Followers of doctor Edsel Maurice Salvaña on Facebook woke up to good news Thursday when the infectious diseases expert gave very comforting, even though brief, notes on the developments in the COVID-19 treatment front.
“We're getting there, people,” Dr. Salvaña wrote on his Facebook wall. “Vaccine data looks promising. Monoclonal antibody data looks promising. Favipiravir data looks promising. Remdesivir, dexamethasone and high flow nasal oxygen WORK when used PROPERLY. So much more good stuff in the pipeline. There has been REAL progress.”
While the microbiologist did not expound on the details, he pointed us to the New England Journal of Medicine (NEJM), where recent findings on the safety and efficacy of Moderna Inc’s mRNA-1273 among the older population is documented. This was an important test since increased incidence of COVID-19, including deaths, have been associated with old age.
According to the article, the mRNA-1273 vaccine produced virus-neutralizing antibodies at levels similar to those seen in younger adults. The study notes mild or moderate reactions—“most frequently included fatigue, chills, headache, myalgia (muscle aches and pains), and pain at the injection site”—which are usual flu symptoms. The said vaccine works by creating viral proteins that mimic the coronavirus, training the immune system to recognize its presence. If successful, it would be the first mRNA vaccine approved for human use.
A recent webcast released by Regeneron Pharmaceuticals revealed initial data from its trials on REGN-COV2—a combination of two monoclonal antibodies (REGN10933 and REGN10987) designed specifically to block infectivity of SARS-CoV-2, the virus that causes COVID-19.
George D. Yancopoulos, M.D., Ph.D., President and Chief Scientific Officer of Regeneron, noted that “Regeneron's antibody cocktail REGN-COV2 rapidly reduced viral load and associated symptoms in infected COVID-19 patients.”
The greatest treatment, the news release mentioned, was in patients who don’t possess an effective immune response. Initial results showed that REGN-COV2 could provide a therapeutic substitute for the naturally-occurring immune response.
This trial is part of a larger program that also includes studies of REGN-COV2 for the treatment of hospitalized patients, and for prevention of infection in people who have been exposed to COVID-19 patients.
Meanwhile, one of the drugs which has recently garnered much attention, especially in India, is an anti-viral drug originally designed for influenza, called favipiravir. Favipiravir is a drug which has a similar mechanism of action to remdesivir but is orally administered.
According to a study published on National Center for Biotechnology Information, the main advantages of favipiravir are: 1) it is administered orally and 2) it can be given to patients who are symptomatic but not ill enough to be hospitalized. As most COVID-19 patients (85%) have mild to moderate cases of the disease and can be treated at home, this drug could potentially be used in large numbers of patients.
“The preliminary results from the first Indian study with this drug have been encouraging with small but significant improvement in time to clinical recovery and a two-day shorter viral shedding time,” the study noted.
Meanwhile, researchers at the University of Alberta have discovered a second mechanism of action: the antiviral drug remdesivir can work against SARS-CoV-2, noted a recent study published in the Journal of Biological Chemistry.
The newly identified mechanism is more like a roadblock, “so if you want to go from A to B with the wrong fuel and terrible road conditions, you either never reach B or you arrive extremely late," said Matthias Götte, chair of medical microbiology and immunology in the Faculty of Medicine & Dentistry.
“Remdesivir stops or heavily delays replication of the virus, which in turn reduces propagation and spread,” he said.
The research team previously demonstrated how remdesivir inhibits the COVID-19 virus’ polymerase or replication machinery in a test tube.
There is also positive development in the trials conducted for dexamethasone, a type of steroid used as an anti-inflammatory agent, noted a study published on JAMA Network, a medical journal published by the American Medical Association.
Among patients with COVID-19 and moderate or severe acute respiratory distress syndrome (ARDS), “use of intravenous dexamethasone plus standard care compared with standard care alone resulted in a statistically significant increase in the number of ventilator-free days (days alive and free of mechanical ventilation) over 28 days.”
In a virtual briefing last August, Health Undersecretary Maria Rosario Vergeire also mentioned that the DOH have seen evidence that high-flow nasal cannula (HFNC) devices can be an option for the clinical management of those with severe and critical COVID-19. HFNC devices allow heated and humidified oxygen to be delivered to the patient through a nasal cannula or a device, increasing the airflow for patients needing respiratory help.
“Ginagamit na yan sa iba’t ibang ospital natin dati pa, nung nagpalabas ang PSMID, yung Philippine Society for Microbiology and Infectious Diseases, ng kanilang guidelines na pwede itong alternative, as it reduces chances of being intubated,” she said.
In lieu of these positive developments, Dr. Salvaña appeals to everyone to continue to take the necessary precautions until we have the means to fight the virus. “Please keep those masks and face shields on and continue to distance. We need to keep as many people alive as we can UNTIL we have the tools to GET RID of this virus once and for all. THEN we can party like there's no tomorrow, because there WILL BE a tomorrow for EVERYONE,” he said.