COVID-19 Treatment Update

Just behind the search for a COVID-19 vaccine is the search for better treatments to help patients cope with severe illness. The National Institutes of Health (NIH) assembled an expert panel to evaluate treatment data and make recommendations doctors can use to treat their patients. Updated whenever a recommendation changes, it is a great way to know which treatments have passed the test. Here’s the latest.

In the early days of the pandemic, one of the most seemingly promising treatments was convalescent plasma. Convalescent plasma is obtained when a person who has recovered from COVID donates blood. Some parts of the blood are removed, leaving the plasma, which carries the antibodies. The plasma is transfused into those who are ill. It is thought that the antibodies in the recoveree’s plasma may help the sick person fight the disease.  After some initial study, the NIH panel reported that there is insufficient data both for and against this treatment. More studies are needed, and those interested in trying the treatment should participate in clinical trials, if available.

A few months into the pandemic, the names of antiviral medications started showing up in the news, notably chloroquine and hydroxychloroquine. Large randomized controlled trials for hospitalized patients revealed no benefit and potential harm in using these drugs to treat COVID-19. The drugs are not recommended for nonhospitalized patients either, except those enrolled in a clinical trial. Other antivirals, like interleukin-6 inhibitors and ivermectin, and those used for treating HIV, like Lopinavir/Ritonavir, have not yielded any benefit and are not recommended.

Remdesivir, one antiviral drug, is showing some promise for patients whose illness is serious enough to require oxygen in the hospital but not so serious as to need help breathing. The NIH panel recommends using remdesivir for this specific patient group. For those who need a high-flow of oxygen or ventilation, they note that they “cannot make a recommendation either for or against starting remdesivir.” Similarly, they cannot recommend continuing remdesivir for patients who have not improved after the first 5 days of the treatment. Remdesivir may be most useful at the beginning of the disease course, as it inhibits viral replication. That being said, most centers are still giving remdesivir to patients with moderate-to-severe illness, as it is one of the only proven options.

There are some very early reports that inexpensive, readily available steroids may help lower the risk of death among those seriously ill with COVID-19. The first study was published on jamanetwork.com, a site of the Journal of the American Medical Association. It describes a complex study conducted by the World Health Organization in which corticosteroids were shown to reduce the risk of death by as much as a third. At least one hospital was using them early in the pandemic with positive results. The NIH’s expert panel agrees that corticosteriods are a recommended treatment for any hospitalized patient who needs oxygen.  

Doctors already know how important vitamin D is in the immune system. In a retrospective study, researchers at the University of Chicago Medicine noted that being deficient in vitamin D may relate to a greater likelihood of COVID infection. They compared the vitamin D levels of 489 patients. Those with low levels were twice as likely to test positive for COVID-19 as those with adequate levels. Researchers acknowledge that the reason for the increased likelihood to test positive may relate to other factors. For instance, minority groups are at higher risk of contracting COVID-19 and often have lower vitamin D levels. The NIH expert panel has not declared vitamin D as an effective preventive measure or a treatment. More study is needed.

Monoclonal antibodies popped up in the news recently, because physicians treating President Trump administered them to treat an infection of COVID-19. Monoclonal antibodies are produced synthetically in a lab. They are designed to bind to a specific antigen, in this case COVID-19, and prevent the antigen from infecting cells. Monoclonal antibodies have been used as a cancer treatment, their use to treat COVID-19 is experimental. According to media reports, only 275 infected people have received the treatment so far.

Just as a viable vaccine is very likely, improvements in treatment—for both hospitalized patients and those with mild cases—are likely to emerge as the pandemic continues to unfold. As physicians, we look forward to using proven treatments to save lives, shorten the duration of the disease, and ease the symptoms.

Marie George, MD, FIDSA, of SVMC Infectious Disease, is an infectious disease specialist.