And From the Boffins

In a Wall Street Journal op-ed Scott Gottlieb reports on prospective treatments for COVID-19:

Even if new cases start to stall in the summer heat, the virus will return in the fall, and so will fresh risk of large outbreaks and even a new epidemic. People will still be reluctant to crowd into stores, restaurants or arenas. Schools may remain closed. The public’s fears won’t relent simply because there are fewer new cases. We’ll be running an 80% economy.

The only way out is with technology. Aggressive surveillance and screening can help warn of new infection clusters that could turn into outbreaks, but that won’t be enough. A vaccine could beat the virus, but there won’t be one this year. The best near-term hope: an effective therapeutic drug. That would be transformative, and it’s plausible as soon as this summer. But the process will have to move faster.

Americans would have the confidence to return to work, even if the virus is still circulating in the fall, if they knew that a robust screening system is in place to identify and arrest new outbreaks and medication can significantly reduce the chance of becoming severely ill. Kevin Warsh, a former Federal Reserve governor, estimates that such a drug could restore at least $1 trillion in economic activity.

Given the enormous public-health and economic stakes, it is worth doing whatever it takes to move such a drug to market. There are two promising approaches, and both could be available soon if government and private industry do things right. It’s time to place some firm bets and put resources behind these experimental treatments.

One approach involves antiviral drugs that target the virus and block its replication. Think of medicines for treating influenza, HIV or cold sores. The drugs work by blocking the mechanisms that viruses use to replicate. Dozens of promising antiviral drugs are in various stages of development and could be advanced quickly. The one furthest along is remdesivir, from Gilead Sciences. There’s evidence from clinical experience with Covid-19 patients that it could be effective.

The other approach involves antibody drugs, which mimic the function of immune cells. Antibody drugs can be used to fight an infection and to reduce the risk of contracting Covid-19. These medicines may be the best chance for a meaningful near-term success.

Antibody drugs are based on the same scientific principles that make “convalescent plasma” one interim tactic for treating the sickest Covid-19 patients. Doctors are taking blood plasma from patients who have recovered from Covid-19 and infusing it into those who are critically ill. The plasma is laden with antibodies, and the approach shows some promise. The constraint: There isn’t enough plasma from recovered patients to go around.

Antibody drugs are engineered to do the same thing as convalescent plasma, but because they’re synthesized, they don’t depend on a supply of antibodies from healed patients. Biotech companies would manufacture them in large quantities using recombinant technology, the same approach behind highly effective drugs that target and prevent Ebola, respiratory syncytial virus and other infections. The antibodies can also be a prophylaxis given to those exposed to Covid-19, or to prevent infection in vulnerable patients, such as those on chemotherapy. These drugs could protect the public until a vaccine is available.

The biotech company Regeneron successfully developed an antibody drug to treat Ebola as well as one against MERS, a deadly coronavirus similar to Covid-19. Regeneron has an antibody drug that should enter human trials in June. Vir Biotechnology is also developing an antibody treatment for Covid-19 and says it could be ready for human trials this summer. Amgen recently started its own program with Adaptive Biotech and Eli Lilly has one as well. If these approaches work, the drugs can advance quickly, because much of the science and the safety is already well understood.

The greatest emphasis is likely to be on things that are patented or can be patented. If there is any prospect that something that isn’t patented or patentable has any applicability we should jump all over it. My point is not to boost one therapy over another, only that we shouldn’t sneer at inexpensive treatments.

Let many flowers bloom. A treatment effective in a minority of cases that can be approved and manufactured in quantity quickly is better than one that can’t be approved or manufactured on a timely basis, however effective it might be. You deploy the one until the other comes along.

10 comments… add one
  • PD Shaw Link

    Meanwhile in the UK, none of the 17.5 million antibody tests it ordered work. I believe there are similar stories about contracts in Ireland, Netherlands and Spain, plus China giving out crappy products in Italy and elsewhere as well. I think the take away is that this stuff is hard; don’t put your eggs in one basket.

