COVID-19: Vaccines to be tested in healthcare workers; Could survivors be the answer for a new treatment?

By Melissa Sammy, MDLinx
Published March 25, 2020

Key Takeaways

With a surge of new COVID-19 cases and a rising worldwide death toll, the medical community has launched a vigorous global arms race to find a cure for those affected by the disease. As things stand now, however, the shortage of medical equipment and supplies are forcing US doctors to consider universal do-not-resuscitate orders for patients with COVID-19. Although the current reality may be bleak, there is hope on the horizon. 

Researchers are taking a second look at some old and relatively new drugs for the treatment of COVID-19. Results from a small scale study are already showing how hydroxychloroquine may fare against the virus, amidst announcements from the WHO that a global trial is underway to test a World War II antimalarial against a drug combo that’s proven effective against HIV and a drug originally developed to combat Ebola virus.

Meanwhile, some physicians and state officials are taking matters into their own hands in the search to save lives by turning their attention toward less conventional treatment options, including the use of a popular supplement in real-time clinical practice and evaluating how survivors can help mitigate risk for future patients. 

Seeking antibodies

The FDA is expediting the use of a blood plasma treatment for seriously ill patients with COVID-19. Blood donors would include those who are COVID-19 survivors. The process—plasma-derived therapy or convalescent plasma—involves doctors analyzing the plasma of people who’ve recovered from the disease for antibodies to the virus, and then injecting that plasma into the affected patient.

New York Governor Andrew Cuomo also recently announced that the state would begin working on a test for COVID-19 survivors, who would be allowed to return to work if their blood contains coronavirus antibodies, indicating immunity to the disease. Of note, there have been cases of reinfection among COVID-19 survivors, and it remains unclear how this test would address this concern. 

Researchers are hopeful that the plasma infusion and antibody tests will save lives and stimulate the economy by treating the most severe patients and allowing survivors to go back to work.

A dose of sunshine for dark times

Although there isn’t any clinical trial evidence supporting the use of vitamin C for COVID-19, that hasn’t stopped doctors from using the antioxidant to treat their critically ill patients. In patients with severe disease, vitamin C levels are often significantly reduced when they suffer sepsis.

“It makes all the sense in the world to try and maintain this level of vitamin C,” Andrew Weber, MD, a New York-based pulmonologist and critical-care specialist, told the New York Post.

To that end, Dr. Weber has been administering 1,500 mg of vitamin C intravenously to ICU patients with COVID-19, with the same massive dose repeated 3-4 times each day. Each dose is over 16 times the daily recommended dietary allowance of vitamin C, which is 90 mg for adult men and 75 mg for adult women.

The treatment regimen is based on positive reports from China, where people in Shanghai received large doses of the vitamin. According to Dr. Weber, “The patients who received vitamin C did significantly better than those who did not get vitamin C.”

A randomized, triple-blind clinical trial on the effectiveness of intravenous vitamin C in patients with COVID-19 is currently underway, and is expected to be complete by September 30, 2020.

An old vaccine for a modern disease

According to some clinical and observational studies, bacillus Calmette-Guérin (BCG)—a vaccine for tuberculosis—may be able to increase immune response against pathogens other than Mycobacterium tuberculosis, the microbe that causes tuberculosis.

In light of this, researchers in four countries will soon begin clinical trials to determine whether BCG can strengthen the immune system to not only better fend against SAR-CoV2, the virus that causes COVID-19, but prevent the viral infection altogether. The trials will include individuals at higher risk of infection than the general population, such as physicians, nurses, and the elderly.

Scientists in the Netherlands will start the first trial this week, which will include 1,000 healthcare workers in 8 Dutch hospitals who will either receive the BCG vaccine or a placebo.

New hope or false promise?

Although President Trump previously touted hydroxychloroquine as a potential “game changer” in the fight against coronavirus, a new study casts doubt on the antimalarial’s effectiveness. According to a pilot study by researchers in China, patients with COVID-19 who were treated with conventional methods—including bed rest and antivirals—saw no further benefit upon the addition of hydroxychloroquine to their treatment regimen.

The study included 30 patients with COVID-19 who were randomized to two groups. Both groups were treated with 5 days of bed rest, oxygen inhalation, and antiviral drugs. But, one group was also given 400 mg of hydroxychloroquine.

After 7 days, there were no statistical differences between the two groups. Interestingly, patient recovery in the hydroxychloroquine group was marginally worse than those in the control group. Specifically, 14 patients in the non-hydroxychloroquine group tested negative for COVID-19 at the end of the experiment, compared with 13 patients in the hydroxychloroquine group.

Ultimately, the authors noted that more research is needed to determine whether hydroxychloroquine can be safely and effectively used to treat COVID-19.

A speedy global trial—but at what cost?

Despite hydroxychloroquine’s disappointing results in the previously mentioned small-scale study, the WHO is pushing forward with a much larger, global trial that will examine the antimalarial, along with three other drugs, for the treatment of COVID-19. The trial, called SOLIDARITY, will focus on testing the efficacy of the four most promising therapies for the disease to date: antiviral remdesivir, antimalarials chloroquine and hydroxychloroquine, HIV combo drug lopinavir-ritonavir, and lopinavir-ritonavir plus interferon-beta.

Researchers are aiming to include thousands of patients across several countries. Enrolled participants will include patients with clinically confirmed COVID-19 randomized to one of the treatment options. Physicians will record the day the patient left the hospital or died, the duration of the hospital stay, and whether the patient required oxygen or ventilation. Seems simple enough, but there’s one caveat: The design is not double-blind, meaning that the placebo effect could come into play. The WHO has acknowledged that the speed of the trial will come at the cost of scientific rigor.

“It will be important to get answers quickly, to try to find out what works and what doesn’t work. We think that randomized evidence is the best way to do that,” said Ana Maria Henao Restrepo, MD, MSc, a medical officer in the WHO’s Department of Immunization, Vaccines and Biologicals.

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