Linda Mascarenhas, BSc, MSc
The outbreak of the new coronavirus disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December 2019, is continuing to affect people across the globe with the World Health Organization (WHO) declaring it as a pandemic in March. As of 02 June 2020, it has claimed 377,888 deaths worldwide and with 6,389,495 total cases.1 The COVID-19 contagion situation in the Gulf Cooperation Council countries can be seen below.1
There has been a trend in the increase in the cases since the past few months and scientists have suggested that early and accurate diagnosis of SARS-CoV-19 is critical to curbing its spread and improving health outcomes. As of March 2020, none of the countries had reliable data on the prevalence of the virus in their population.2 However due to the availability of various testing methods over the course of time, the number of tests conducted in every country has been increasing.3
Diagnostic testing for COVID-19
COVID-19 testing can identify the SARS-CoV-2 virus and includes methods that detect the presence of virus itself (RT-PCR, isothermal nucleic acid amplification) and those that detect antibodies (antibody tests) produced in response to infection.
The FDA has approved a test by Abbott Laboratories that uses isothermal nucleic acid amplification technology instead of PCR since this does not require a series of alternating temperature cycles (like PCR tests typically do) this method can deliver positive results in as little as five minutes and negative results in 13 minutes.17
Treatment approaches for COVID-19
From the public health perspective, there is an urgent need to develop effective vaccine and antiviral therapeutics to stop the SARS-CoV-2 pandemic. Previous work with SARS-CoV and MERS-CoV has provided an opportunity to accelerate the identification of meaningful therapies for fighting the novel virus.
The treatment approaches include repurposing the existing drugs like antivirals and using anti-coronavirus antibodies produced by patients. Antivirals like remdesivir might treat the specific virus, as well as host targets, such as interleukin-6 (IL-6) receptor inhibitors that may be helpful in reducing lung inflammation and improving lung function in COVID-19 patients.18Remdesivir inhibited the replication of SARS-CoV and MERS-CoV in tissue cultures, and it displayed efficacy in nonhuman animal models. In addition, a combination of the human immunodeficiency virus type 1 (HIV-1) protease inhibitors lopinavir/ritonavir and interferon beta (LPV/RTV–IFN-β) was shown to be effective in patients infected with SARS-CoV.18Another antiviral drug, called favipiravir, has been used in Japan to treat influenza, and last month, the drug was approved as an experimental treatment for COVID-19 infections.18
An oral drug called EIDD-2801 has shown promise in in vitro experiments with human lung and airway cells and this drug might even be more efficient at blocking SARS-CoV-2 than remdesivir as it introduces genetic mutations into the virus’s RNA that further prevents the virus to infect cells.19
There is also interest in examining whether therapies such as convalescent plasma and hyperimmune globulin, antibody-rich blood products that are taken from blood donated by people who have recovered from the virus, could shorten the length or lessen the severity of the illness. The high mortality rates observed in some emerging respiratory diseases induced by viruses like MERS-CoV, SARS-CoV, and novel SARS-CoV-2 have given rise to the hypothesis that the proinflammatory response might be involved in the disease pathogenesis. Consequently, immunosuppressants (e.g., corticosteroids) might be used as an adjunct for treating severe forms of the disease. However, the therapeutic use of immunosuppressants is not free of controversy.18
Ongoing clinical trials for SARS-CoV-2
As of April 2020, there have more than 200 clinical trials of COVID-19 treatments or vaccines that are either ongoing or recruiting patients.20
The first clinical trial in the United States was the randomized, controlled clinical trial to evaluate the safety and efficacy of the investigational antiviral remdesivir in hospitalized adults diagnosed with coronavirus disease 2019 (COVID-19) has begun at the University of Nebraska Medical Center (UNMC) in Omaha funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.21 The NIH has also funded a clinical trial to evaluate the safety and effectiveness of hydroxychloroquine for the treatment of adults hospitalized with COVID-19.22
The World Health Organization (WHO) has launched SOLIDARITY, a giant multinational trial for testing therapies that researchers around the world have suggested may be effective against the novel coronavirus. The Solidarity Trial will compare four treatment options (remdesivir; chloroquine and hydroxychloroquine; lopinavir plus ritonavir; and lopinavir plus ritonavir and interferon-beta) against standard of care, to assess their relative effectiveness against COVID-19.23 A group of researchers in Beijing, China have conducted a trial to evaluate mesenchymal stem cell treatment for pneumonia patients infected with the novel coronavirus.24
The increased number of cases worldwide suggest that we are in the thick of a SARS-CoV-2 pandemic and there is a dire need to develop an ideal treatment option for COVID-19 at the earliest. With the number of drugs under development in clinical trials, there is a hope to curb the pandemic.
