Living with Covid means prioritising prevention and treatment


Shirley HawkinsShirley Hawkins | Updated: 22-10-2021 14:41 IST | Created: 22-10-2021 14:39 IST
Living with Covid means prioritising prevention and treatment
Image Credit: Kayla Speid on Unsplash

For much of the pandemic, New Zealand lived life largely like normal, thanks to the country's strategy of eliminating Covid-19 through tight border controls and short, sharp lockdowns. The country was among a tiny cohort of nations that enjoyed a virus-free spell last year.

The Delta variant, however, has put an end to the country's zero-Covid strategy, with Prime Minister Jacinda Ardern announcing on October 4 that New Zealand would modify its approach after a recent 50-day lockdown in Auckland failed to control community spread of the virus. For the first time over the course of the pandemic, New Zealand is accepting that Covid will continue to circulate in the community, and public health experts are advising New Zealanders to prepare to encounter the virus by Christmas.

Ardern's policy shift mirrors that of other countries which are pivoting towards a strategy of 'learning to live' with the virus, including neighbouring nation Australia. After heavy restrictions in Melbourne failed to control the disease, Victoria state Premier Daniel Andrews acknowledged that "we have thrown everything at this, but it is now clear to us that we are not going to drive these numbers down, they are instead going to increase."

China is now one of the last few countries still stubbornly chasing a virus-free policy. Although three-quarters of its population is fully vaccinated, Delta is still causing pockets of infection that have prompted multiple lockdowns. It's unclear how the government plans to maintain its game plan as Beijing prepares to welcome thousands of athletes from all over the world to the upcoming Winter Olympics, slated for February 2022.

Taking a hybrid approach

As even the most risk-averse countries accept that Covid cases are an inevitability, the new strategy, often called "living with the virus", will combine mass vaccination with a drive to keep people out of the hospital and to prevent serious illness and death, as far as possible.

While vaccination programmes will continue to be at the forefront of Covid defences, a hybrid approach, involving the increased use of therapeutics, is likely to prevail.

Fortunately, there are several encouraging options: pharmaceutical company Merck recently released clinical trial data indicating that a new antiviral Covid pill, developed in partnership with Ridgeback Biotherapeutics, reduces the risk of hospitalisation or death by roughly 50 percent for patients with mild or moderate cases.

The new drug, molnupiravir, was tested on unvaccinated volunteers with underlying health conditions and was shown to inhibit the replication of the virus inside the body. It was found to be effective in treating known variants of Covid, including the Delta strain which is prevalent in many countries. If approved, the pill would signal a major breakthrough in the fight against the pandemic—and a number of countries, including New Zealand, have already secured supplies of molnupiravir, hoping that the experimental antiviral will help keep Covid patients out of the hospital.

Repurposing existing therapies

Existing drugs have shown promise as well – and could prove to be a vital resource. New drugs cost millions of dollars to develop and take an average of ten years to progress from the early stages of clinical trials to approval. By contrast, repurposed drugs cost around half as much and are ready for market sooner because they've already passed through a stringent approval process.

Encouraging prospects include Rigel Pharmaceuticals' fostamatinib (marketed in the United States as Tavalisse and in Europe as Tavlesse), already approved for the treatment of adult patients with chronic immune thrombocytopenia (ITP). Phase II data evaluating the drug as a potential treatment for hospitalized Covid patients, recently published in the journal Clinical Infectious Diseases, suggests that it may significantly reduce health risks for these patients.

In Phase II double-blind clinical trial, a 14-day treatment regimen of fostamatinib resulted in 50 percent fewer 'serious adverse events' compared to the placebo group, and patients treated with fostamatinib spent significantly less time in the ICU and on oxygen. Fostamatinib is now undergoing several Phase III trials, including one supported by $16.5 million from the U.S. Department of Defense. This crucial phase will evaluate the drug's safety and efficacy among a 300-strong group of high-risk hospitalised Covid-19 patients.

Other existing treatments that could be pressed into service in the fight against Covid-19 include those originally designed to relieve hypertension or to provide relief for patients with rheumatoid arthritis, for example. A recent pilot study also suggested that the affordable hypertension drug metoprolol could deliver encouraging clinical benefits, including improving lung function in Covid patients on ventilators. Meanwhile, the immunosuppressant drug tocilizumab is showing promising results for those critically ill with Covid-19 in early findings from REMAP-CAP.

Facing the future

As the pandemic has progressed, scientists' understanding of how the virus is transmitted – and how it can be most effectively tackled – has developed. The initial push to manufacture and distribute effective vaccines has given way to a broader quest to find the best strategies for learning to live with Covid-19 in the longer term.

While vaccines – tweaked to tackle virus variants – will continue to form the backbone of most countries' Covid management plans, non-vaccine research shouldn't be underestimated. The use of therapeutics—both experimental medications and proven drugs that can be repurposed— could make a massive difference to clinical outcomes and will be essential to protecting unvaccinated people as well as those with breakthrough infections.

Indeed, as new variants emerge, the recovery of people across the globe will rest on the understanding that vaccination alone is unlikely to be enough in the fight against Covid. A hybrid approach that combines effective vaccines with therapeutic treatments will protect and support the world's populations as we all transition to a strategy of coexisting with the virus.

(Devdiscourse's journalists were not involved in the production of this article. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)

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