SARS-CoV-2 is a novel RNA virus from the coronoviridae family of viruses that was identified in December 2019. Unlike other coronaviruses associated with the common cold, this particular virus is highly transmissible and fatal. This virus causes the devastating coronavirus disease 2019 also known as COVID-19. As of December 15, 2020, it has caused more than 1.62 million deaths worldwide and over 72.8 million cases. In the United States approximately 16.6 million have been affected with over 300K deaths. Symptoms of COVID-19 may include shortness of breath, fever, chills, loss of taste and/or smell, fatigue, and headache. As the name indicates it can lead to severe acute respiratory syndrome requiring hospitalization and in some cases it proves fatal.
In addition to the development of vaccines to prevent COVID-19, research is ongoing to create a medication to treat this illness. Remdesivir is one such treatment. On May 1, 2020 it was issued an Emergency Use Authorization (EUA) by the Food and Drug Administration to treat adults and children with COVID-19. It is a 10 day intravenous treatment that prevents viral replication. Similar to the antiviral tamiflu used to treat influenza, remdesivir shortens the time to recovery by a few days. Side effects may include nausea, liver function test abnormalities, and allergic reactions. It is not recommended for patients with stage 4 or 5 chronic kidney disease (GFR <30). Unfortunately, despite treatment with remdesivir mortality rates remain high and thus more treatment options are needed.
Treatment for patients requiring respiratory support
Another therapeutic that has shown promise in the treatment of COVID-19 is the glucocorticoid dexamethasone. Glucocorticoids are steroids that reduce tissue inflammation. Respiratory failure is usually the cause of death in those with severe COVID-19. Thus, a medication that can modify the effects of this virus on the lung would be most beneficial. Use of 6mg of dexamethasone for 10 days in patients receiving invasive mechanical support with a ventilator or on supplemental oxygen has been shown to reduce mortality likely by reducing inflammation in lung tissue and in turn preventing respiratory failure and death. The benefit however is dependent on the patient and the stage of the disease process.
Treatment for outpatients
Monoclonal antibodies are being developed to reduce viral load in outpatients with COVID-19. During this pandemic it has been identified that up to 10% of patients who begin with mild symptoms can rapidly progress to severe symptoms warranting hospitalization. Neutralizing antibodies have been developed to target this unique population. The antibody Ly-CoV555 (bamlanivimab) was derived from convalescent plasma in a patient who had COVID-19. This antibody blocks the virus from gaining entry into a cell by interfering with the attachment of the viral spike protein to a receptor on the target human cell. Once the antibody binds the receptor on the target cell, the virus cannot enter or replicate. Subsequently, viral load is reduced. Studies show that outpatients who receive this treatment have less symptom severity and less hospitalizations.
On November 9, 2020 the FDA granted emergency use authorization of this single dose infusion for outpatients 12 years of age and older who have been recently diagnosed with COVID-19 and with risk factors such as age over 65 years, diabetes, immunocompromised state, and obesity. Nausea and infusion related reactions were commonly reported.
Scientific research must continue to prevent and treat COVID-19 for a variety of patient populations. We have found that the use of new therapeutic options and medications that have been in existence for years are key in reducing symptoms, hospitalizations, and death from COVID-19. In time, with medical advances and innovation, the right cocktail will be formulated to treat hospitalized patients and those convalescing at home.
More COVID-19 Information
COVID-19 continues to devastate our world and thankfully promising vaccines are being developed. With so much talk about these vaccines over the recent months, the discussion below will review some key steps in the production of vaccines, the purpose of vaccines, and comparison of the two vaccines nearing widespread distribution against SARS-CoV-2.