Possible medicines against the coronavirus

The first people have been vaccinated with a test vaccine against the new coronavirus (aka COVID-19, aka SARS-CoV-2). Which medicines and vaccines are currently being investigated?

The first vaccine was tested within 66 days after China shared technical knowledge about the virus. This is unprecedentedly fast, the World Health Organization WHO responded. However, we are not there yet. This is a phase 1 study, or research involving 45 healthy volunteers aged 18 to 55 years.

It can only be used by the population after phase 3. The vaccine can fail at all stages, for example, because it does not work (enough) or because it has too many side effects. Each phase normally lasts months to years and many participants are required.

Possible medicines against the coronavirus

Fortunately, many vaccines and medicines are tested against corona. That increases the chance of success. Here is an overview of the vaccines and drugs that are currently being tested in humans, or are about to be tested.

1. Vaccines of all kinds

So the first vaccine study in humans has just started in the Seatle, the scientific journal Nature reports on March 18. The vaccine has the technical name mRNA-1273. It is developed by the US National Institute of Allergy and Infectious Diseases (NIAID) and Moderna, a biotechnology company. This new vaccine is an mRNA vaccine that targets the spikes, or spines, that you see on all pictures of the virus. This article with virologist Raoul de Groot explains how this mRNA works and those spines.

In addition to this Moderna vaccine, there are more vaccines in the running. For example, there are vaccines that have already been studied with the MERS virus. This is also a coronavirus and caused the outbreak in Saudi Arabia.

Another type is the BCG vaccine, which will soon be given to 500 healthcare workers by Radboudumc and UMC Utrecht. This is a vaccine against tuberculosis. The hope is that it gives a kind of «kick» to the immune system, so that once shaken awake it also protects against the new coronavirus.

2. Vaccine housings, ie an apple pie without an apple

Another important line of research is that of vaccine housings. Think an apple pie. An apple is tasty, but an apple pie even better. Manufacturers make that empty vaccine housing (the cake) available pending the required filling (the apples, or the active substance). Bill and Melinda Gates' fund just put $ 5 million into such a vaccine case. Large vaccine manufacturers are also making ingredients for a vaccine available.

The new vaccine may be a syringe, but research is also ongoing into vaccines in nasal spray form or as a tablet. It is, therefore, possible that we will all get a nasal spray against the coronavirus in a year.

3. Antivirals, thanks to the AIDS epidemic

Antibiotics do nothing against the coronavirus, but thanks to the AIDS crisis of the 1980s, we now also have antiviral medicines. We now use this to keep HIV infection in check, but also against a cold sore or (sometimes) with the flu. For example, for the impending Mexican flu outbreak, the government has purchased antiviral drugs for millions of people: Oseltamivir (Tamiflu) and Zanamivir (Relenza).

Many researchers, therefore, try antiviral drugs against the new coronavirus. For example, China has approved the drug favilavir as an accelerated drug, after a study in 70 people. Other agents being tested include remdesivir (which was conceived against Ebola), galidesivir, Kaletra (lopinavir and ritonavir, an AIDS drug), and darunavir.

4. Antibodies, thanks to recovered patients

Some medications are made up of antibodies. These are substances that stick to the coronavirus, which is then more easily tackled by the immune system. They mainly work in the short term, not the longer ones like a vaccine. Antibody medications are being made that are grown in animals. But there are also antibodies that have been «harvested» from patients who have recovered from the coronavirus. The latter form is also known as 'plasma therapy'.

5. Medicines that are intended for something else

Researchers are trying out whole batteries of known drugs against the new coronavirus. Who knows there might be something that works. The anti-malarial drug chloroquine is an example of this. It was active against COVID-19 in a test tube and is now being tried in a dozen studies in humans. There are also studies of nitric oxide gas, sildenafil (Viagra), the high blood pressure drug losartan, thalidomide (formerly known as the dangerous Softenon, which is now also used in cancer) and so on.
Beware of reports of drugs that are only invented in the laboratory or that are tested on laboratory animals. It is far from certain whether they will really work. These drugs often drop out in later human testing. Reason: they appear to be too dangerous or do not work against the virus.

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