Two years ago today, Wuhan’s Municipal Health Commission in China calmed down weeks of suspicion and officially reported an unusual cluster of pneumonia cases in the city.
Ever since, lockdowns and closed borders, vaccines and ventilators have tried to eradicate or control the disease we now know all too well as COVID-19.
In the process, Australia’s fight with the SARS-CoV-2 virus has normalized ideas that just two years ago felt like impossible tropes from history: city-wide lockdowns, restriction of movement within and between cities and countries, laws that kept family separate.
But with the Omicron variant delivering Australia’s most significant outbreak of the pandemic, COVID-19 is without a doubt stronger than ever.
As we embark on another year overshadowed by this virus, and despite serious questions about how it may mutate in the future, now is a good time to reflect on how far medical science has taken us in two years.
Vaccines and rapid antigen tests help deal with serious illness and COVID spread. And for those who get the virus, an increasing number of new treatments and therapies are being developed or approved for use in Australia.
Here’s a look at some of the treatment areas you’ll probably want to hear more about in 2022.
The ‘MABs’ – monoclonal antibodies
Monoclonal antibodies are proteins produced in a laboratory that mimic the way the immune system fights viruses. They are given to a patient intravenously and started within a few hours.
MABs lock onto the tip protein from an invading coronavirus and boost the body’s immune response, hopefully preventing the virus from invading cells and causing disease.
Research suggests that MABs can help people with mild COVID-19 disease if administered early in the infection.
Researchers still believe that vaccination provides better protection because it generates a stronger immune response and is beneficial from the moment of infection. MABs will only be administered after a patient has tested positive. This means that people at risk for serious illness may be too far into their illness before realizing that they need MAB treatment.
Different MABs are useful in supporting vaccination depending on what other health problems the patient is juggling with and the severity of their COVID disease.
So which monoclonal antibody therapies are approved for use in Australia?
A new therapy, tentatively approved by the Therapeutic Goods Administration in December. Regkirona is used in adult patients with a confirmed SARS-CoV-2 infection.
This is another new one, also approved in December. Actemra is useful for very sick adult patients who are also receiving corticosteroids, supplemental oxygen or ventilation.
Casirivimab and imdevimab (Ronapreve)
Ronapreve received its preliminary approval in October and can be used to treat patients from the age of 12, especially those who do not have antibodies to SARS-CoV-2.
Xevudy, tentatively approved in August, is designed to be administered within five days of the onset of symptoms in patients over 12 years of age.
The ‘VIRs’ – antiviral drugs
Antiviral drugs can help the body fight a virus and come as an oral pill or as an intravenous infusion. Antiviral agents work by disrupting the way the virus replicates, slowing or stopping the spread, and reducing symptoms. But as with MABs, vaccination is the preferred front-line defense.
A number of antiviral drugs are being used for COVID-19 treatment, but they are not yet immediately available in Australia. That may change in 2022. This is where things stand:
TGA tentatively approved Veklury in 2020. It can be used for adults admitted with moderate to severe COVID-19.
However, the WHO has advised against its use.
Nirmatrelvir and Ritonavir (Paxlovid)
Pfizer has a brand new antiviral drug that is approved in the United States but is being evaluated for use in Australia. Also known as PF-07321332, it is an antiviral drug, Nirmatrelvir, taken in combination with the HIV drug Ritonavir.
This is another antiviral drug under evaluation in Australia, produced by Merck Sharp and Dohme and Ridgeback Biotherapeutics. This is supplied as a pill and is designed to be the first home treatment for COVID-19. It will be prescribed to people with a mild to moderate illness but with comorbidities that put them at high risk of hospitalization or death as a result of a COVID-19 infection.
Advances in intensive care
Jill Carr, a virologist at Flinders University in Adelaide, is looking to improve treatment for COVID-19 patients admitted to an intensive care unit.
“No matter how good a vaccine is, no matter how good our public health strategies are, there are still people who get sick and end up in the hospital,” Carr says. “So how can we help them once they’re in the intensive care unit?”
Carr says that while ventilators can be life-saving for COVID-19 patients with serious illness, the force needed to push oxygen into the body can also damage the lungs.
“The covid lung is completely different from the flu lung,” she says. “Getting oxygen into the lungs and into the bloodstream is quite a challenge.”
Carr uses rat models to figure out how to use ventilation better and what other treatments can be used in combination to reduce inflammation and improve oxygen transfer.
“Our research aims to inform practice so we know what pressure and flow rates are best applied to the fan,” she says. “So you can get oxygen into the patient’s lung without causing a ventilator-induced lung injury.”
Researchers are rapidly advancing a variant-safe vaccine that can be administered as a booster and provide immunity to any COVID-19 mutation that emerges in the future.
The road between research and a marketable vaccine remains long and difficult, but Deborah Burnett of the Garvan Institute hopes her team can begin human trials by 2022.
With research teams from the Westmead Institute as well as in the US and Norway all studying the promise of a universal booster, 2022 could be the year we receive some hopeful news.
Recycled or off-label drugs
Throughout the pandemic, physicians have discovered that some drugs designed for one disease have potential benefits for the treatment of COVID-19.
Of interest, several drugs were developed to treat HIV and malaria.
Most famous are those given to former US President Donald Trump during his treatment for a COVID-19 infection in October 2020.
Trump is said to have received the steroid Dexamethasone, the antibody treatment Regeneron and the antiviral drug Remdesivir, which the WHO says does not show any evidence of being effective.
And the Australian Therapeutic Goods Administration warns that a drug used to treat one condition does not mean it will be safe to treat another. It follows a strict process of controlling medication before it is released for authorized use.
Physicians prescribing “off-label” medications must outline the risks to the patient and seek informed consent.
Other drugs that have been touted as treatments throughout the pandemic, but which have been widely discredited for lack of evidence or causing harm. These include ivermectin (used to treat parasites in animals), doxycycline (a broad-spectrum antibiotic used to treat bacterial infections and also to prevent malaria) and the mineral zinc, which is known to support the immune system but has been shown to to have no benefit from subsidies for the treatment of COVID-19.
Another malaria drug – hydroxychloroquine – has also not been shown to provide any benefit against COVID-19.
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