This editorial by University of Hawaiʻi at Mānoa College of Tropical Agriculture and Human Resources Department of Molecular Biosciences and Bioengineering Professor David A. Christopher ran in the Honolulu Star-Advertiser on March 29, 2020.
Turbulent times are at our doorstep. News of the COVID-19 pandemic, with the economy plunging, death rates rising and curfews disrupting lives, has raised doubts about when sweet normalcy will return. Eventually, the social restrictions designed for viral containment must have an end-point, followed by businesses resuming. But we are not hearing about short-term shutdowns. The medical experts state that controls are needed for many months.
The rationale for the statewide restrictions is strong. COVID-19 is four times more infectious than influenza and has a higher death rate. In Italy, 70% of the deaths are senior males, indicating that restrictions are needed to protect our senior citizens, and adequate gear is needed to protect doctors and nurses at the front lines.
Although containment shields us, it cannot continue very long without civil unrest and chronic economic depression. We must ask then: What encouraging scientific tools will extricate us from the pandemic and shorten the worrisome restrictions?
South Korea aggressively tested its citizens for COVID-19 and fevers. Positive tests led to mandated quarantining and identifying contacts. Further restrictions were applied to the most sensitive citizens. It worked, flattening the curve because they comprehensively diagnosed and separated the infected people.
Hawaiʻi should adopt this approach. Instead, our testing efforts are woefully inadequate, turning people away. Good news: More and faster tests are coming. The most accurate tests detect the viral RNA genes using RT-PCR in a couple hours. New point-of-care tests use ELISA on a small drop of blood to detect antibodies against the virus in a few minutes.
Patients with severe infections need effective treatments. Some drugs approved for other diseases can be repurposed to fight COVID-19. The viral replication inhibitor, Favipiravir, could be a game-changer. Originally discovered in Japan, but not yet approved in the U.S., it is undergoing clinical trials in China. Patients on the drug cleared the virus in four versus 11 days for those not on it, and recovered from fever in 2.5 versus 4.2 days, and spent less time on the ventilator.
Gilead’s drug, Remdesivir, is a leading anti-COVID-19 candidate undergoing NIH trials in 50 hospitals in the U.S. and in separate trials in China. It is 80 times more potent than Favipiravir in cell assays and also works by targeting virus replication in cells.
But a few months, plus time to produce adequate quantities, are still too long for a sick person to wait for a drug. Available now is the anti-malarial drug, hydroxychloroquine, which is a newer and safer derivative of the older chloroquine. Australian scientists reported that chloroquine dissipated virus counts in infected subjects. In the U.S., the CDC describes small clinical trials with hydroxychloroquine alone and in combination with the antibiotic, azithromycin, as dramatically lowering COVID-19 in the upper respiratory tract vs. untreated subjects. Anecdotally, actor Daniel Dae Kim and others expounded that hydroxychloroquine hastened their recoveries.
The COVID-19 urgency demands that hydroxychloroquine should be administered before the perfect trial results are in. It seems that the FDA is listening. Gov. Andrew Cuomo said New York, which as of Friday has the highest infections (46,015) and deaths (519) in the U.S., has obtained 70,000 doses of hydroxychloroquine and 750,000 doses of chloroquine, as well as azithromycin. The trial began last Tuesday with a lessening of the FDA restrictions.
With a COVID-19 vaccine over a year away, the antiviral drugs become more crucial. Nevertheless, the resiliency of the human body and its amazing ability to heal are instrumental. Most people recover on average in two-three weeks and become resistant to COVID-19. They will be vital to our national recovery to get us back to business. Furthermore, doctors are intravenously introducing the plasma from recovered patients into sick patients with the goal of hastening their recovery.
Whether COVID-19 diminishes in the summer is uncertain. Precious time is needed to turn the tide on COVID-19 before cool weather returns for a potential resurgence. Ultimately, we will have to live with the virus, but in a world where its threat is mitigated due to medical treatments.
We have reason to be optimistic. Society has defeated smallpox. Before 2000, HIV/AIDS was a death sentence; now, excellent drugs allow HIV-positive people to lead nearly normal lives. Hepatitis C is cured in more than 95% of patients. So, too, we’ll defeat COVID-19 by boosting investment in scientific solutions to save lives, protect our health-care workers, and restore our fragile economy.