Steady progress is being made in the treatment of patients hospitalized for COVID-19. The advances come together with the understanding that the disease is far more complex than a simple pneumonia. The most recent progress comes from a May 6th report in the Journal of the American College of Cardiology examining medical records of 2773 COVID-19 patients in five New York City hospitals.
The study was initiated after the realization that COVID-19 disease includes the formation life-threatening blood clots. These clots can cause heart attacks, strokes, kidney failure, and additional lung damage. Such clots are often the cause of death in younger patients too. The records were examined to determine what impact blood thinners had on a patient’s survival and the length of time to discharge or death. Of the patient records studied, 786 having received a full treatment dose of anticoagulants. Those patients were further divided into those who were intubated and those who were not.
The most striking results were observed for those with the most serious disease who were intubated. The survival rate rate of intubated patients treated with anticoagulants was 70.9% as compared to 37.3% for who did not. The time to discharge from the hospital for those who did survive was also shorter for those who received anticoagulant therapy as compared to those that did not. This is very good news. Not long ago another New York hospital system reported that 88% of intubated COVID-19 patients died.
Still, there is much more work to do. Several anticoagulants are approved for use. Which one and in what dose is best for what type of patient? Hospitals are beginning to be much more selective about which patients are intubated and which are not, recognizing the complex course of the disease.
Infusing a patient with serum from a COVID-19 survivor has yielded promising results in preliminary trials. Efforts to improve serum based treatments by purifying and concentrating the responsible antibodies are in progress. These will be followed by administration of monoclonal antibodies, the best form of serum based therapies.
I recently described an independent study from Hong Kong demonstrating the benefit of a four drug cocktail of antiviral drugs that both reduce the time to discharge and the viral load of patients with mild to moderate COVID-19 symptoms. All of the drugs in the “Hong Kong Cocktail” are approved for the treatment of viral diseases and, importantly, are generic and abundantly available. I have also reviewed the published evidence for some if the most highly touted drugs including hydroxchloroquine and remdesivir and do not find the data convincing. Fortunately, drugs and treatments that have statistically significant effects on the course of the disease are coming into view.
Doctors around the world recognize that much of the damage to the lung and the organs is inflicted not by the virus directly but rather as a consequence of an overactive immune response called a cytokine storm. Many already approved drugs that modulate the immune response, including many used for the treatment of arthritis and other autoimmune diseases, are currently being tested in COVID-19 patients. Some have failed to make a difference but there are existing and new drugs still left to try.
Once a drug is shown to improve outcomes the next course is clear: Learn to make the best use of that drug—determining who to give it to, when to give it, and in what dose. The next steps are also clear— combine two different treatments, for example the Hong Kong Cocktail with anticoagulatn therapy. Add anti-cytokine storm drugs if and when they are shown to work.
All this progress can and has made a real difference for COVID-19 patient survival. The goal is to save as many lives as possible with existing drugs until such time as new drugs that specifically target SARS-CoV-2 come on line. This new generation of drugs should stop the virus altogether before it has a chance to cause much damage. Many such drugs are now entering human trials and there are many more to come. Then we can be confident that there is a cure for COVID.