Effective, Early Interventions would Benefit Individual Patients and Healthcare System

COVID-19 treatments for people with early infection are needed urgently, according to a JAMA Viewpoint article by NIAID Director Anthony S. Fauci, M.D., and colleagues. Treating people early in the course of infection with SARS-CoV-2, the virus that causes COVID-19, would speed their recovery, reduce the likelihood that they develop severe outcomes and reduce demand on the healthcare system, they write.

Despite experiencing only mild symptoms early in infection, many COVID-19 patients progress to severe disease that leads to hospitalization. Some also will experience lengthy recoveries and develop long-lasting fatigue, mental impairment and problems with heart and lung function. 

While several treatments such as remdesivir and dexamethasone are either available or in development for severe COVID-19, interventions that can be administered early during the course of infection to prevent disease progression and longer-term complications are urgently needed.

Studies are underway to assess whether existing antivirals can be repurposed for early treatment.  

Several antivirals approved or in development for other viral infections,
such as HIV, hepatitis C virus, and ebolaviruses, are under investigation for
early treatment of COVID-19. These investigations have not yet yielded
clinically actionable results; however, many trials are ongoing.

Examples of antivirals in trials for early treatment of COVID-19 are:
1) MK-4482 (EIDD-2801), an orally bioavailable ribonucleoside inhibitor that was originally developed for influenza (NCT04575597);

2) SNG001, a nebulized formulation of interferon-β1a developed for viral
infections in patients with chronic obstructive pulmonary disease (NCT04385095) and

3) camostat mesylate, a serine protease inhibitor approved for treatment of chronic pancreatitis and postoperative reflux esophagitis (NCT04353284).

Scientists also are exploring the effectiveness of early treatment with therapies that specifically target SARS-CoV-2, such as convalescent plasma and monoclonal antibodies. Investigators also are exploring strategies to deliver therapies by alternative routes than by intravenous infusion, such as by inhalation or intramuscular injection. 

Continued research is needed to refine current treatment candidates and develop new drugs, and treatments will need to be administered easily and made available widely at low cost, according to the authors. 

The article also highlights the need to design novel antiviral treatment approaches akin to successful efforts for hepatitis C virus and HIV. Such approaches could be helpful against future emergent viruses as well. 

The article says robust support from the medical community and public is needed to ensure the success of these critical areas of research. Those interested in learning more about an ongoing NIAID-sponsored trial (ACTIV-2) evaluating therapies for people who were recently diagnosed with COVID-19 but are not hospitalized can visit RiseAboveCOVID.org(link is external) or go to clinicaltrials.gov and search NCT04518410(link is external). 

ARTICLE:
P Kim et al. Therapy for early COVID-19—A critical need. Journal of the American Medical Association DOI:10.1001/jama.2020.22813 (2020).

WHO:
NIAID Director Anthony S. Fauci, M.D., is available to comment on this article.