    Also, the UK PM has been taken to intensive care.

  • steve Link

    “Meanwhile in the UK, none of the 17.5 million antibody tests it ordered work. ”

    But they got them quickly. None of that stop and see if it actually works stuff.

    ” only that we shouldn’t sneer at inexpensive treatments.”

    Sigh. Ok, who is sneering at inexpensive treatments? We have had very good results with proning. Just having people l/ie on their stomach for several hours a day, sleeping or otherwise, seems to have a very positive effect. Cheap as hell. No one is sneering.

    Steve

  • Ok, who is sneering at inexpensive treatments?

    The emphasis of the Food & Drug Administration is routinely on patented drugs. It’s understandable. They have champions who feel a great sense of urgency. And haven’t you been listening to Dr. Fauci? He routinely mentions various patented drugs that are under trial. I’ve never heard him mention anything that wasn’t proprietary.

    Not mentioning any specific treatment would be fine.

    I first became aware of the political machinations of the FDA nearly 60 years ago. My lab partner’s dad was deputy director.

  • TarsTarkas Link

    To Steve: An interesting article and link to as to how Kung Flu may be causing acute respiratory distress and why ventilators aren’t helping:

    https://threadreaderapp.com/thread/1244717172871409666.html

    They are positing that COVID-19 is damaging the ability of red blood cells to carry oxygen and carbon dioxide to and from the tissues. The elevated levels of ferritin may be indicators of this. And why early intervention with drugs that interfere with the virus’ ability to damage red blood cell oxygen receptors may be why later interventions don’t work, an inability of the body to turn over its hemoglobin supply quickly enough; even when atmospheric oxygen becomes available the body simply can’t absorb it.

    If you already know this, I apologize. But you’re busy saving lives and I’m a less busy bystander.

  • steve Link

    ” He routinely mentions various patented drugs that are under trial.”

    That equates to sneering at inexpensive drugs? How often in the past have we found that an old drug sitting around was effective against a viral illness? Look, maybe Vitamin C has some effect. Maybe something in the HC cocktail helps, but if they were curative like we see with antibiotics working on bacterial disease it would have been obvious already and that is what we want. We want something that will reliably arrest the disease so people dont end up in the ICU, and if they do it has a chance to rescue them. That is much, much more likely to happen with guided research than it is by accident.

    Does the FDA cater to the rich and powerful pharma corporations? Of course.

    Steve

  • TarsTarkas Link

    Steve: Very interesting comment on ‘proning’. I almost always sleep on my belly, rarely on my side, never on my back, even though I’m type 2 diabetic and am supposed to keep my feet up to reduce lymph swelling (sleeping on back with legs up hurts knees and causes calf cramps, belly down I sleep with knees bent and feet elevated, much more comfortable). Would be an interesting statistic if anecdotal data to ask your patients what positions they normally sleep in.

  • Greyshambler Link

    If that’s a treatment at all, blood will be harder to get than T P. The profit vampires will come out of the woodwork.

  • bob sykes Link

    If the virus returns in the fall, we will have an economic collapse more complete than the depths of the Great Depression. It will, in fact, be a civilizational collapse, Mad Max on steroids.

  • GreyShambler Link

    “economic collapse”
    Not likely. Today the body count rises by another thousand. I sense an alarm fatigue setting in. People go to work every day under threat of unexpected, sudden violent death. Convenience store clerks, taxi drivers, road repair crews, drivers of any kind. Tree trimmers, linemen, loggers, fishermen, maybe the worst is prostitutes, but they put on their makeup and go.
    Really wonder what it is, besides novelty, that makes this different.
    I believe it’s the forecasts of exponential spread, the sense of looming. Add in the lack of personal control over our own safety. We need that to get through the day. The new mask wearing directive is a good idea for that reason, if only as a placebo.

  • GreyShambler Link

    What I mean to say, Bob Sykes, is that you are extrapolating a trend.
    If, (when), it returns in the fall, it will no longer be novel. WE will be different too.

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