COVID-19: Prevention & Investigational Treatments

Treatment Options Infection Viral Infection
COVID-19

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COVID-19: Prevention & Investigational Treatments

Other names: 2019 Novel Coronavirus; 2019-nCoV; Coronavirus; Novel Coronavirus Pneumonia; SARS-CoV-2 Infection

Updated - April 30, 2020 J.Stewart BPharm
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What is COVID-19
Symptoms
Transmission
Prevention
If you are sick
Risk factors
Investigational treatments
Off label drugs

What is COVID-19?

COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, first identified in the city of Wuhan, in China's Hubei province in December 2019. COVID-19 was previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease before the World Health Organization (WHO) declared the official name as COVID-19 in February 2020.

The SARS-CoV-2 virus belongs to the family of viruses called coronaviruses, which also includes the viruses that cause the common cold, and the viruses that cause more serious infections such as severe acute respiratory syndrome (SARS), which was caused by SARS-CoV in 2002, and Middle East respiratory syndrome (MERS), which was caused by MERS-CoV in 2012. Like the other coronaviruses, the SARS-CoV-2 virus primarily causes respiratory tract infections, and the severity of the COVID-19 disease can range from mild to fatal.

Serious illness from the infection is caused by the onset of pneumonia and acute respiratory distress syndrome (ARDS).

Stay up to date on COVID-19

COVID-19 News (Newsfeed from Drugs.com)

Symptoms

The most common symptoms of COVID-19 include dry cough, fever, and shortness of breath. It is thought that symptoms can appear between 2-14 days after exposure although there have been isolated cases which suggest this may be longer. If you develop symptoms, you should stay at home to prevent the spread of the disease into the community. Wearing a face mask will help prevent the spread of the disease to others.
Update: March 10, 2020 -- According to research published in the Annals of Internal Medicine, the median incubation period is estimated to be 5 days, and almost all (~98%) patients who have been infected will develop symptoms within 12 days.
Update: April 14, 2020 -- A new study suggests losing your sense of smell and taste is an early sign of COVID-19.
Update: April 27, 2020 -- CDC adds six new symptoms to its list of COVID-19 symptoms to include: chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell.
Transmission

The SARS-CoV-2 virus is thought to spread from person-to-person via:

droplet transmission (large respiratory droplets that people sneeze, cough or drip)
aerosol transmission (when someone coughs or sneezes in the room)
contact transmission (touching a contaminated surface then touching your mouth, nose or eyes)
direct transmission (kissing, shaking hands etc.)

Prevention

The best way to prevent infection is to avoid exposure to the virus.

The most important way to prevent COVID-19 is to WASH YOUR HANDS.

Wash your hands regularly and thoroughly with soap and water (lather for 20 seconds) OR use an alcohol based (at least 60%) hand sanitizer.

Other actions that help to prevent the spread of COVID-19:

avoid contact with others who are sick
avoid touching your mouth, nose, eyes or face
cover coughs and sneezes (into a tissue or into your elbow)
clean and disinfect surfaces (alcohol or bleach based cleaning solutions work best for coronaviruses)
face masks will not protect you from COVID-19 directly, but can help in reminding you to avoid touching your face, and will help prevent the spread of the disease to others.
social distancing
self isolation

What to do if you are sick

Prevent the spread of COVID-19 if you are Sick (CDC)
Environmental Cleaning and Disinfection Recommendations (CDC)

What to do if you come into contact with someone who is sick

Stay at home. If you have been exposed to someone who has tested positive for COVID-19, or someone who is showing symptoms of COVID-19, it may take up to two weeks for your symptoms to present. To keep yourself and others safe, you should isolate yourself from other people for 14 days.
What is social distancing?

