Since the outbreak of COVID-19 caused by the virus SARS-CoV-2 began, I have continually heard multiple treatments bandied about by the press and other forms of Social Media. In order for us to understand any of these possible solutions, I take a step back and ask: what are the different ways we can deal with viruses?

Vaccines

A woman receiving a vaccination from her doctor

Vaccines are likely the type of intervention that is most known to the public and the most common, but what is a vaccine? Without a vaccine, when your body is exposed to a new pathogen for the first time, it begins to build Antibodies (proteins produced by the immune system to help stop intruders from harming the body) through a slow process called Active Immunization. If the pathogen is deadly, there may not be enough time for the body to create antibodies.

To solve this time crunch, we can use a vaccine, which creates an “Artificial” Active Immunization. Before a person comes into contact with the actual pathogen — they are exposed to a treated version of the pathogen (or just a piece of it) that causes no harm, but allows the body to create antibodies at its own pace without an associated illness. Once the body has antibodies created, if the real virus invades, the body is already primed and ready with antibodies to fight off the invader.

Even though there are multiple companies on the road to vaccination for COVID-19, there is a very long testing time required to ensure safety in humans. Because vaccines are given to a large population of healthy individuals, they have an even higher bar for safety than drugs given to those who are already sick.

Antiviral Drugs

The class of drugs that inhibit viruses are called Antivirals. Unlike antibiotics, antiviral drugs don’t destroy the target pathogen, but instead inhibit its development and replication. HIV, Herpes, and Hepatitis C are some of the viruses which have antivirals.

The flu (influenza) obviously has the flu shot (vaccine) that is updated annually, but it also very famously has the antiviral Tamiflu as a medication that is on the World Health Organization’s List of Essential Medications.

Repurposed Drugs

Repurposing means taking a drug that has been approved for one disease, and then to turn around and use it for a different disease. This has the potential to be a very rapid response because once a drug has been approved for a single disease, that means its toxicology is understood and you can utilize it for a different disease without running a brand new clinical trial. There is still quite a bit of regulation required, but repurposing allows us to bypass the mountain of requirements to bring a new drug to market.

Please note: As of the writing of this article, Hydroxychloroquine (antimalarial) and Azithromycin (antibiotic) have not proven to be effective as either prophylaxis (prevention in a healthy person) or treatment for COVID-19. There were very small studies done in France (~40 patients) and another in China (~30 patients), but the small sample sizes did not result in a statistically significant result. There is absolutely no reason to start taking or hoarding these medications without an indication to do so.

Convalescent Plasma

This has gained some steam in the last week or so, as the FDA has allowed investigational treatment for COVID-19, therefore I will address it here as well.

Convalescent Plasma is a form of “Passive Immunization” — remember in Active Immunization, our own body builds immunity over time by creating antibodies. In Passive Immunization antibodies from the blood of someone who has already recovered are harvested and then injected into the patient — this is someone else’s immunity being given to you.

Think about it like antivenom when you get a snake bite. Antivenom is actually created through the following (simplified) steps:

Harvesting venom from the snake

Injecting the venom into a large animal like a horse or sheep (they are hypersensitive and create a large amount of antibodies very quickly — don’t worry the animals aren’t very badly affected by this).

The antibodies are harvested from the animal’s blood, stored, and then injected into the snake bite victim.

Using this same logic, if someone has recovered from COVID-19, we can harvest antibodies from their blood and inject them into a very sick patient. This passive immunity is usually only temporary whereas Active Immunization can be lifelong, but its use is being investigated “in patients with serious or immediately life-threatening COVID-19 infections”

Symptomatic Treatment

When all is said and done, the overall strategy for dealing with viruses is Symptomatic Treatment, also called Supportive Care. That means to support our body while it creates antibodies to deal with the infection itself. For example: if you have an uncomfortably high fever — take Tylenol to lower it.

For those who are showing more severe symptoms, our front line healthcare workers are working hard regulating temperature, blood pressure, oxygen, and more in order to let the immune system do the heavy lifting of creating antibodies against the virus.

Conclusion

There has yet to be a clear cut winner for treatment in the fight against COVID-19. Even if one eventually emerges, the precautions that have been suggested such as washing our hands properly and often, coughing into our elbows, and not touching our face unnecessarily are great for keeping healthy in general. Let’s take the necessary precautions, think critically before jumping onto a new treatment, and get through this crisis together.