Anti-viral clinical trials for severe COVID-19 patients in China
Published: 21 Aug 2020
The “COVID-19: Updates from Singapore” weekly webinar series is a forum for leading clinicians, scientists, public health officials and policy makers to share insights from their fields of study. The 20th webinar session was held on Thursday, 20 August at 7pm.
Professor Cao Bin, Vice-Director of the National Clinical Research Centre for Respiratory Diseases in the People’s Republic of China, was this week’s invited guest speaker. Prof Cao has years of extensive experience in investigating severe respiratory tract infections and performing randomised clinical trials. When the COVID-19 outbreak happened in Wuhan, Prof Cao relocated from Beijing to assist in COVID-19 efforts such as helping with the severe respiratory infection management, clinical trial design and deployment and analysing possible therapeutics for COVID-19.
Titled Anti-viral Clinical Trials for Severe COVID-19 Patients in China, Prof Cao began by recounting the early days of the COVID-19 outbreak in Wuhan when the first few severe patients were experiencing the clinical presentation of a viral pneumonia. After further observations, it became clear that COVID-19 patients shared similar symptoms of community-acquired pneumonia and had no positive response when given antibiotics. Time was of the essence in identifying possible pathogens that were infecting the patients in huge numbers, some of whom had their conditions worsened with artery failure and Acute Respiratory Distress Syndrome (ARDS). Based on the evidence presented, it would seem like sepsis was the cause but it was eventually discovered that this was a new version of viral sepsis and septic shock happened because of the presence of bacteraemia, caused by a novel coronavirus or SARS-CoV-2.
During the early days of COVID-19, there was a lot of fear, anger and helplessness among people who were just getting to know this new virus that was spreading rapidly around the world due to air travel and commute. The search for a magic bullet seemed like the only solution to end this misery. Unfortunately, Prof Cao made it clear that there would be no magic bullet to “cure” COVID-19 for now. Clinicians had to depend on emergency measures to manage the symptoms of COVID-19, such as lung protective ventilation strategy and prone position ventilation, and the administration of hydroxychloroquine, until it was revoked in mid-June.
Based on research and clinical literature in the past few months, the virus replication starts in the first week and can last as long as 10 days. During the third week, the COVID-19 patient may start to experience the severity of the disease, complicated by ARDS or multi-organ insufficiency. It was observed that the antivirals had optimal impact during the increase of viral load during the first week to the second week. After a month, the patient would have entered the recovery stage, but it is still unknown how long the symptoms persist and how severe and lasting the organ damage is. It is of crucial importance to continue to study and follow-up with COVID-19 patients who have recovered for a few months following their discharge to get these answers.
Prof Cao went on to present meta-analysis of past drug treatments such as systemic corticosteroids, hydroxychloroquine, remedesivir and lopinavir-ritonavir. Prof Cao posits that the combination of antiviral drugs and immune-modulator drugs is the future because relying on either antiviral therapy or immune-modulator therapy is insufficient for severe COVID-19 patients.
Prof Cao urged clinicians to remain committed to doing the best they can for their patients and make clinical decisions based on proven evidence. He cautioned that another pandemic will follow in the next decade but we need not fret because we already have collective knowledge from this pandemic to guide us towards better clinical decision-making.
WATCH: COVID-19 Updates from Singapore: Webinar 20 | Prof Cao Bin