- COVID-19 coronavirus pandemic. https://www.worldometers.info/coronavirus/#countries. Accessed on 02 June 2020.
- Ioannidis JPA. A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data. STAT. Accessed on 10 May 2020.
- Roser M, Ritchie H, Ortiz-Ospina E. Coronavirus Disease (COVID-19) – Statistics and Research. Available at: https://ourworldindata.org/coronavirus. Accessed on 10 May 2020.
- Real-Time RT-PCR Panel for Detection 2019-nCoV”. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/php/testing.html. Accessed on 10 May 2020.
- Curetis Group Company Ares Genetics and BGI Group Collaborate to Offer Next-Generation Sequencing and PCR-based Coronavirus (2019-nCoV) Testing in Europe”. GlobeNewswire Newsroom.
- Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral Load of SARS-CoV-2 in Clinical Samples. Lancet Infect. Dis. 2020, 20, 411.10.1016/S1473-3099(20)30113-4.
- Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. Laboratory Diagnosis and Monitoring the Viral Shedding of 2019-nCoV Infections. medRxiv, 2020. 10.1101/2020.02.11.20021493.
- Advice on the use of point-of-care immunodiagnostic tests for COVID-19. World Health Organization. Available at: https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19. Accessed on 10 May 2020.
- Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020, 2020, 200642.10.1148/radiol.2020200642.
- Winichakoon P, Chaiwarith R, Liwsrisakun C, Salee P, Goonna A, Limsukon A, et al. Negative Nasopharyngeal and Oropharyngeal Swab Does Not Rule Out COVID-19. J. Clin. Microbiol. 2020, 10.1128/JCM.00297-20.
- Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne Li YCL, et al. Diagnosing COVID-19: The Disease and Tools for Detection. ACS Nano. 2020:acsnano.0c02624.
- Developing Antibodies and Antigens for COVID-19 Diagnostics. Technology Networks. 6 April 2020. Retrieved 30 April 2020.
- Madavalli A and Thomas K. Will an Antibody Test Allow Us to Go Back to School or Work? New York Times. 10 April 2020. Available at https://www.nytimes.com/2020/04/10/health/coronavirus-antibody-test.html. Accessed on 11 May 2020.
- Mount Sinai Emergency Use Authorization”. FDA. 15 April 2020. Retrieved 18 April 2020.
- NIH launches competition to speed COVID-19 diagnostics. AAAS. 29 April 2020. Retrieved 1 May 2020.
- What to know about the three main types of coronavirus tests. WRBC tv. Available at: https://www.wrcbtv.com/story/42069309/what-to-know-about-the-three-main-types-of-coronavirus-tests. Accessed on 11 May 2020.
- ID NOW COVID-19, Instruction for Use, FDA.
- Martinez MA. Compounds with therapeutic potential against novel respiratory 2019 coronavirus. Antimicrob Agents Chemother. 2020; 64:e00399-20.https://doi.org/10.1128/AAC.00399-20.
- A new antiviral drug heading into clinical trials offers hope for COVID-19. Available at: https://neurosciencenews.com/coronavirus-antiviral-16088/. Accessed on 11 May 2020.
- US National Library of Medicine. Available at: https://clinicaltrials.gov/ct2/results?cond=covid-19&age_v=&gndr=&type=Intr&rslt=&Search=Apply. Accessed on 11 May 2020.
- NIH clinical trial of remdesivir to treat COVID-19 begins. National Institute of Health. Available at: https://www.nih.gov/news-events/news-releases/nih-clinical-trial-remdesivir-treat-covid-19-begins. Accessed on 11 May 2020.
- NIH clinical trial of hydroxychloroquine, a potential therapy for COVID-19, begins. Available at:https://www.nih.gov/news-events/news-releases/nih-clinical-trial-hydroxychloroquine-potential-therapy-covid-19-begins. Accessed on 11 May 2020.
- “Solidarity” clinical trial for COVID-19 treatments. World Heath Organization. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments. Accessed on 11 May 2020.
- Mesenchymal Stem Cell Treatment for Pneumonia Patients Infected With COVID-19. Available at: https://clinicaltrials.gov/ct2/show/NCT04252118. Accessed on 11 May 2020.