By mid month, COVID-19 global fatality surpassed 440,000 lives. These deaths are no longer foreign or of mere statistical significance to a lot of us and many families. The US, six months into the pandemic still features some of the most infectious centers in the world, accounting for a disproportionately higher number of deaths. The month was filled with daily commentary of bad news and hard facts about COVID-19 virus ravaging communities. Incidents of police brutality and the protests that soon followed made the need to social distance, even among those willing to comply, a tall order. Local and regional variabilities in public health responses are yielding variable outcomes that will only ensure that the pandemic lasts as much as the virus would like. The unfolding rate of new infections tell the rest of the story as some cold spots turn hot in the second half of the month. In June, the US Food and Drug Administration (FDA) at the request of the US Biomedical Advanced Research and Development (BARDA) dealt a death blow to what was left of hope around chloroquine and hydoxychloroquine (CHQ/hCHQ) as COVID-19 therapeutic agents. Revoking the emergency-use authorization (EUA) for CHQ/hCHQ , the FDA noted that data shows the drug unlikely to be effective and said "Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquone and hydoxychloroquine no longer outweigh the known potential risks for the authorized use". It based its decision on some of the already known scientific data citing that the observation of reported decrease in viral shedding with chloroquine and hydroxychloroquine as a mechanism of action could not be replicated reliably in large controlled studies. Even more alarming in the report, was that the co-administration with remdesvir, another drug that enjoys an EUA status, in COVID-19 patients reduces remdesvir's antiviral efficacy. It warned that in vitro data shows the two drugs are antagonistic.The agency, however, did not recommend the cessation of use of the drugs in hospitalized patients for whom the drug was already in use or for whom it had been authorized.
Providers of care and the public remained apprehensive as everyone waited for some clarification from the scientific community as soon as some US politicians started advocating for the drugs and self-medicating against doctors' advice. Never had there been so much side talk, suspicion towards, and motives ascribed to an agency's pronouncements for or against a drug as we saw with CHQ/hCHQ. CHQ/hCHQ nevertheless remains a staple as part of the anti-COVID cocktail in some countries. The preceding non-scientific messaging around the agents could not have happened at a worse time and was unfortunate because so many lives depended on good information. Doctors and most importantly those they treat needed to have absolute confidence that they have the best and scientifically vetted information about the tools available to them .
Various agents are under investigation for treatment of COVID-19 infection at the same time that there is a scramble to develop a protective vaccine. Three months ago in March of 2020, the RECOVERY trial was established as a randomized clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients were enrolled from over 175 NHS hospitals in the UK.Some of the agents under clinical trials include:
- Lopinavir-Ritonavir (commonly used to treat HIV)
- Dexamethasone (a type of steroid, which typically used to reduce inflammation)
- Hydroxychloroquine (which has now been stopped due to lack of efficacy)
- Azithromycin (a commonly used antibiotic)
- Tocilizumab (an anti-inflammatory treatment given by injection)
- Convalescent plasma (collected from donors who have recovered from COVID-19 and contains antibodies against the SARS-CoV-2 virus).
Some good news though came when on June 16, 2020., the University of Oxford published preliminary results of its RECOVERY (Randomized Evaluation of COVid-19 thERapY) trial which show that low dose dexamethasone decreased mortality in seriously ill ventilator requiring COVID-19 patients by as much as a third compared to those who received usual care.