various hospitals should be done in real time.

   Bob Clark


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