Social distancing means the physical separation of people. To practice social or physical distancing:

Stay at least 6 feet (2 meters) from other people
Do not gather in groups
Stay out of crowded places and avoid mass gatherings

Risk Factors

Scientists are still researching risk factors for COVID-19 but data from China CDC suggest that the elderly, and people suffering from pre-existing medical conditions (such as heart disease, respiratory disease including asthma and COPD, or diabetes) have a higher risk of dying from the disease. There is research that suggests that smokers may be more susceptible to the SARS-CoV-2 virus. There is also evidence to suggest that people who use e-cigarettes (vaping) are at much higher risk of developing serious respiratory infections.
Update: March 16, 2020 -- A Chinese study claims to have found that people with type A blood may be more susceptible to the novel Coronavirus (COVID-19).
Update: March 22, 2016 -- CDC now includes people aged 65 years and older, people who live in a nursing home or long-term care facility, and people who are immunocompromised including those receiving cancer treatment as those who are at higher risk for severe illness. People with HIV may also be at higher risk of serious illness.
Investigational Treatments

Currently, there are no FDA approved treatments for COVID-19.

Update: FDA Approves Malaria Drugs to Treat COVID-19, Despite Little Proof They Work March 31, 2020
Update: The Lowdown on COVID-19 Treatments April 21, 2020
Update: Lots of Drugs Are Being Tested Against COVID-19 -- But Will Any Work? April 23, 2020

