Antiviral Medications, Treatment Trials (Remdesivir, Chloroquine) Lecture 11
Welcome to another MedCram coronavirus update. The deaths have gone from 427 to 493. That’s an increase of about 15%. That’s a little bit less than it’s been in the last couple of days. Normally it’s been running in the 18% to 20%. Confirmed infections have gone to 24,516; that’s up around 19%. And then we’ve got recovered; yesterday was at 657; today up to 906, and I think we should see that these numbers are going to continue to increase because we’ve gotten through a number of weeks of illness with these patients.
Okay, we’re going to talk about some of the quick items in the news, and then we’ll get to the big topic, which has been new drugs that are being looked at to treat the coronavirus pneumonia and lung diseases.
Okay, quick items in the news. First of all, testing in the United States has typically been done by the CDC up to this point. Well, now they are going to distribute those two specific local labs so that those labs can process some of these tests that could be done perhaps on a more regular basis. This is the swab up to this point. There have been eleven positive out of 178 tests that have been performed. There are another 82 tests that are outstanding right now, and we’ll see what the results of those show.
Yesterday, we talked about the Diamond Princess; about 3700 are on board. And this is floating off the coast of Japan, and it looks as though there are 10 positive onboard based on the stories that are coming out. Remember this was a ship that had sailed, and it was found out that there was a man that was on this ship in late January.
And 10 of them are positive already on the ship. Unclear if it was a direct result of this man that had tested positive earlier. Thirdly. There is another dashboard out there. I know we’ve had some positive feedback for the Johns Hopkins dashboard. I wanted to make you aware of another dashboard that I thought was very clean, had a lot of good information on it. And so we’ll put a link in the description.
Okay. So there’s this letter to the editor to Nature. Nature’s of big journal, very prestigious. This is February the 4th that this was published, and it is describing the medications specifically Remdesivir and Chloroquine.
And why this is important? So let’s talk about Remdesivir first. Going back, there were a number of medications that were looked at during the SARS and MERS outbreaks. Both of which by the way are coronaviruses. There were medications that they had tried like Rebrivin. Obviously, they had tried Remdesivir as well.
And these were shown to be efficacious in stopping viral production in vitro. So the key there is the word in vitro. In vitro means in a Petri dish, in a test tube, not necessarily in a human being. And this is where a lot of tests are done at first.
Now, what they did do is they looked at this medication called Remdesivir, and they tried it in Ebola. The reason why they did this was because it worked in Ebola. It worked in vitro in Ebola, and they said hey, maybe we can try this in Ebola patients, or in people who are in proximity to people with the Ebola virus so that they don’t get Ebola.
So, when they tried it, it didn’t work. Okay, people still got Ebola. So that’s an example where a medication works in vitro, but not in vivo. Nevertheless, before they could take this medication Remdesivir to market, before they could even try it in these patients. They have to make sure that it was safe. And so the safety tests have already been done on Remdisivir. We know that it’s a relatively safe medication to use in patients. The problem was it just didn’t work in vivo in patients in real life, but it did work in vitro against a bunch of viruses.
So enter in now, the coronavirus 2019, and you’ve got a situation where people are dying, and there’s an epidemic. Why not try Remdesivir? Well, the first thing you got to want to do is to make sure this medication actually works against not the SARS, not the MERS, not Ebola, but the actual coronavirus 2019. And so that’s what they did. They actually tried it in cells that were infected with the current strain of the coronavirus from Wuhan, China.
Now, how does this medication work? What does it do? So you’ve got the cell, and you’ve got the virus, and the virus has to fuse with the cell, and it goes inside the cell, and when it does that, it basically dumps its RNA into the cell and uses the cellular machinery to reproduce more RNA.
Well, for those of you who are aware of what RNA is or DNA for that matter, it’s basically just the code. You know, the DNA code, for instance, is like ATGC, and this can go on and on and on. With, however, RNA, instead of having the Ts, those Ts become Us. So instead of Ts, you’d have AUGCUU. Okay, that’s the only real difference, and of course, it’s usually single-stranded, and DNA is usually double-stranded.
So what happens is that these nucleotides are lined up one after the other, and there are, you know, tRNAs that come in and help put the nucleotides in the correct order, and this is done using different polymerases.
Well, what this medication does is it resembles one of the As, except it doesn’t allow the next one to come on, whatever that happens to be. So the virus comes into the cell, and this is a Ha, I’m taking you over, and you’re going to start to produce more RNA viruses like me, and so the machinery starts to go along, and as soon as it gets to an A, this medication gets put in and boom. It’s done. There’s no more polymerization. The strand cannot continue, and so this arrests the production of virus.
Well, the good news is that they found that this worked well in the new 2019 strain of the coronavirus, and so, here you’ve got a medication that is already been tested on human beings for safety. It’s available. It’s there. You just don’t have a good FDA indication because it doesn’t work on Ebola, and you don’t have SARS outbreak currently, but now you’ve got this coronavirus outbreak.
So what do they do? Even though they don’t have any evidence that it’s going to work, and usually we only give medications to people when we have evidence that it works, they use it for something called compassionate use, in other words, look, this patient’s going to die, let’s give them this medication see if it works. So they did that, they did that in the first patient in the United States that came down with the virus, and it was in Washington state, and within a day this patient started feeling better, and within three or four days the fever completely run away.
And we’ve got a number of articles that talk about this, and we’ll put those in the links. So this could be a big breakthrough here if this works, but remember, want to make sure you understand that this medication has never worked in vivo.
So we don’t know if it’s going to work. So what they’re planning on doing here coming up very shortly is actually they are going to undergo a trial in China where they give some people Placebo, and they give others this Remdesvirir there and see whether or not it works. We should know by the end of April whether or not this thing is going to work.
Now, as you can imagine, this is cause some store. The company is Gilead that makes this, and I’m sure if you look at their stock prices, they are probably going up in the hopes that this thing works, and that the epidemic can be abated.
So the other drug that they looked at in the same letter to the editor, and that study was chloroquine. Now chloroquine has been around for a very long time. It’s a generic medication. It’s been used in malaria for years. In fact so much so that you actually have chloroquine resistance areas.
They also found that this work really well as well. So how does that work? Well, you’ve got the cell, you’ve got the virus. There’s a special PH that these lysosomes have to be before these things can merge, and what chloroquine does is it raises the PH of those lysosomes, preventing these things from merging, so it’s possible that you could prevent against viral particles from infecting other cells.
Now these are just two drugs that are being looked at. There are the Pinonabir and Ratonabir. These are other medications that are being used. In fact, they were used in Thailand, and they were thought to improve.
The problem is with any of these medications that are used for compassionate use, if you use them, and the patient gets better, you don’t know if that was the reason why they got better, or if it was some other reason they got better. That’s why you need to do a randomized, placebo-controlled trial。
Okay, so this is the latest hot-off-the-press information regarding coronavirus. If you found this is helpful, you found this channel is helpful, please subscribe and that will help us make more of these videos and continue the updates as this saga unfolds. Thanks for joining!