Is the Coronavirus Treatable?
- There is a race going on to develop treatments and vaccines that might be effective in fighting the coronavirus
- Remdesivir, an antiviral drug that was developed to treat Ebola, has shown promise as a treatment for the virus
- Chloroquine, an anti-malaria drug that has been in use since 1934, is likewise showing good potential against the coronavirus in initial laboratory tests.
So how long will it take for the world to get an effective treatment or vaccine for the coronavirus? People in cancer treatment, and any others with a lowered immune system, are of course all the more concerned about contracting the virus and eager to take all reasonable precautions to avoid it. Fortunately, there's also some good news on the horizon, in the form of potentially successful treatments for the virus. Given the desire to contain the disease, these treatments will be moved forward as quickly as is medically responsible.
Read MoreRemdesivir
One promising option is the investigational drug remdesivir, which was originally developed to counter the Ebola virus. A controlled clinical trial of this drug, for adults diagnosed with the coronavirus who are now hospitalized, has begun at the University of Nebraska Medical Center. Remdesivir inhibits an enzyme called an RNA-dependent RNA polymerase. Coronaviruses, along with many other RNA viruses, use this enzyme to replicate themselves. Because coronaviruses use the enzyme to thrive, an antiviral like remdesivir may well be able to counter them. The drug has been approved for testing in humans but not yet approved for marketing. In January, a 35-year-old man in Washington State who had traveled to China and was then diagnosed with the coronavirus, was given remdesivir on a "compassionate care" basis; he recovered from the virus. Some experts say that the drug will especially benefit patients who are treated with it in the earlier stages of the disease; prescribing it upon someone's initial diagnosis with COVID-19 may prove most productive. Two trials are currently underway in China, and early results have been promising.People with cancer who contract COVID-19 may have a greater chance of being offered this drug option.
"There will be a lower threshold for medical attention for cancer patients," explains Amesh A. Adalja, M.D., a physician specializing in infectious disease and a Senior Scholar at the Johns Hopkins Center for Health Security, "and, as such, they may be candidates for remdesivir."
Because the trials for remdesivir are just beginning, decisions about its use with COVID-19 will be case-by-case.
"In situations where a drug is given as 'compassionate care,' it's done with full communication between…the patient, the primary care team, the hospital ethics board, the drug manufacturer, and the FDA," explains Dr. Desai. "Based on the available data," he says of remdesivir, "I think that it should be given in situations where a person is clinically worsening and those most closely involved agree that it's the best path forward."
Chloroquine
An anti-malaria drug that came into use in 1934, Chloroquine, is being examined for COVID-19 in various clinical trials, spanning over 100 patients and 10 hospitals in China, and has also shown encouraging early results. The drug has both anti-viral and immune-modulating effects, which may work together for more powerful benefits. While testing continues, says Dr. Adalja, "since [chloroquine is] FDA-approved, clinicians can use it off-label if they so choose."
They will likely not, however, at this time prescribe it in combination with remdisivir or any other early COVID-19 treatment option. Until potential drug interactions are better known, "combination therapy should be studied in a controlled fashion, to monitor for drug-drug reactions or additive toxicity," Dr. Adalja notes.
Understanding of drug efficacy must also be considered, Dr. Desai tells SurvivorNet: "Typically when a medication is given for an off-label use, it's done in isolation. That's because it's important to closely monitor for clinical improvement or deterioration and share that information with everyone involved, so that others can learn from the experience. Offering two medications off-label isn't done, because that can make it difficult to know which medication, if either, is helping."
Chad Sanborn, M.D., an infections disease specialist at KIDZ Medical Services in West Palm Beach, Florida, tells SurvivorNet he himself would prescribe either of these drugs to benefit COVID-19 patients, but he advises us to bear in mind that our current understanding of the situation is limited.
"At this time, as a clinician, I personally would not have a problem giving either remdesivir or chloroquine…to severely ill and/or severely immunosuppressed patients, including those with cancer," he states. However, since this coronavirus appeared only recently, "we do not have proof of these medications’ effectiveness in humans against COVID-19, nor their safety in people with this particular infection."
Vaccine
Clearly, a vaccine to ward off COVID-19 would be a welcome development; and several companies, including pharmaceutical agency Sanofi Pasteur and biotech group Moderna, are working intensely to deliver one.
Dr. Sanborn points out that for people with cancer, the health status of others with whom they interact most is an important consideration.
"I do think that a vaccine could be enormously helpful in our fight against this virus," he says. "While I can’t say that any vaccine will or will not be safe to give in individuals with cancer, immunizing their healthy family members and close contacts will be helpful in infection prevention."
Dr. Adalja, on the other hand, hypothesizes that people with cancer may be prioritized to receive a vaccine when it arrives. "A vaccine is not expected to be available for 12-18 months," he notes, "but when it is, it may be that cancer patients are among the first tiers of the population to receive it."
However, Dr. Desai notes the importance of dedication and perspective regarding public health issues like this one, even at times when there is no obvious need for urgency. "Thankfully scientists working on vaccines had the foresight to begin working on this after SARS and MERS [viruses]," he notes, "but they were stalled due to lack of funding. Typically when there's no crisis it's hard to gather the political will to work on a public health outbreak. This should serve as a lesson in terms of other looming public health disasters, such as those that could be brought by climate change."
Precautions
Of course, avoiding contraction of the virus is the primary goal. To that end, everyoneand certainly anyone who's immune-compromisedshould wash their hands thoroughly when they come in from outside or when they've touched public objects that many others have as well, such as elevator buttons. Make sure you use hot water and spend about 20 seconds hand-washing each time. This particular coronavirus possesses little resistance to soap and water and will be killed by a good wash; remember that if you start to feel overwhelmed by it.
You can also try to keep a distance of several feet between yourself and those who are experiencing symptoms such as fever, cough, and sore throat; therefore, especially for those who are immune-compromised, entering tightly packed crowds may not be ideal at this time. (It's generally recommended that people receiving chemotherapy avoid such situations, with or without the threat of the coronavirus.) Try to keep your hands away from your eyes and mouth, to avoid loading yourself with germs your hands may inadvertently be carrying.
Cancer centers are taking precautions to keep patients safe. And the advice to stay home if you're displaying possible coronavirus symptoms goes double for visiting anyone who's currently immune-compromised. Save the visit for a time when your symptoms have resolved.
Dr. Waleed Javaid explains what coronaviruses are and what precautions immunocompromised people should take now.
Perspective
Dr. Desai offers some excellent insight for people with cancer in regard to COVID-19.
"In the months ahead," he says, "the world will learn more about how to diagnose and manage COVID-19 in individuals with pre-existing illnesses like cancer. Meanwhile, I think that people with cancer have something to teach the world.”
Indeed, people facing cancer know better than many that, though with extra precautions at times, ultimately life is for living.
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