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Is there a roadblock in the cure for COVID-19? - (7/21/2020)

By Dr. Ron Gasbarro

Bert was in the pharmacy, getting his diabetes medication refilled. “Hey, Doc,” Burt said to the pharmacist, “Why is it with all of our medical advances, even with cancer, that we cannot exterminate a simple virus? I keep hearing about certain drugs, but nothing is on the market yet. Why are there roadblocks? I’m confused.” The pharmacist agreed with Bert. Yes, confusion is common when the executive branch of the United States hawks a drug for lupus that research showed little or no activity against COVID-19. Or that Americans should inject Clorox® into our veins or shine an ultraviolet light up our behinds. Disastrously, people did this stuff! Aren’t we all waiting for the magic potion that will render our facemasks obsolete? A tonic that will allow us to hug one another again? Coincidentally, a vaccine has been sworn to appear exactly one day before the presidential election on November 3rd. A typical vaccine takes years to discover, test, manufacture, and distribute. But don’t expect people to line up at Walgreen’s for a Dr. Drumpf’s Miraculous Snake Oil Shot on their way to the voting booth.

Flashback to the 1990s. HIV had been around for a decade, with a near 100% fatality rate, and still, no vaccine emerged. Even today, no vaccine against AIDS exists. Many molecules have been tested, but roadblocks abound. However, plenty of oral compounds can be used to keep that viral disease at bay. Similarly, researchers are studiously seeking anti-COVID medications that will genuinely work to save lives – not line the pockets of impeached politicians. 

Newscasts will always tempt viewers by announcing a “promising” drug in the COVID-19 pipeline. Yet, most of these molecules will never go to market. However, several medications are a few steps ahead of the others. For example, dexamethasone (Decadron®) is an older steroid clinicians use to treat various respiratory conditions that cause inflammation in the lungs, such as asthma. In COVID, when patients are on a ventilator and are likely to expire, the drug can decrease the inflammation and ease breathing until the patient gains enough strength to survive. The drawback: Patients must be in critical condition to receive the drug.

Because a virus causes COVID, finding an appropriate antiviral drug to fight it makes sense. Remdesivir is one such antiviral that keeps the virus from replicating inside the body. This drug is not new. It was initially formulated to treat hepatitis C and was also researched as a treatment for other novel coronaviruses that infect humans like the virus that causes COVID-19. Remdesivir does not prevent the viral infection but can reduce the time to clinical recovery. The benefit of remdesivir is most evident in hospitalized patients who are not on a ventilator but require supplemental oxygen. The drawback: The drug does not necessarily extend life. Hence, other antivirals are being tested.

The pharmacist told Bert that about 170 potential vaccines for COVID are presently in the works. Not only are drug companies competing with each other, but also countries who want to be the first to treat their own citizens. The fastest a vaccine has ever gotten to market was the mumps vaccine, which went from brainstorm in 1963 to public use in 1967. To imagine that a vaccine could effectively clear the safety hurdles and traverse the politics associated with such a venture in an even shorter time is the stuff of medical textbook legend. The FDA can approve a vaccine if it helps up to 50% of the population. Even then, there are no promises. Until then, wear a mask, wash your hands, and assume there will be roadblocks along the way. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.  

 


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