There's No Specific Drug That Kills Coronavirus. But Doctors Have Ways To Treat It

Feb 11, 2020
Originally published on February 12, 2020 8:55 am

Even though the coronavirus disease that has sickened tens of thousands of people in China is new to science, doctors have a pretty good idea about how to treat it. COVID-19, as it is now named, attacks the lungs. Doctors see similar symptoms from other diseases all the time, especially from serious cases of the flu.

There's no specific drug that can kill this virus. So doctors provide what's known as supportive care, says Dr. Laura Evans, a critical care specialist at the University of Washington and a member of the Society of Critical Care Medicine's Leadership Council.

"Supportive care is something we're quite used to," Evans says, "particularly in the intensive care unit environment, because we lack specific therapies for a lot of the things that we deal with in the intensive care unit."

The strategy of supportive care is to do whatever's possible to keep vital organ systems functioning. That means monitoring vitals such as temperature, blood pressure and oxygen levels "and trying to keep those as normal as we can," she says.

Providing oxygen can be critical, particularly for a lung ailment. The method can range from a simple tube in the nostrils (a nasal cannula) to much more aggressive approaches, such as a mechanical ventilator, which involves a breathing tube threaded into a person's airways.

"We're just trying to support their bodies through it while they deal with the infection themselves," she says.

At the end of the day, it's the person's immune system, rather than the doctors, that does the hard work of fighting off an infection. Drugs can help as well, whether it's for blood pressure, heart performance or infection control.

"Sometimes these patients could have bacterial infections along with the viral infections," says Dr. Charles Dela Cruz, a critical care specialist at Yale University's School of Medicine. "They may or may not need antibiotics in certain situations."

He has helped analyze case reports of coronavirus from China. About 80% of COVID-19 cases are comparatively mild and don't require major medical interventions, but the remaining 20% can be quite serious.

Dela Cruz notes that patients who survive a crisis still may have a long road ahead of them.

"They have a lot of consequences of what they've gone through, especially if they're mechanically ventilated for a long time," Dela Cruz says. "And so a lot of them have a harder time to get back to their baseline. It sometimes takes weeks or even months. And there's also a lot of mental health distress."

People who have had a disorienting experience in the ICU may end up with delirium, which can have long-term consequences.

Researchers in China are already testing drugs that target the coronavirus. One is an experimental medication from the United States called remdesivir, which was originally developed by Gilead Sciences to treat Ebola (but has not been approved for any purpose). These drugs stop the virus from replicating but can't undo damage that the virus has caused to a person's body.

Dr. Fred Aoki at the University of Manitoba has studied antiviral drugs in the context of the flu, which has strong parallels to COVID-19. Those drugs are mostly effective within just a day or two of a person developing symptoms — that is, before the virus has had a chance to make someone really sick. They can prevent the virus from doing a lot of damage at that point.

The drugs can also reduce the risk of death in hospitalized patients, Aoki says. "In those cases, anti-influenza drugs will have an effect out to five and six days after onset of illness and will produce a salutary change in the course of the illness."

He says these flu medicines are actually most effective in people who are well but who have been exposed to the virus, say from a member of their household. The drug can actually prevent disease at that point.

Researchers studied this effect during the pandemic flu a decade ago. "These pills would reduce the illness in the other family members by about 70 to 80 percent," he says.

Logistics are the biggest challenge, Aoki says, because if people have to wait for doctors' appointments to get a prescription, they've lost precious time.

But even in the best of circumstances, we should not expect too much from antiviral medications.

"In the case of influenza, where we have approved antiviral therapy, we still see people become very ill and requiring hospitalization or requiring intensive care," says Evans of the University of Washington. "And we know thousands in the U.S. die every year from influenza. So I don't think we should think of an antiviral drug as a magic bullet here."

People will still need supportive care, she says, to buy them time to heal.

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

ARI SHAPIRO, HOST:

The coronavirus that has sickened tens of thousands of people has a new official name, COVID-19. The virus attacks the lungs. And even though it's new, doctors have a pretty good idea about how to treat it. NPR science correspondent Richard Harris reports that doctors see similar symptoms all the time, especially from serious cases of the flu.

RICHARD HARRIS, BYLINE: About 80% of COVID-19 cases are fairly mild and don't require major medical interventions. The 20% that have sent thousands of Chinese patients to the hospital can be quite serious. There's no specific drug that can kill the virus, but Dr. Laura Evans, a critical care specialist at the University of Washington, says doctors provide what's known as supportive care.

LAURA EVANS: Supportive care is something we're quite used to, particularly in the intensive care unit environment, because we lack specific therapies for a lot of things that we deal with in intensive care units.

HARRIS: The strategy of supportive care is to do whatever's possible to keep vital organ systems functioning.

EVANS: We're monitoring their body temperatures, heart rate potentially, blood pressure, oxygen levels and trying to, of course, keep those as normal as we can.

HARRIS: Providing oxygen is a big one, particularly for a lung ailment. That can be a simple tube in the nostrils to much more aggressive approaches, such as a mechanical ventilator, which involves a breathing tube threaded into a person's airways. Doctors also manage fluids, blood pressure, high fevers and heartbeats as needed.

EVANS: We're just trying to support their bodies through it while they deal with the infection themselves.

HARRIS: At the end of the day, it's the person's immune system, rather than the doctors, that does the hard work of fighting off an infection. Dr. Charles Dela Cruz, a critical care specialist at Yale, says even without a specific drug to treat this virus, the pharmacy can be brought to bear.

CHARLES DELA CRUZ: Sometimes, these patients could have bacterial infections along with the viral infections. They may or may not need antibiotics in certain situations.

HARRIS: He's helped analyze case reports of coronavirus from China and notes that patients who survive a crisis may still have a long road ahead of them.

DELA CRUZ: They have a lot of consequences of what they've gone through, especially if they're mechanically ventilated for a long time. And so a lot of them have a harder time getting back to their baseline. It sometimes takes weeks, even months. And there's a lot of also mental health distress.

HARRIS: Researchers in China are already testing drugs that target the coronavirus. One is an experimental medication from the United States called remdesivir, which was originally developed for Ebola. Dr. Fred Aoki at the University of Manitoba has studied antiviral drugs in the context of flu, which is similar. Those drugs are mostly effective within just a day or two of developing symptoms - that is, before the virus has had a chance to make someone really sick. Aoki says the drugs can also reduce the risk of death in hospitalized patients.

FRED AOKI: For those cases, anti-influenza drugs will have an effect out to five and six days after the onset of illness and will produce a salutary change in the course of the illness.

HARRIS: He says these flu medicines are actually most effective in people who are well but who've been exposed to the virus, say from a member of their household. Researchers studied this effect during the pandemic flu a decade ago.

AOKI: These pills would reduce the illness in the other family members by about 70, 80%.

HARRIS: Logistics are the biggest challenge, Aoki says, because if people have to wait for doctors' appointments before taking the drug in that circumstance, they've lost precious time.

In any event, Dr. Evans in Seattle says we should not expect too much from antiviral medications.

EVANS: Even when in the case of influenza, where we have approved antiviral therapy, we still see people become very ill from influenza and requiring hospitalization or requiring intensive care. And we know thousands in the U.S. die every year from influenza. So I don't think we should think of an antiviral drug as sort of a magic bullet here.

HARRIS: People will still need supportive care to buy them time to heal. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.