Research scientists around the world, including on Long Island, are working nonstop to test drug treatments for COVID-19, as the number of people infected with the virus continues to climb.
Medical experts hope some of the treatments will at least slow down the coronavirus, which made it to Long Island on March 5. First detected in mainland China in December, there have been no drugs specifically approved to treat people with COVID-19.
“Right now, we are moving mountains to start clinical trials in days that would normally take months,” said Dr. Kevin J. Tracey, president and CEO of the Manhasset-based Feinstein Institutes for Medical Research at Northwell Health.
Those trials include using drugs already approved by the U.S. Food and Drug Administration, as well as an investigational anti-viral medicine and the use of blood plasma from COVID-19 patients who have recovered.
“I think we are going to improve the treatment of our patients with existing drugs through these careful studies,” Tracey said.
Globally, about 1.1 million people have tested positive for the virus and more than 62,000 have died, according to the World Health Organization. In the United States, the number of positive cases is more than 304,000 with more than 7,600 deaths, according to the Centers for Disease Control and Prevention.
The elderly and people with underlying health conditions are especially vulnerable to COVID-19, which can cause severe respiratory illness.
Clinical trials are key to effective treatments, even if it means long delays in use by the majority of patients who need them, said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and an infectious disease specialist at Vanderbilt University Medical Center.
“There are any number of drugs in the laboratory that seem to have some kind of anti-viral effect,” he said. “That’s very intriguing. But there’s a long distance between what works in the lab and what works in humans.”
Hope in existing drugs
Two federally approved drugs — one used to treat arthritis and prevent malaria and the other an antibiotic that clears sinus infections — are being touted as a promising treatment for COVID-19.
Supporters, including President Donald Trump, said the combination of hydroxychloroquine (Plaquenil) and azithromycin (Zithromax) has helped some COVID-19 positive patients recover from their illness.
A recent study in China showed that COVID patients given hydroxychloroquine showed improvements in pneumonia.
But some experts are pushing back against the hype, warning that none of these findings were the results of rigorous, peer-reviewed trials.
“The one paper that was published has been challenged — severely challenged — by the world of medicine and science,” Tracey said.
Dr. Kenneth Kaushansky, senior vice president of health services and dean of the Renaissance School of Medicine at Stony Brook University, said he reached out to New York State Health Commissioner Howard Zucker to discuss Stony Brook as a site for a clinical trial of hydroxychloroquine and azithromycin.
“No one believes these drugs are going to be the silver bullet that cures COVID-19,” he said. “At best, it might prevent the disease from progressing.”
Kaushansky said the anecdotal evidence shows it might be effective.
“We ought to be testing that in a carefully controlled clinical trial,” he said.
Another drug experts think might help COVID-19 patients is sarilumab (Kevzara), which was designed by pharmaceutal company Regeneron to help people who suffer from juvenile rheumatoid arthritis.
Both Stony Brook and Northwell are using it in clinical trials.
The drug blocks Interleukin 6, a protein in the body that drives inflammation, Kaushansky said.
“When you get COVID-19, there’s a lot of inflammation in the lungs,” he said. “If you can calm down the IL-6, you might calm down the lung problems.”
The promise of remdesivir
An experimental medicine that has gotten attention publicly and in the science community is remdesivir. Developed by Gilead Sciences to treat people infected with the Ebola virus, the drug is being used in trials to treat people infected with COVID-19. The drug inhibits the enzyme needed to replicate the virus.
“The idea is if you stop the virus from replicating, the patient will hopefully get better,” Tracey said, explaining how the drug works.
Hospital systems including Northwell, Stony Brook, NYU Langone Health and Catholic Health Services are participating in remdesivir clinical trials.
Mount Sinai South Nassau is currently treating some patients with remdesivir as well as sarilumab, said Dr. Aaron Glatt, chair of the department of medicine and the chief of infectious diseases at Mount Sinai South Nassau hospital in Oceanside.
"As we learn more and more every day, we are going to get closer to having more definitive and better answers and hopefully be able to help people," he said.
People who have recovered from COVID-19 could have a powerful weapon in their blood — antibodies.
Researchers are trying to determine if those antibodies could stop the infection in another patient or prevent the infection.
Northwell, Stony Brook and Catholic Health Services are poised to launch clinical trials on the use of convalescent plasma.
“There’s been a lot written about this as if it was a simple thing to take plasma out of one person and give it to another,” Tracey said. “It’s not a simple thing. There are risks and benefits to everything you do in medicine.”
“Most of our efforts right now are trying to help the most severely ill people with medications — we have to focus on the people whose lives are at risk,” said Dr. Vincent M. B. Silenzio, professor at the Department of Urban-Global Public Health at the Rutgers School of Public Health. “At the same time, maybe three dozen companies are out there working on a vaccine."
Vaccines can take years or even decades to develop. The most ambitious estimates show a COVID-19 vaccine ready for the public in 12 to 18 months.
“You want to prove they are safe and effective and that just takes time,” Glatt said. “You certainly don’t want to do something that’s dangerous.”