The COVID-19 pandemic has resulted in unprecedented times across the globe: novel measures such as lockdown have meant that people could not see their families or friends for months, shops and other businesses have had to close, and consequently most economies have seen their worst contractions for many decades! In hospitals worldwide, many Intensive Care Units (ICUs) have been either overwhelmed or stretched to breaking point and worst of all, so many lives have been lost with many having to die all alone.

While lockdown measures continue to be relaxed, a cure or preventative treatment, i.e. a vaccine, is needed to make this safer, ease the pressure on ICUs, save lives and make Coronavirus a milder disease for a very long time (Gallagher, 2020). As we gradually move towards carrying on with life as it used to be, a treatment is needed more than ever as transmission rates (R number) are likely to increase, which could lead to more people being infected, admitted to hospital and possibly dying as a consequence.

Every effort is already being made to help find a cure, or at the very least, some form of effective treatment for the disease: more than 150 different drugs are being researched into around the world, most of these drugs which are already in existence and are effective treatment for other illnesses.  These drugs are being trialled against Coronavirus (Gallagher, 2020) to gauge their efficacy. Drugs that may work are antiviral drugs (they directly affect the ability of SARS-coV-2 to thrive in the body), drugs that reduce the immune system’s response and convalescent plasma – antibodies collected from survivor’s blood or synthesised in the lab that can attack and destroy the virus (Gallagher, 2020). The World Health Organisation (WHO) launched the Solidarity trial, which aims to investigate the most promising treatments, while the UK initiated the ‘Randomised Evaluation of COVID-19 Therapy’ trial (RECOVERY) led by the University of Oxford. The RECOVERY trial was set up in 9 days and is the world’s biggest with 11,500 patients taking part across 175 hospitals in the UK (Walsh, 2020)! The fact that the outbreak of coronavirus in the UK was worse than the rest of Europe meant that there were sufficient numbers of patients to allow for the world’s biggest trial of COVID-19 treatments (Walsh,2020). Multiple research centres around the world are also doing their best to find a treatment and cure for Coronavirus (Gallagher,2020).

RECOVERY trial

Drugs included in this trial are low- dose Dexamethasone, Azithromycin (an antibiotic), Tocilizumab (anti-inflammatory treatment), Convalescent plasma (Welcome — RECOVERY Trial, 2020)

Dexamethasone is a low-cost anti-inflammatory steroid and is probably the most promising Coronavirus drug to date. This is due to it being the first drug seen to save the lives of those with COVID-19: initial findings saw that the risk of death was decreased by a third for those on oxygen, and a fifth for those on ventilators (Walsh, 2020). Coronavirus consists of two phases, the first is when the virus invades the body and the immune system consequently responds – most people who contract the virus experience this stage (Walsh, 2020). The second stage is experienced by a minority of those who contract the virus: after the disease alters after a week of infection, the immune system is led to overreact, causing inflammation so that the body’s response results in damage to the lungs and other parts. The randomised trial found that Dexamethasone only aided those in the second phase (those who were on oxygen or a ventilator), it is now given to all COVID-19 patients on oxygen or ventilator in the UK (Walsh,2020).

Research of Tocilizumab has also been conducted by the RECOVERY trial. Hypoxic COVID-19 patients from the 13th March – 19th April with lung infiltrates and high inflammatory markers were treated with one dose of Tocilizumab, given that there were no contraindications (Kewan, Covut and Akbik, 2020).Hydroxychloroquine, azithromycin, and systemic steroids were used simultaneously with Tocilizumab for most patients. Patients with severe COVID-19 who were treated with Tocilizumab appeared to have a shorter time on invasive ventilation and shorter time to improve in health, however these results were not statistically significant. Consequently, more research needs to be done to observe the impact of Tocilizumab (Kewan, Covut and Akbik et al, 2020).

Furthermore, Convalescent plasma is being researched into; if someone survives coronavirus, they should have antibodies in their blood, which, if infected again, will quickly destroy the virus before symptoms appear. Research is therefore being done to determine if treating sick patients with blood plasma from previously sick patients will be an effective treatment. NHS Blood and Transplant have been asking survivors to donate their blood so the therapy can be assessed in trials (NHSBT, 2020).  Several groups like the University of Wales in Cardiff and Professor Sir Robert Lechler (President of the Academy of Medical Sciences and Executive Director of King’s Health Partner) hope to set up a small trial (Morelle, 2020). Additionally, there is a US nationwide project with approximately 600 patients being treated also in progress (Morelle, 2020). This means that there is hope of the effects of convalescent plasma against COVID-19 being published soon as so many are working on it.  Professor Michael Joyner of the Mayo Clinic has said that in the first week of the US project there were “no major safety signals” or “unanticipated effects”(Morelle, 2020), which indicates that the Convalescent plasma therapy, at the very least, should be a  safe treatment. There are also anecdotal reports of oxygenation improving as a result of the treatment, although obviously, a proper evaluation needs to be done (Morelle, 2020).

On the 3rd June, the first patient of a trial in the UK was treated with convalescent plasma as part of the RECOVERY trial conducted by NHSBT. Selected hospitals are able to randomise patients to receive Convalescent plasma in the RECOVERY trial (Child given plasma in coronavirus treatment trial| ITV News, 2020) If this proves successful, this treatment will be used more widely in hospitals.

