Most medical professionals agree that we are at least a year to 18 months away from finding a “cure” or a vaccine for the coronavirus, if one exists. But in the meantime, have scientists and medical professionals discovered a treatment for coronavirus patients? That’s the question many Americans are asking, and the answer remains unclear.
The most promising treatment is a combination of hydroxychloroquine and azithromycin, but the studies on its effectiveness have thus far been hit and miss.
Here’s how it works. Coronavirus or COVID-19 is a unique derivative of Severe Acute Respiratory Syndrome or SARS and is considered an RNA virus. Per the National Human Genome Research Institute, RNA, which stands for Ribonucleic acid, “is a molecule similar to DNA. Unlike DNA, RNA is single stranded. … Different types of RNA exist in the cell: messenger RNA (mRNA), ribosomal RNA (rRNA), and transfer RNA (tRNA). More recently, some small RNAs have been found to be involved in regulating gene expression.”
According to an article entitled “The Molecular Biology of Coronaviruses” written in 2006, the virus has the largest genome of all RNA viruses, “including those RNA viruses with segmented genomes. This expansive coding capacity seems to both provide and necessitate a wealth of gene-expression strategies, most of which are incompletely understood.”
Coronavirus works by using its spikes of (S) glycoprotein to enter the cells and blocks the immune system from calling for help. For people with high blood pressure, it’s especially dangerous because enzyme it uses is a protein that helps regulate blood pressure.
“SARS-CoV-2 blocks (the immune system warning system) by a combination of camouflage, snipping off protein markers from the cell that serve as distress beacons and finally shredding any anti-viral instructions that the cell makes before they can be used. As a result, COVID-19 can fester for a month, causing a little damage each day, while most people get over a case of the flu in less than a week.”
Needless to say, COVID-19 is dangerous and there’s still far too much we don’t know.
Hydroxychloroquine (HCQ) has been posited as one of the strong treatment options for COVID-19. Per a member of Focus on the Family’s Physicians Resource Council, “it is an anti-malarial drug that is also used to treat some autoimmune conditions. There is some in vitro data showing that it also inhibits viral replication of some viruses, including SARS-CoV-2, likely by interrupting virus/cell fusion. Animal studies to investigate whether HCQ has any in vivo antiviral activity against SARS-CoV-2 have not been completed. Please note that it is very common for drugs that show in vitro activity to then be shown to have no in vivo activity—this is why we can’t just assume it works in humans based on lab tests. The studies need to be done.”
Hydroxychloroquine is also effective at treating cytokines storms, which usually develops in the plasma of critically ill coronavirus patients and can lead to death.
China was the first to discover that chloroquine can be effective in treating COVID-19, but there is a problem. Chloroquine can cause acute poisoning or be lethal if given in large doses. Hydroxychloroquine, a derivative of chloroquine with hydroxyl added to its DNA, is both seemingly as effective and 40% less toxic than its counterpart. It’s also readily available if proven effective at treating the symptoms of the coronavirus.
Though studies are being run across the world, the results so far remain somewhat promising but inconclusive.
In a small study run out of France, the results were tenuous at best. According to the researchers, those in the study included seven men and four women with a mean age of 58.7 year. Ten of the 11 patients had fevers when the project was initiated, one died and two were eventually transferred to the ICU. After four days of treatment, one patient was pulled off of the hydroxychloroquine and azithromycin because of “prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination.” Long QT syndrome “is a heart rhythm condition that can potentially cause fast, chaotic heartbeats. These rapid heartbeats might trigger a sudden fainting spell or seizure. In some cases, the heart can beat erratically for so long that it causes sudden death.” Normal QT interval is usually below 400 to 440 milliseconds.
The study concluded that, “despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety.”
In another small study, also conducted in France, scientists came to a different conclusion. Based on a study of 36 patients, six of whom were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory infection symptoms, the hydroxychloroquine in combination with the azithromycin was effective. According to the study, “twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature.”
About six patients were lost in follow-up, including three that were transferred to the ICU and one patient who died. None of the control group, those that did not receive the hydroxychloroquine, died. Also, the age of those given the treatment were older (51.2) that those that did not (37.3). Despite some of the setbacks and patients being taken to the ICU, the conclusion was still promising though the concerns about prolonged use resulting in elevated Long QT Syndrome remained unresolved. “We show here that hydroxychloroquine is efficient in clearing viral nasopharyngeal carriage of SARS-CoV-2 in COVID-19 patients in only three to six days, in most patients.”
At this point, more studies with greater protocols and patients must be adopted, but in the midst of a crisis that’s challenging. Does it mean that patients that look terminally ill won’t receive hydroxychloroquine and azithromycin as a ‘hail Mary’ treatment? No, of course not. And it is frustrating to those outside to see some scientists, or journalists as the case may be with CNN, discounting the possibility of hydroxychloroquine and azithromycin being what is needed for us to gain control over the growing crisis.
That’s why we do need to see more studies and larger test and control groups to make a final decision. This makes sure that not only are people receiving the medical support that they need, but that people aren’t dying as an unproven treatment is rolled out in mass.