COMMUNITY CORNER: COVID-19 treatments; updates to consider 
•	Dr. Anis Ansari ,Apr 16, 2020 
Coronavirus is a newly discovered enemy that continues to ravage many countries.
It has killed more than 128,000 people worldwide and 26,000 people in the United States up to April 15. Healthcare providers are frustrated due to the rapidly worsening conditions without any set of definitive guidelines for treatment to combat this pandemic.
It is time to review medications that are on the horizon that can be utilized and their current status.
Fortunately, 80 percent of infected patients with COVID-19 will experience mild to moderate symptoms. They do not need admission to the hospital and their symptoms can be controlled at home.
Patients admitted to the hospital present with a high-grade fever, low pulse oximetry (oxygenation level) and worsening shortness of breath and who have other comorbid conditions like heart disease, diabetes and hypertension. They are also likely to rapidly deteriorate and require ventilator support.
Realistically, time is not on our side. Some of these experiments in randomized controlled trials will take a year or more to finish. Of all the research in process, 52 percent of studies are vaccine based, 33 percent are antibodies based, 16 percent antiviral and 25 percent concentrate on other areas like cell-based therapy. In general, many experiments are being done on mice or in petri dishes but not on human beings.
Some experiments are being conducted on humans, but they are too small to be useful. The Center for Disease Control – https://www.cdc.gov/ – reports that in February 2020, 100 patients were treated with Chloroquine (antimalarial) in China. The scientist demonstrated that Chloroquine was superior to control treatment in inhibiting the worsening of pneumonia, improving lung imaging, eliminating the virus from the body and shortening the duration of the disease.
In Southern France, a case study involving 26 patients received Hydroxychloroquine (used to treat rheumatoid arthritis and lupus) compared to 16 patients who did not. After six days, the virus was not detected in 70 percent of those given the drug compared to only 12.5 percent who were not treated. Zithromax, a common antibiotic, also has been used at times. Ultimately, depending on each situation, physicians can decide what is best for their patients.
Next up, a new solution discussed is convalescent plasma. When people recover from COVID-19 their blood contains antibodies produced by their cells to fight coronavirus. This is a trusted process in which plasma products can be separated from a recovered patient and transfused to a COVID-19 patient. Unfortunately, there is not much experience with this treatment except in China, where it was able to help fight infection by reducing the duration and severity of the disease.
Remdesivir is an antiviral medication that has been successful in treating coronaviruses in animals, causing a reduction in the virus and lung disease. Interleukin-6 inhibitors like Actemra or Sarilumab have limited data and are not available for use. Corticosteroids are not recommended unless the benefits exceed the risk.
There are a lot of anecdotal reports that Ivermectin (antiparasitic medication) was able to kill the virus in petri dishes within 48 hours along with reports of high dose Vitamin C, etc. Predictions are that a COVID-19 vaccine will take some time. Unfortunately, the next flu season is only six months away.
Again, currently there is no official treatment available, which make things very frustrating. Physicians can make a judgment about the use of any one or more of the above medications, depending on the situation. You can be sure that scientists are working feverishly to find a cure and save lives.
Dr. Anis Ansari, of Clinton, is Board certified in internal medicine and nephrology