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Developing COVID-19 Treatments Is A Main Focus For Medical Experts

SCOTT SIMON, HOST:

Remember the earliest days of the coronavirus pandemic? Health care workers tried all kinds of treatments with varying degrees of success. Doctors have learned a lot over the past year and a half and are still learning. Dr. Arturo Casadevall is a professor of microbiology and immunology at Johns Hopkins University and joins us from Baltimore now. Thanks so much for being with us, Doctor.

ARTURO CASADEVALL: Thank you, Scott, for having me.

SIMON: What are some of the current options for treatment for COVID patients, and how effective have they been?

CASADEVALL: The past year has seen tremendous advances in the sense that mortality has been greatly reduced for hospitalized patients from the situation where we were back in March and April, when as many as 25% of the hospitalized patients were dying. The situation is much better today. The advances include medicines. Before you get to the hospital, we have monoclonal antibodies. Once you are in the hospital, we have two antiviral agents. One of them is remdesivir, and the other one is convalescent plasma. That remains for the emergency use authorization by the FDA. And then if the patients progress and they get further short of breath - that's an indication of progressive inflammation - we have anti-inflammatory agents. If the situation continues, treatment in the intensive care unit has improved tremendously. At all stages, there are better options.

SIMON: And are there drawbacks to some of these treatments that have to be noted at the same time?

CASADEVALL: In general, the antibody therapies, which include the monoclonals and the convalescent plasma, are very well tolerated. I think with remdesivir, we need to be careful with its use, sometimes, with the kidneys. And I think with steroids, which is what is used for inflammation, the concern is always that when to use them right because they're immunosuppressive. They can set the patient up for other types of infectious diseases, like fungus.

SIMON: Like fungus?

CASADEVALL: Yeah.

SIMON: Certainly seems like vaccines were developed with record rapidity. Have better therapies kept pace with that?

CASADEVALL: So you're absolutely right. I don't think anyone anticipated that the vaccines would be developed within a year. But I think it is important that the public knows that this happened because there have been 50 years of basic science research that could be deployed off the shelf.

I think for other therapies, they have come on slower. We were all hoping for more antiviral agents, but they haven't materialized. And part of that is that drug development is hard, and it is being done in the middle of a pandemic, and it is being done as rapidly as possible. I'm hopeful that they will come, but they are not here at the same rate as vaccines.

SIMON: Are there therapies under development that we should know about, some as simple as a pill?

CASADEVALL: I think that many companies are working very hard to identify antiviral agents. You would love to have a pill that you could give someone when they first began to have symptoms. If you can stop progression, you can stop the disease and you can stop death and maybe convert this into something a lot milder. There is also a lot of research in looking at better anti-inflammatory agents. This is a disease that kills you because of inflammation. You tend to get overexuberant response to the virus. If you can downregulate that inflammatory response, you can reduce damage. And if you can reduce damage, well, then people do better.

SIMON: You know, Doctor, we've heard so much about how the disease changes to meet the latest challenge, mutates. Eli Lilly already withdrew one of its antibody treatments because it apparently wasn't working against variants. Is there this broader concern with COVID treatments, too, that the disease will simply outwit some of them?

CASADEVALL: Yes, Scott. The way to think about it is that there are antibodies that target the virus and that there are antibodies that target the host. We worry about the therapies that target the virus because the virus is mutating, and it's changing. The antibodies that Lilly made worked last fall. But then the virus changed, and then it was no longer effective. So there is concern, but it is also important to know that you can make other antibodies to treat the new variants. And in particular, there is one therapy that keeps up with the virus, and that is convalescent plasma, since anybody who recovers from a variant has antibodies in their blood that can be used to treat that variant.

SIMON: Arturo Casadevall is a professor of microbiology and immunology at Johns Hopkins University. Thanks so much for being with us, Doctor.

CASADEVALL: Thank you, Scott. Transcript provided by NPR, Copyright NPR.