Learning to treat COVID-19

With vaccines still in the development stage and COVID-19 cases rising each day, the race is on to find effective medical treatments. 

In the latest installment of the COVID-19 Conversations webinar series, organized by APHA and the National Academy of Medicine, experts discussed “Learning to Treat COVID-19 – Clinical Trials and Developing Therapeutics During a Pandemic.”

While clinical trials are underway around the world to find the safest, most effective treatments for COVID-19 — with many already generating important results — panelists said big hurdles still remain. 

For example, among patients with mild symptoms, unwillingness to participate in clinical trials is a significant challenge, as is low representation of vulnerable populations, such as pregnant women and children, said panelist Judith Currier, MD, professor of medicine in the Division of Infectious Diseases at the University of California-Los Angeles.

Among hospitalized COVID-19 patients with severe symptoms, challenges include varying standards of care, as well as limited and disparate resources across hospital settings that make it difficult to implement and take part in trials. 

However, Currier said clinical trial strategies pioneered in cancer research and used in treating Ebola — known as adaptive platform trials — have “really come to the rescue.” An adaptive platform trial is a trial of alternative treatment strategies that follows a single master protocol. 

To further improve trial implementation, she emphasized the need for more dedicated infrastructures and trained investigators, more adaptive platform trials, remote monitoring and better collaboration and coordination between stakeholders.

When thinking about COVID-19 treatment, we need to address three different dimensions: host, stage and severity and intervention, said panelist Rajesh Ghandi, MD, associate professor of medicine at Harvard Medical School. Ideally, he said the method of treatment and desired outcomes should be based on the spectrum of a person’s COVID-19 illness, from mild to critical. 

“Can we get a bigger bang for our buck by treating earlier, treating people who are just exposed, treating people who are early in the disease course,” asked Ghandi. “And will that have the benefit of not only preventing progression, but could we actually prevent acquisition or transmission to others?” 

Adapting lessons from the HIV pandemic will be especially helpful, said panelist and APHA member Myron Cohen, MD, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina.

Those lessons include the success of combining multiple prevention and treatment strategies, such as behavioral change, antiviral drugs and vaccine development. Such a multipronged approach will be key to stopping COVID-19 as well, he said.

“There is no one magic bullet,” Myron told webinar attendees. “All three of these things have to be developed concomitantly. We can’t really give up one of these prevention activities or treatment activities for the other. We need our new normal to embrace combination prevention.”

Visit APHA for a recording, transcript and slides from “Learning to Treat COVID-19 — Clinical Trials and Developing Therapeutics During a Pandemic.” And register for the next COVID-19 Conversations webinar, “Reopening Colleges and Universities During COVID-19 — Keeping Students and Communities Healthy,” which takes place Wednesday, July 8, at 5 p.m. EDT.

Written by Latoya Chimilio.