While vaccination and natural immunization by infection might eventually make Covid-19 less lethal, like seasonal flu, that time will not likely come soon. With more than 700,000 deaths attributed to the virus in the U.S., treating those already infected is a growing area of research and practice.
The Centers for Disease Control and World Health Organization agree that vaccination remains the most effective method of preventing infection and keeping those who become infected from severe illness or death. But other treatments are necessary since the vaccines are not 100 percent effective and because not everyone plans to, or can be, vaccinated. Also, not all countries have vaccines.
Keeping those exposed to the virus from developing illness through treatment is another method of prevention, and the search for effective therapies for those already infected has always been a goal, albeit not as widely publicized as the vaccines.
When former President Trump became infected with Covid-19, he received monoclonal antibodies (mAbs) and an antiviral, Remdesivir. Remdesivir is the only FDA approved treatment for Covid-19 in patients requiring hospitalization. According to the National Institutes of Health, it may result in shorter hospital stays for those with moderate or severe Covid-19 but hasn’t been shown to lessen death rates.
The mAb combination, REGEN-COV, used with Trump is one of two currently under Emergency Use Authorization (EUA). Use of Remdesivir and mAbs is restricted to individuals 12 and over, weighing at least 88 pounds. Use of mAbs is further restricted to recently diagnosed patients not requiring hospitalization but at high risk of developing severe illness.
MAbs are expensive, difficult to manufacture, and must be infused or injected. Drugs in this class, like REGEN-COV, and another made by GlaxoSmithKline, (GSK-Vir), are only used for early stage asymptomatic or mild infections.
REGEN-COV reduced the chance of hospitalization and death by 70 percent and shortened the duration of symptoms by four days in a not yet peer-reviewed research study, according to the Washington Post. GSK-Vir is 79 percent effective in reducing hospitalization for more than 24 hours, or death, according to the company’s statements.
Trump and Gov. Greg Abbott of Texas both were given REGEN-COV, and Florida Gov. Rick DeSantis is a vocal proponent. Chris Christie and Rudy Giuliani also received the monoclonal antibodies while hospitalized.
MAbs are not the only treatment options. Corticosteroids, especially dexamethasone, are used to treat hospitalized patients and can reduce the likelihood of dying by 33 percent in patients receiving supplementary oxygen, according to a study by the University of Oxford. They’re also prescribed to treat chest congestion experienced by many Covid-19 patients. Corticosteroids are cheap and readily available.
Protease inhibitors are also an emerging area of interest. They work by inhibiting an enzyme the virus needs to replicate in human cells and are already used to treat other viral pathogens such as HIV and hepatitis C. Pfizer’s new experimental oral drug to treat Covid-19 is a protease inhibitor to be used at the first sign of illness and could be available by the end of the year, according to Pfizer. It can be taken at home. Health experts are calling it a potential game changer although safety and effectiveness remain under investigation.
One antiviral is an experimental drug currently being touted by Merck. Molnupiravir, is said by the company to reduce hospitalization and death in those with mild or moderate cases, by half. An independent oversight panel recommended Merck’s initial study be concluded and summarized early due to highly promising results. The drug will be presented to the FDA for EUA consideration.
There’s a political side to the mAbs and other treatments. Promotion of treatments in general over vaccines by DeSantis, Abbott, and others has resulted in pushback by some healthcare experts.
“We know what works to prevent people from contracting this disease in the first place, masking and vaccination. We should be focusing on these preventive measures,” Dr. Leana Wen, an emergency physician and visiting professor at the George Washington University Milken Institute School of Public Health, wrote in a statement published by CNN. “It’s totally backwards to say that we should be focused on treatment instead of emphasizing prevention, and the steps that we know work to stop Covid-19 in the first place.”
The stock market is also weighing in, with shares in Pfizer and Moderna falling in premarket trading on Friday on expectations that Merck’s pill for treating the disease could undercut future demand for vaccination, according to a Reuters report.