Solidarity trial

Drugs in this trial include, Remdesivir, Lopinavir and Ritonavir (World Health Organisation, 2020).

Remdesivir is an antiviral drug, which was originally used to treat Ebola. A US-led trial of more than 1,000 people worldwide was conducted, and the finding was that Remdesivir shortened the duration of symptoms from 15 to 11 days (Gallagher, 2020), although studies have not shown that it can prevent deaths from COVID-19. It is thought that antivirals such as Remdesivir are most effective in the early stages of the disease, and immune anti-inflammatory drugs in later stages of the disease (Gallagher, 2020). Although Remdesivir is available on the NHS (as well as Dexamethasone), the US have bought most of Gilead’s (a research-based biopharmaceutical company) upcoming supply of drugs, South Korea possesses an unknown quantity (Gallagher, 2020), as a result of which there may not be enough for the UK to give to sick patients.

There was hope for the HIV drugs Lopinavir and Ritonavir to prove effective, however on the 29th June, it was announced that they proved to be of no clinical benefit. 1596 patients were randomised to Lopinavir and Ritonavir, and 3376 to usual care alone, but the before and after results did not show much difference or benefits (Lopinavir-Ritonavir results — RECOVERY Trial, 2020)

 

Hydroxychloroquine and Chloroquine

Drugs used to treat malaria (Hydroxychloroquine and Chloroquine) were part of both the Solidarity and RECOVERY trials. They both could have antiviral and immune calming properties and hydroxychloroquine is used to treat rheumatoid arthritis because it can help to regulate the immune system. There has been little evidence to prove its efficacy so far from RECOVERY trial research (Hydroxychloroquine results — RECOVERY Trial, 2020). WHO previously suspended global hydroxychloroquine trials after a large study by ‘The Lancet’ found use of the drug with a macrolide such as Azithromycin could increase mortality rates and cause ventricular arrythmias (Mehra et al, 2020), however this article was retracted at the end of June (Gallagher, 2020).  Consequently, WHO is now going to resume the hydroxychloroquine arm of the Solidarity trial (Davey, 2020). Oxford University are going to conduct more research on it (COPCOV trials will begin – chloroquine and hydroxychloroquine or placebos will be given to 40,000 healthcare workers from Europe, Africa, Asia and South America) as they could be a realistic prospect when thinking of protecting key workers in the winter (Coronavirus: Hydroxychloroquine trial to restart, 2020).

To conclude, I do think there is definitely hope of a cure for Coronavirus: scientists across the globe, who are very skilled in their fields, are all working laboriously to find a cure for the virus. Promising results have already been shown by the Dexamethasone trials, and with the Convalescent plasma research continuing and hydroxychloroquine research restarting, a cure has to be likely.

 

Written By Bernice Kwei-Tagoe

Bibliography

Davey, M., 2020. WHO To Resume Hydroxychloroquine Trial After Earlier Halt Over Safety Concerns. [online] The Guardian. Available at: <https://www.theguardian.com/world/2020/jun/04/who-to-resume-hydroxychloroquine-trial-after-earlier-halt-over-safety-concerns> [Accessed 8 July 2020].

Gallagher, J., 2020. How Near Are We To Curing Coronavirus?. [online] BBC News. Available at: <https://www.bbc.co.uk/news/health-52354520> [Accessed 8 July 2020].

Kewan, T., Covut, F. and Akbik, B. et al , 2020. Eclinicalmedicine. [online] Thelancet.com. Available at: <https://www.thelancet.com/journals/eclinm/home> [Accessed 5 July 2020].

Mehra, P. et al, 2020. RETRACTED: Hydroxychloroquine Or Chloroquine With Or Without A Macrolide For Treatment Of COVID-19: A Multinational Registry Analysis. [online] The Lancet. Available at: <https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext> [Accessed 8 July 2020].

Morelle, R., 2020. Coronavirus Blood Treatment To Be Tried. [online] BBC News. Available at: <https://www.bbc.co.uk/news/health-52348368> [Accessed 8 July 2020].

Walsh, F., 2020. Fergus Walsh: At Last Some Good News About Coronavirus. [online] BBC News. Available at: <https://www.bbc.co.uk/news/health-53096736> [Accessed 8 July 2020].

BBC News. 2020. Hydroxychloroquine Coronavirus Trial To Restart. [online] Available at: <https://www.bbc.co.uk/news/health-53233070> [Accessed 12 July 2020].

ITV News. 2020. Child Given Plasma In Coronavirus Treatment Trial | ITV News. [online] Available at: <https://www.itv.com/news/2020-06-03/child-given-plasma-in-coronavirus-treatment-trial/> [Accessed 8 July 2020].

Recoverytrial.net. 2020. Welcome — RECOVERY Trial. [online] Available at: <https://www.recoverytrial.net/> [Accessed 8 July 2020].

Recoverytrial.net. 2020. Lopinavir-Ritonavir Results — RECOVERY Trial. [online] Available at: <https://www.recoverytrial.net/results/lopinavar-results> [Accessed 8 July 2020].

Recoverytrial.net. 2020. Hydroxychloroquine Results — RECOVERY Trial. [online] Available at: <https://www.recoverytrial.net/results/hydroxychloroquine-results> [Accessed 8 July 2020].

World Health Organisation. 2020. “Solidarity” Clinical Trial For COVID-19 Treatments. [online] Available at: <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments> [Accessed 8 July 2020].