Thursday, March 19, 2020

Surviving the Coronavirus: Part 4

I begin with a quick review of previous posts in this series.

Part 1: I describe the potential magnitude of the problem if we don't "flattening the curve" and quickly find an effective treatment.

Part 2: Brits say that we Yanks will suffer more than a million dead, even with "flattening the curve." They fail, however, to consider effective treatments. I discussed two possible effective treatments. 

Part 3: As a recovering engineer, I take issue with a Stanford epidemiologist regarding the significance of the Diamond Cruise experience.

Now on to Part 4, in which we look at some exceptionally exciting news in the world of effective treatments.

Recall that in Part 2, I described two existing drugs, one for malaria and one for HIV, both of which looked promising as potential treatments for coronavirus. I declared the malaria drug as my top pick and the AIDS drug as a runner up. I will give you an update on those two before moving on to more candidates.

My runner up, the HIV drug, appears to no longer be in the running. We learn of that in the disappointing article "HIV drug combo fails as treatment for severe COVID-19 in China study."
A pill containing two HIV drugs that was touted as a potential treatment for the novel coronavirus was not effective, according to a study released late on Wednesday in the New England Journal of Medicine. 
A test in Chinese patients with severe COVID-19 disease found the 99 who received AbbVie Inc's Kaletra, a combination of lopinavir and ritonavir, fared no better than the 100 who received standard care. [...] 
The lopinavir-ritonavir combination also produced more side effects, prompting the treatments to be halted in 13.8% of patients.
On the very bright side, my top pick, the malaria drug chloroquine / hydroxychloroquine, seems to have considerably opened its lead over the 50 or so other contenders in the race for an effective treatment / cure. Several papers detailing good success in separate human trials are here and here. China, South Korean, and Belgium are already using the medication in practice, not just in trials. The drug may have preventative as curative potential. The U.S. authorities have knocked down bureaucratic hurdles and the medication will be used in human trials and/or actual practice within a matter of days. Bayer is preparing to donate the a large quantity of the medication. (Good on Bayer.)

Also in the running is a Japanese flu drug favipiravir. According to an 18 March 2020 article in the The Guardian:
Medical authorities in China have said a drug used in Japan to treat new strains of influenza appeared to be effective in coronavirus patients, Japanese media said on Wednesday. 
Zhang Xinmin, an official at China’s science and technology ministry, said favipiravir, developed by a subsidiary of Fujifilm, had produced encouraging outcomes in clinical trials in Wuhan and Shenzhen involving 340 patients. “It has a high degree of safety and is clearly effective in treatment,” Zhang told reporters on Tuesday. 
Patients who were given the medicine in Shenzhen turned negative for the virus after a median of four days after becoming positive, compared with a median of 11 days for those who were not treated with the drug, public broadcaster NHK said. 
In addition, X-rays confirmed improvements in lung condition in about 91% of the patients who were treated with favipiravir, compared to 62% or those without the drug. [...] 
Doctors in Japan are using the same drug in clinical studies on coronavirus patients with mild to moderate symptoms, hoping it will prevent the virus from multiplying in patients. But a Japanese health ministry source suggested the drug was not as effective in people with more severe symptoms. “We’ve given Avigan to 70 to 80 people, but it doesn’t seem to work that well when the virus has already multiplied,” the source told the Mainichi Shimbun.
Meanwhile, the ebola drug remdesivir may have already saved the life of an American dying of coronavirus. I excerpt from the Wikipedia article.
Remdesivir [...] is a novel antiviral drug [...] developed by Gilead Sciences as a treatment for Ebola virus disease and Marburg virus infections. [...] 
In response to the 2019–20 coronavirus outbreak induced by coronavirus SARS-CoV-2, Gilead provided remdesivir for a "small number of patients" in collaboration with Chinese medical authorities for studying its effects. 
Gilead also started laboratory testing of remdesivir against SARS-CoV-2. Gilead stated that remdesivir was "shown to be active" against SARS and MERS in animals. 
In late January 2020, remdesivir was administered to the first US patient to be confirmed to be infected by SARS-CoV-2, in Snohomish County, Washington, for "compassionate use" after he progressed to pneumonia. While no broad conclusions were made based on the single treatment, the patient's condition improved dramatically the next day, and he was eventually discharged. 
Also in late January 2020, Chinese medical researchers stated to the media that in exploratory research considering a selection of 30 drug candidates, remdesivir and three other drugs, chloroquine, lopinavir/ritonavir and favipiravir, seemed to have "fairly good inhibitory effects" on SARS-CoV-2 at the cellular level. Requests to start clinical testing were submitted. On February 6, 2020, a clinical trial of remdesivir began in China. 
On 17 March 2020, remdesivir was provisionally approved for use for COVID19 patients in a serious condition in the Czech Republic. 
On 18 March 2020, the first Italian COVID-19 patient was successfully cured with remdesivir in Genoa.
So, as this series draws to a close, I want to summarize what I consider to be our best strategy for surviving the corona virus.

1. Flatten the hell out of the curve. Keep the hospitals from becoming overwhelmed. Geezers and other high risk individuals should be particularly disciplined about their social distancing. The young whippersnappers, who are at the lowest risk, should carry the burden of keeping essential distribution systems in place.

2. Crank out, in record time, an effective treatment.

Most of us have no way of contributing to item #2. All of us can contribute to item #1. That is why I have broken my indefinite sabbatical from this site to write this series. We need to recognize that we face a deadly foe, and we need to pitch in to combat it in whatever fashion we can.

As a society, we are responding in spectacular fashion. Nice job, everybody.

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