Indeed, case-reports from hospitals across the world seem to suggest multiple points and pathways of attack in the body.
One arm—low-dose dexamethasone—of the University of Oxford’s RECOVERY trial of therapeutics to fight Covid-19 has reported major success. Dexamethasone cuts risk of death by a third for those who are on ventilators and by a fifth for those requiring oxygen-supply. The trial involved 2,000 hospitalised patients who were administered low doses of the corticosteroid that is used to treat many chronic and acute conditions arising due to the immune system acting up. Given mortality in Covid-19 has been linked to, among other pathologies, cytokine storms—the immune system going into an overdrive and attacking healthy cells in the body, precipitating organ failure—the immunosupressant action of dexamethasone is also likely to have helped. But, the excitement over dexamethasone needs to be tempered so that it doesn’t get hyped up like hydrochloroquine was, which, in turn, will fuel strong dismissals of the line of treatment—quite like the fate HCQ has met—in cases where it doesn’t prove as effective; bear in mind, Covid-19, and how the pathogen, SARS CoV-2, interacts with the body, is not fully understood at the moment.
Indeed, case-reports from hospitals across the world seem to suggest multiple points and pathways of attack in the body. Therefore, the WHO line that dexamethasone can be a life-saver for those critically ill with Covid-19 is a more pragmatic stance than the UK hailing it as the “world’s first coronavirus treatment”. That said, the landscape of pharmacological interventions certainly looks brighter than it did just a few weeks ago. Signs of progress have come earlier than they did with past pandemics, perhaps because the genetic details of the virus were shared much earlier than usual, large-scale trials are being coordinated across nations, there is unprecedented knowledge-sharing (albeit with obvious risks) and technology & data science have become big enablers.
There are multiple vaccine candidates that are either in or are approaching late-stage human trials—US-based Moderna’s (developed by public sector National Institute of Allergy and Infectious Diseases), China-based CanSino Biologicals (developed by public sector Beijing Institute of Biotechnology), AstraZeneca’s (developed by the University of Oxford), among others. Depending on how they measure up against the endpoints in the respective trials, the world is likely to have a Covid-19 vaccine by the end of the year. Twelve of the 140-odd vaccine candidates under development are in various stages of human trials. Trials are underway for some repurposed vaccines—BCG, polio—also. Then, there are a host of monoclonal antibodies under development, after reports of some degree of success with neutralising the SARS CoV-2 virus. China’s Capital Medical University, the Netherlands’ Utrecht University-led team, the US’s University of Maryland and University of California-San Diego, Israel’s top biotechnological research lab funded by the country’s defence ministry, and many private pharma concerns, have all reported potent monoclonal antibodies that can be marshalled to fight Covid-19.
While all this pharmacological progress is encouraging, two things need to be carefully considered—one, the trade-offs of fast-tracking vaccine/drug approval, and two, ensuring equitable access. While ‘faster than usual’ approval for a vaccine/drug—by reducing the number of regulatory loops—seems justified given the way the disease is progressing, it is important to study over the longer term the effects of sidestepping regulatory obligations. Equitable access is also important because a large part of the global population has to have access to pharmacological interventions as early in the day as possible if the virus is not to be allowed to become a lingering threat. Without this, all promises of pharmacological interventions could sour.