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COVID-19 | School of Public Health Expert Insights


School of Public Health Expert Insights

A Drug for COVID-19 May Already Exist

By Melissa Hartman | March 25, 2020

There are currently no drugs approved to treat COVID-19.  But in trials around the world, researchers are putting candidate treatments to the test.

According to Caleb Alexander, MD, MS, codirector of the Center for Drug Safety and Effectiveness and a professor in Epidemiology at the Bloomberg School, some promising treatments for COVID-19 may already be on pharmacy shelves.

Do you think it’s more likely that a new drug will be developed for COVID-19 or that an existing one will be found effective?

I think it’s far more likely that we’ll identify an existing product that can be used “off label” for the treatment of COVID-19 infection. There’s an extraordinary number of studies that have already been initiated evaluating existing products. At last count, more than 150 randomized controlled trials have been registered in the U.S., European Union, and China, as well as other countries, to evaluate treatments for possible efficacy against COVID-19.

These treatments have already been fairly extensively evaluated, albeit for different indications. The billion dollar question is whether these same products may prove effective for the treatment of COVID-19.

Why did the drug chloroquine, which President Trump mentioned in a press conference, come to the fore as a likely treatment?

I don’t know. There is some anecdotal evidence that chloroquine could have a potential beneficial effect in treating COVID-19 infection, but we have little more than that. We certainly have no rigorous, carefully designed studies examining this matter, let alone the evidence needed to recommend its wholesale adoption. If it’s being used, it should be used in carefully controlled scientific studies of COVID-19.

How were the drugs selected for the trials currently underway? Was it based on the kinds of symptoms that they treat, or because they’ve worked for other viral infections?

They’re selected a number of different ways. Some have been demonstrated to be effective against other viruses. Others have been demonstrated in laboratory or animal models to be potentially beneficial. And yet others may have been selected because of anecdotal evidence of their potential benefit.

The scientific establishment can’t afford to look under every rock in the field, so we need to be smart about selecting which products are going to be investigated, and investigated first. This is a major challenge for scientists and policymakers alike. Time is of the essence so we need to select products for further study that we believe will offer the greatest return on investment.

Have any of the drugs selected for trials been shown effective against SARS—a cousin of the novel coronavirus?

While several drugs have been demonstrated, in laboratory settings, to have some effect against SARS, there are no confirmed treatments for SARS infection. But we can learn from these prior studies, and they certainly contribute to a rapidly growing evidence base that is focused on identifying an effective treatment for COVID-19 infection.

Since these drugs have already been through regulators, are they essentially cleared to give to sick patients?

The vast majority of products under investigation have been evaluated and approved by regulators around the world, but not all are necessarily approved by the FDA.

There is interest in identifying products that may hasten recovery among individuals who are not hospitalized, but the primary investigational thrust currently is on hospitalized patients, where the real concern is critical illness or death.

Could you give a range between a best case and a more cautious estimate for when we might have a treatment for COVID-19?

It’s very hard to predict when we may identify an effective treatment. We’ve been remarkably successful in identifying treatments for some viruses and less so for others. Consider our remarkable success identifying treatments for HIV and cures for viruses such as Hepatitis C, for example.

There’s such an incredible concentration of intellectual activity and scientific effort being devoted to this cause that I’m hopeful we will identify effective treatments. But we have to let science do its job. We have to let the scientific process work. We can’t afford to undercut it. The stakes are simply too high.