Baricitinib Clinical studies are in preparation to determine the effectiveness of a Janus kinase (JAK) inhibitor called baricitinib (marketed under the brand name Olumiant for the treatment of rheumatoid arthritis) in the treatment of COVID-19 patients.
Bemcentinib An AXL kinase inhibitor called bemcentinib has been fast-tracked in a UK Phase II clinical trial to study its effectiveness in the treatment of hospitalized patients with COVID-19. Bemcentinib has previously been studied in cancer patients and has been shown to be safe and well-tolerated. It has also been reported to exhibit potent antiviral activity in preclinical models against several enveloped viruses, including Ebola and Zika virus, and recent data have expanded this to include SARS-CoV-2.
Bevacizumab A VEGF inhibitor called bevacizumab (marketed under the brand name Avastin for certain types of cancer) being studied as a treatment for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in critically ill patients with COVID-19 pneumonia at the Qilu Hospital of Shandong University in Jinan, China.
Chloroquine phosphate The older anti-malaria drug chloroquine has been shown to have a wide range of antiviral effects, including anti-coronavirus. Studies in Guangdong Province in China suggest that chloroquine may help improve patient outcomes in people with novel coronavirus pneumonia.
Colchicine An older anti-inflammatory drug called colchicine is being studied to prevent complications of COVID-19 in high risk patients. Colchicine has long been used in the treatment of gout.
EIDD-2801 A team of researchers at UNC-Chapel Hill is hopeful that a broad spectrum oral antiviral called EIDD-2801 could be used as a potential prophylactic or treatment for COVID-19 and other coronaviruses. Ridgeback Biotherapeutics has licensed EIDD-2801 and has received permission from the FDA to begin patient trials.
Favipiravir An antiviral drug called favipiravir which was reported February 17, 2020 to have received marketing approval in China for the treatment of influenza, was also approved for use in clinical trials as a treatment for novel coronavirus pneumonia.
Update: March 31, 2020 -- Fujifilm announced the start of a Phase 3 clinical trial of Avigan (favipiravir) on COVID-19 patients in Japan. Avigan is approved in Japan for use as an antiviral in the treatment of influenza.
Update: April 9, 2020 -- Fujifilm announced the start of a Phase 2 clinical trial of favipiravir in approximately 50 COVID-19 patients in the U.S.
Fingolimod An approved drug called fingolimod (marketed under the brand name Gilenya for the treatment of relapsing forms of multiple sclerosis) is being studied as a treatment for COVID-19 at the First Affiliated Hospital of Fujian Medical University in Fuzhou, China.
Hydroxychloroquine and azithromycin In a small study commissioned by the French government, 20 patients with COVID-19 were treated with a combination of the anti-malaria drug hydroxychloroquine and the macrolide antibacterial drug azithromycin (Zithromax). Results showed that all patients taking the combination were virologically cured within 6 days of treatment.
Hydroxychloroquine sulfate It was reported in the journal Clinical Infectious Diseases on March 9 that the malaria drug hydroxychloroquine was effective in killing the coronavirus in laboratory experiments. Hydroxychloroquine was first approved by the FDA in 1995 under the brand name Plaquenil, and it is also used in the treatment of patients with lupus and arthritis.
Ivermectin An anti-parasitic drug called ivermectin has been shown to be effective against the SARS-CoV-2 virus in an in-vitro laboratory study by researchers at Monash University in Melbourne, Australia. Further clinical trials need to be completed to confirm the effectiveness of the drug in humans with COVID-19.
Leronlimab A CCR5 antagonist called leronlimab has shown promise in calming the 'cytokine storm' in a small number of critically ill COVID-19 patients hospitalized in the New York area.
Lopinavir and ritonavir A drug combination called lopinavir/ritonavir approved to treat HIV under the brand name Kaletra is being studied in combination with the flu drug oseltamivir (Tamiflu) in Thailand. It was reported on February 18, 2020 that an elderly Chinese woman, the first patient to receive the "Thai cocktail" in Bangkok's Rajvithi Hospital, had made a complete recovery after suffering from severe COVID-19-related pneumonia.
Update: March 18, 2020 -- According to a study in the New England Journal of Medicine, the lopinavir/ritonavir combination showed no benefit over standard care in hospitalized adult patients with severe COVID-19.
Methylprednisolone A widely used glucocorticoid called methylprednisolone is being studied for safety and effectiveness in the treatment of novel coronavirus pneumonia in a number of hospitals in the Hubei province of China.
Remdesivir An investigational antiviral drug called remdesivir is being studied in clinical trials in China, the United States, and the United Kingdom. Remdesivir has demonstrated in vitro and in vivo activity in animal models against the viral pathogens that cause MERS and SARS, which are coronaviruses structurally similar to SARS-CoV-2.
Sarilumab An interleukin-6 (IL-6) receptor antagonist called sarilumab (marketed under the brand name Kevzara for the treatment of rheumatoid arthritis) is being studied as a potential treatment for acute respiratory distress syndrome (ARDS) in patients critically ill from COVID-19.
Tocilizumab An interleukin-6 receptor antagonist called tocilizumab (marketed under the brand name Actemra for the treatment of rheumatoid arthritis and other inflammatory conditions) is being studied in a number of locations worldwide for the treatment of patients with COVID-19.
Umifenovir An antiviral drug called umifenovir (marketed in Russia under the brand name Arbidol, and also available in China for the treatment of influenza) is being studied in China and other countries as a treatment for COVID-19.

More information

Information for Clinicians on Therapeutic Options for COVID-19 Patients (CDC)
Therapeutic Options for COVID-19 Currently Under Investigation (NIH)
Assessment of Evidence for COVID-19-Related Treatments (ASHP)
DRAFT Landscape of COVID-19 Candidate Vaccines (WHO)

Several pharmaceutical companies and research organizations worldwide are involved in the development of potential vaccines.

Update: Why Will It Take So Long for a COVID-19 Vaccine? April 6, 2020

mRNA-1273 A novel coronavirus vaccine called mRNA-1273 (Moderna, Inc.) has been shipped to the National Institute of Allergy and Infectious Diseases ready for use in a Phase 1 study.
CSIRO, Australia’s national science agency, announced April, 2 2020 that it has commenced the first stage of testing potential vaccines for COVID-19.
Tonix Pharmaceuticals Holding Corp. has announced it is researching the development of a potential vaccine against COVID-19 using its proprietary horsepox virus platform.
Researchers in Israel are working to adapt a vaccine that is effective against avian coronavirus Infectious Bronchitis Virus (IBV) to work as a vaccine against COVID-19 in humans.

References