The Road Towards a Cure

By IGHN Key Correspondent, Quwam Kelani

Coronavirus is a large family of viruses that can cause illnesses varying from the common cold to severe diseases such as Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus named COVID-19 (SARS-COV-2) has spawned a pandemic, infecting over 2 million people and more than 100,000 fatalities globally.

The crown-shaped virus moves through the respiratory tract by attaching itself to cell receptors from the nasal passage to the mucous membranes behind the throat of its host. The spike-like property of the virus permits the genetic material of the virus to penetrate the human cell. The virus then multiplies in the host’s body in the disguise of human cells,  further infecting neighbouring cells. This trend continues progressively through the bronchial tube to the lungs. When it gets to the lungs, the infection causes inflammation in the mucous membrane and damages the alveoli (air sac). The inflamed lung leads to difficulty in oxygenation of the blood and removal of carbon dioxide from the bloodstream. This impaired flow of gasses causes life-threatening infections such as pneumonia bearing flu like symptoms. In severe cases, the inflammation caused by the virus can lead to organ malfunctions, notably, to the kidneys, liver and the heart.

There is no current form of prevention or treatment to reduce the burden of COVID-19 due to its novelty. However, the genetic sequence published early in the year by Chinese scientists has triggered the search for vaccines and active drugs by scientists and big pharma around the world. 

Over the years, vaccine projects use a traditional prevention approach. Like the flu vaccine, modified forms of the virus are introduced into the body to stimulate the immune system to produce antibodies to prevent the pathogen from infecting its host. For COVID-19, pharmaceutical companies are experimenting with modern technology platforms that involve extracting the genetic code from SARS-COV-2 to construct recombinant proteins, nucleic acid (DNA and RNA), peptides, amongst others.

Sars-CoV-2 is a novel pathogen in humans. Similarly, modern technologies currently used are relatively new and unproven. Moreover, vaccinologists have not recorded a successful human vaccine against any member of the coronavirus family. While the race to provide the first coronavirus vaccine is fierce, it is important to handle it conscientiously  by establishing necessary scientific principles such as safety and efficacy.

The incomplete vaccine stereotype pharmacovigilance during past coronavirus related outbreaks in SARS and the Middle East Respiratory Syndrome (MERS) play a significant role in the Preliminary phase of COVID-19 Vaccine production. A biotech company named Moderna was the first to start clinical trials. The latest pharma to try their vaccine prototype on humans is Inovio Pharmaceuticals. A biotech company based in Maryland; Novavax, shows their vaccine prototype has already stimulated the immune systems of animals to produce antibodies that fight off coronavirus. Human trial for the candidate vaccine will commence in May.

Ideally, it takes between 10 to 15 years for vaccines to go from development, through testing phases toward licensing, including large-scale manufacture. The WHO has raised cautious hope; COVID-19 vaccine could take 12 to 18 months to be universally available. By that estimate, vaccines approved for COVID-19 may arrive when the current pandemic is over.

In the meantime, the incidence rate of COVID-19 is significantly on the rise in tandem with increased daily deaths. The WHO has launched a solidarity clinical trial to investigate the use of existing medicines to treat COVID-19. The test will involve enrolling patients from hospitals around the world in one single randomized trial to compare worldwide unproven treatments. The solidarity clinical trial will eliminate 80% of the time used in randomized clinical trials for medications.  

The selected treatments based on laboratory, animal and clinical evidence are; Hydroxychloroquine or Chloroquine, Lopinavir/Ritonavir, Lopinavir/Ritonavir with interferon beta-1a and Remdesivir.

Hydroxychloroquine and chloroquine are the current treatment for rheumatology conditions and malaria, respectively. Recent studies indicate the presence of chloroquine sulphate is effective against COVID-19 induced pneumonia, but they are yet to undergo randomized trials. Lopinavir/Ritonavir is one of the treatments for HIV. Though laboratory experiments suggest the combination may be effective against COVID-19, studies with COVID-19 patients appear inconclusive. Remdesivir beforehand has been tested as an Ebola regimen. It generated positive results in animal studies for SARS and MERS caused by coronaviruses. Those studies signify it might replicate its positive effects with COVID-19.  

Remdesivir is being used as an ad hoc treatment before regulatory approval alongside current containment measures. It potentially suggests that treatments for COVID-19 may be available before vaccines. If that is the case, COVID-19 vaccine will be more efficient if COVID-19 becomes a seasonal infection. Furthermore, it can be redeployed when a different coronavirus outbreak occurs. 

Whenever the drug or vaccine for COVID-19 is introduced to the market, political tension similar to the allocation of personal protective equipment (PPE), test kits and ventilators will arise. There is a need for global procurement and distribution agreements to allocate stocks to countries worldwide. Everyone has a fundamental right to equal access to essential medicines.

References:

1. Akst, J. (n.d.). COVID-19 Vaccine Frontrunners. Retrieved from https://www.the-scientist.com/news-opinion/covid-19-vaccine-frontrunners-67382
2. (2020, February 15). Retrieved from https://www.cdc.gov/coronavirus/types.html
3. Off-label use of medicines for COVID-19. (n.d.). Retrieved from https://www.who.int/news-room/commentaries/detail/off-label-use-of-medicines-for-covid-19
4. (2020, April 5). Coronavirus vaccine: The race to keep millions safe from COVID-19. Retrieved from https://news.sky.com/story/coronavirus-vaccine-the-race-to-keep-millions-safe-from-covid-19-11968262
5. “Solidarity” clinical trial for COVID-19 treatments . (n.d.). Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments