COVID-19 Therapeutics

“An ounce of prevention is worth a pound of cure.” And still, it is, even though much of this article will be about the new rescue treatments for COVID-19.

The word “rescue” means being saved from a dangerous situation, and rescue is what we hope can happen when we get seriously ill. As a person who was diagnosed with invasive cancer some years ago, I am grateful to have been rescued by knowledgeable physicians who prescribed the latest evidence-based treatments involving surgery, chemotherapy, radiation, and hormone therapy. There are over 17 million cancer survivors alive in the United States today, which is a vast increase over the dismal survival numbers decades ago. And while I cannot speak for those grateful millions in our “survivorship” club nor for all the courageous cancer patients currently undergoing powerful treatments, I do know that if there were a safe, preventive vaccine that could have made my fearful cancer journey unnecessary, I would have been first in line. Wouldn’t you?

Just as I have thanked Drs. Messeih, Glaser, John Jones, Collins, and Keenan for their expert care during my treatment, I also have taken many opportunities to thank cancer researchers in person as a lay stakeholder when I met with them regularly to peer review grant proposals for studying cell cycle and growth. These senior level researchers from universities across the country are some of the unseen laboratory and physician scientists who design and carefully test hypotheses that sometimes translate into lifesaving treatments. They are brilliant, dedicated people who deserve our appreciation. They have mine.

Returning to COVID-19, we know that vaccines are our best tool to avoid severe disease from SARS-CoV-2, but they are not perfect, and some fully vaccinated and even boosted individuals get sick, not to mention the immunocompromised and unvaccinated people who are at much greater risk. In October 2021, unvaccinated people’s risk of dying after getting COVID-19 was 20 times higher than that of fully vaccinated and boosted individuals in the U.S., and half of Lycoming County’s residents are among the unvaccinated. So, when folks contract COVID-19 for any reason, how can they be treated?

There is a range of interventions for COVID-19. Some are for people having mild disease, while others are for patients who have been hospitalized with more severe illness. To learn more about outpatient treatment options, you should phone your doctor or other healthcare provider early in the course of confirmed or suspected COVID-19.

Three different monoclonal antibody treatments were authorized this past year for use in patients aged 12 and over who have risk factors for progressing to severe disease. Eligible patients should be within the first ten days of illness and must not require new or increased use of supplemental oxygen. Generally given as intravenous infusions, monoclonal antibodies work by supplying a burst of antibodies to help the immune system clear the virus. Due to its honing in on a very specific part of the spike protein’s receptors, only one of those three FDA-authorized monoclonal antibodies—sotrovimab—turns out to be effective against the virus’ highly mutated Omicron variant. Sotrovimab is still in short supply. It is being allocated, or some might say “rationed,” to the most at-risk patients who qualify, and not even all of those individuals are presently able to obtain it.

Other than Tamiflu and HIV therapies in the past, there are precious few medicines to combat replicating viruses once they get inside our bodies’ cells. The CDC’s COVID-19 panel recently put remdesivir, another antiviral, on the list of recommended treatments for infected, non-hospitalized patients at high risk of disease progression. It is given as an intravenous outpatient infusion on three consecutive days. Impressively, too, the FDA in December authorized two new game-changing antiviral pills, each to be prescribed to people at high risk within the first five days of illness. One of those medications, Paxlovid, was 88% effective in decreasing death and hospitalization among high-risk clinical trial participants with COVID-19 compared to a placebo control group. Further independent research has also shown that Paxlovid does work against the Omicron variant. Molnupiravir, the other prescription antiviral pill given early in infection, has a different mechanism of action. It is just 30% effective in preventing hospitalization and death, yet it provides significant enough benefit to patients that it gained narrow approval for authorization from the FDA’s independent scientific advisory panel.

Oral antiviral medications are easy for people to take at home, but because they are difficult to manufacture, an adequate supply will not be available for several months. Pricing considerations may also impact equitable distribution to all who might benefit, something that policy-makers must address quickly.

Rescue is costly and at times, precarious, making an ounce of prevention well worth a pound of cure. Please vaccinate, boost, and mask up.

Barbara Hemmendinger, MSS, is a retired clinical social worker and family medicine educator. She is a member of the Lycoming County Health Improvement Coalition and Let’s End COVID!
Published: 1/15/22

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