Fauci: Early-Stage COVID-19 Treatments Are Urgently Needed

Despite encouraging news on Monday regarding a Moderna vaccine candidate’s ability to prevent COVID-19, new treatments are still urgently needed for patients in early stages of the virus. 

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, co-authored a viewpoint article last week emphasizing the need for research dedicated to the early stages of COVID-19. The article, also written by Sarah Read, MD, deputy director, NIAID Division of AIDS, and Peter Kim, MD, director, Treatment Research Program, NIAID Division of AIDS, was published on November 11 in JAMA.

“While treatment options for patients with severe disease requiring hospitalization are now available…interventions that can be administered early during the course of infection to prevent disease progression and longer-term complications are urgently needed,” the researchers wrote.

Researchers are worried that news of effective vaccines, in spite of the fact they’re not yet available, could turn attention away from vital COVID-19 research in other areas. Barry Bloom, PhD, professor of public health at the Harvard T.H. Chan School of Public Health in Cambridge, Massachusetts, reminded reporters in a call on Monday that the vaccines, if authorized, will be distributed in phases based on need. They may not be distributed to the general public until April or later. And a lot of spread can happen between now and then. “Younger people tend not to have serious illness, but they can, and if they get the virus, they can transmit it, and serious cases can result,” Bloom said on the call. 

Treatment for early-stage, mild disease is critical to curb this transmission. “Treating people early in the course of infection with SARS-CoV-2, the virus that causes COVID-19, would speed their recovery, reduce the likelihood that they develop severe outcomes and reduce demand on the healthcare system,” the NIAID researchers write.

Reducing severe outcomes is especially important, the researchers say, since many people have “long recoveries and develop long-lasting fatigue, mental impairment, and problems with heart and lung function.”

The good news is that research regarding early-stage therapeutics is underway. In an email to Verywell, Kim and Read discussed promising treatment developments in three categories: 

1. Antiviral treatments that act directly on the virus and to help stop it from replicating 
2. Immune-modulating treatments that curtail the hyper-inflammatory reaction associated with many COVID-19 symptoms
3. Antithrombotic drugs that prevent the hypercoagulation (blood clotting) associated with COVID-19 

Antiviral Treatments

• Convalescent plasma is blood plasma taken from people who have had COVID-19 may contain antibodies to the SAR-CoV-2 virus. Therefore, it may be useful as a treatment for people who are ill. 
• Monoclonal antibodies, which are clones of a specific parent immune cell, can bind to or block SARS-CoV-2. Companies working on manufacturing these antibodies include Eli Lilly, Regeneron, Astra Zeneca, Brii Biosciences, and Boehringer Ingelheim. Bamlanivimab, the version made by Eli Lilly, received emergency use authorization from the Food and Drug Administration last week. Currently, monoclonal antibodies are given as an intravenous treatment, which requires time in the hospital or a doctor’s office. But Kim and Read say they may eventually be formulated as injectables, which could allow them to be used at scale. 
• Polyclonal antibodies, which are clones of several different immune cells, are also being developed against SARS-CoV-2. SAB Biotherapeutics is one company developing polyclonal antibodies.
• Interferon-based treatments such as Synairgen's SNG001 are inhaled through a nebulizer.  

Immune-modulating Treatments

Read and Kim say there are many immune modulating treatments in the pipeline, but some noteworthy candidates include:

• Fluvoxamine is a selective serotonin reuptake inhibitor drug used to treat obsessive compulsive disorder (OCD) that may also reduce the hyper-inflammatory response associated with COVID-19. A study published in JAMA last week shows potentially promising effects of this drug.  
• Leronlimab may be able to decrease the damaging immune response of COVID-19 in some people. It is also being evaluated as a potential treatment for cancer and HIV.
• Cyclosporine is a drug commonly used by transplant patients. It may impede negative immune effects seen in COVID-19 and possibly offer antiviral effects as well.

Antithrombotic Treatments

Apixiban and rivaroxaban are two examples of antithrombotics currently being evaluated to prevent the hypercoagulation/blood clotting that has been associated with some cases of COVID-19.

What's Next?

Kim and Read say that while there are a number of hurdles that make developing early-stage drugs challenging, the biggest one may be enrolling enough clinical trial participants. Thousands of volunteers are needed. 

“To definitively test these treatments for COVID-19, we need volunteers who are willing to become participants in clinical trials,” Kim and Read say. “We want treatments that will work for all those affected by COVID-19, including Black, Indigenous, Hispanic, and other communities of color who have been disproportionately affected by this disease. We are working hard to earn their trust and ensure that they are well-represented in COVID-19-related clinical trials so we can be sure that the treatments we are developing will work for them and meet their needs.” 

Patients who have been tested positive for COVID-19 within the last six days can access the clinical trials website to find out about ongoing trials.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.