As the coronavirus pandemic still spreads across the world, there is a massive effort to find effective treatments and a vaccine. Pharmaceutical and biotech companies’ world-wide are focusing their research efforts into finding drugs that can treat all the different symptoms associated with Covid-19, and of course, a vaccine remains the ultimate goal.

Billions of pounds have been pouring into research projects with the hope that treatments (that usually take years to find, test and get to market), can be found and fast-tracked to market.

Being a new virus, very little is known about how Covid-19 would affect the body. Since the first reports of cases in China, a lot has been learnt about the virus and hundreds of scientific papers have been written by doctors and scientists from different countries, sharing their experience and observations.

We now know that what initially appeared to be a respiratory infection, similar to SARS or Avian flu, actually has many other effects on the body beyond the lungs and can go on to affect the brain, eyes, nose, heart, blood vessels, livers, kidneys and intestines — virtually every organ in the human body.

Being a new virus there was also no cure or treatment plan. The search for therapies for Covid-19 falls roughly into several distinct categories: Preventing infection, reducing viral infection and treating the consequences of infection. Firstly, there is the search for a vaccine.

Vaccines work by priming the body’s immune system to a pathogen so that when it encounters that pathogen for real the body can launch an effective immune response quickly and the person does not go down with the disease. However, the common cold is a coronavirus, and there is still no vaccine for that. Many research projects are looking into potential candidates for a vaccine and several trials are already underway.

Usually developing a vaccine takes many years as potential candidates have to go through several clinical trials to test for safety, then how effective they are at launching an immune response and protecting people from the disease. The failure rate for drug candidates is high. Even given the amount of financial backing and international will power to find a vaccine it is doubtful one will be developed, and ready within the next year to 18 months.

Without a vaccine, it is critical that research is also focused on finding drugs that can treat Covid-19. One approach is to try to stop the virus from getting established in the body and entering cells. This can be problematic as people do not show symptoms for several days after being infected and even after that many will show only mild symptoms.

So, by the time patients are seriously ill and get to the hospital the virus is already causing problems. But there is a class of drugs called antivirals that prevent viruses from replicating — and they have been effective in treating some diseases including HIV and hepatitis. There is still no vaccine for HIV, but antiviral drugs have managed to reduce the viral load in HIV patients and allowed them to remain symptom-free.

Several anti-viral drug candidates are being trialled for Covid-19. Currently, an anti-viral drug called Remdesivir, which is an investigational drug that has been previously tested for use against Ebola, has been trialled for Covid-19 and some studies have shown it can reduce the recovery time in hospital. On this basis, the FDA in America has authorised the emergency use of Remdesivir in patients with severe disease.

The basis of this decision is that there are currently no other treatment options or approved drugs available, and this drug may offer an approach in severe cases. However, Remdesivir remains an investigational drug which has not been approved by the FDA for any other use.

Clinical trials of Remdesivir continue all over the world — and although more knowledge of its side effects and biochemical profile are still needed, in the absence of other options, it is now being used to treat patients in the US, UK, Japan and no doubt other countries will follow until other options are found. More trials are needed to assess how effective Remdesivir is in patients with different severity of the disease and if it can reduce the death rate.

Patients who end up in the hospital often cope at home for the first week, then seem to go downhill (think about Boris Johnson.) and end up needing hospital treatment. Many of these patients experience difficulty breathing and low oxygen levels as the lungs are affected, but also many exhibit a heightened inflammatory response due to the body’s immune system over-reacting to the virus.

This inflammatory response adversely affects the body’s other organs, including the heart and kidneys, and can lead to multi-organ failure. In addition, blood clotting complications have been observed in many hospital patients. So, targeting treatments that can moderate this inflammatory response is another target area for drug development.

Trying to reduce the body’s overreacting immune system is a difficult balancing act — on the one hand, you want to dampen down the immune system and inflammatory response but not allow the virus to take hold again. Given that there are currently no treatment options to prevent Covid-19 from progressing doctors need therapies now that can save the lives of the most severely ill Covid-19 patients in the hospital that present with a range of symptoms.

One treatment that has already been trialled is taking immune material from the blood of patients who have recovered from Covid-19, based on the assumption that it will contain antibodies to the virus. This is an expensive and time-consuming option and relies on donations from previously infected people. As a therapy, it is more of a stop-gap treatment as it cannot easily be up-scaled to a treatment option to treat thousands of patients. But there are trials to see how effective this treatment is.

Other therapies in development are focused on reducing the body’s inflammatory response to the virus; these include the use of monoclonal antibodies that modulate the immune system.

Some of these candidates are already being looked at for other inflammatory diseases such as rheumatoid arthritis, and scientists are looking to see if any could be used for Covid-19.
Despite the political promises and financial investments, finding a vaccine or effective treatment for Covid-19 might still take some time.

Doctors globally have learnt a lot about the virus and the varying symptoms it causes, plus identifying those most at risk of more severe disease.

What they have learnt from this first wave of infections will be shared globally and best treatment options will be assessed — but without any effective new treatments, such as anti-virals, a second wave of the virus could still be devastating in terms of numbers affected, hospitalised and dying. Science will hopefully find a solution, but we need to be prepared for the fact it may not be here as quickly as we would like.

In the meantime preventing the virus from spreading is our best line of defence — social distancing, mask-wearing and hand washing are the mainstays of prevention and need to be adhered to by all of us. Otherwise, a second wave could be just as devastating as the first.

Rachel Kayani