With the rapid spread of the coronavirus, readers have understandably voiced their concerns about this emerging viral threat. One particular email I received this week caught my attention:
DEAR DR. PRESCOTT: I read coverage of all the problems with the novel coronavirus, but I tire of the doom and gloom in the daily press. In that vein, could you dedicate a column to the medical care of those already infected with this new virus and what’s being done, besides isolation, to halt the spread of it? I’ve seen a line or two printed about a potential inoculation similar to our annual flu shot, but that information always seems to get glossed over.
— Rick Jones, Choctaw
There are a lot of great questions rolled in there. I’ll see if I can tackle them.
Medical care for mild cases
Let’s start with the good news: Although the virus that causes the disease known technically as COVID-19 can be deadly, the great majority of those infected to date have shown only mild symptoms and make a full recovery.
COVID-19 hails from a viral family that can cause coldlike symptoms; in mild cases, it appears to be virtually indistinguishable from a cold or the seasonal flu. It causes an upper respiratory infection, and it also may result in symptoms like a cough, shortness of breath, sore throat, congestion, headache, fatigue, muscle aches or fever.
As with a cold, there is no known effective treatment for the underlying virus. (But read on to learn about efforts to find one.) So, that means treating symptoms by resting, staying hydrated and using over-the-counter cold medications and pain relievers as needed.
In mild cases, treatment won’t require hospitalization or, for many, even a trip to the doctor. Indeed, health experts now believe that statistics may be significantly under-counting the number of cases, as lots of folks who’ve been infected don’t even realize it. They just come down with what seems like a cold, recover and go on with their lives.
Treating severely ill patients
In some patients, the virus can cause pneumonia and acute respiratory distress. As with the flu, those most at risk for severe symptoms are the elderly and people already facing other health challenges like heart disease, diabetes and chronic respiratory disease.
These cases often require hospitalization, with oxygen therapy to help breathing. In the most serious cases, doctors will place patients on ventilators. Patients also may receive antibiotics to prevent secondary infections.
While early reports from the Hubei Province of China, the initial center of the outbreak, showed a fatality rate of almost 3%, more recent statistics for the rest of the country are much more reassuring, showing death rates of only 0.4%. (In reality, that number could be even lower, as many cases go unreported.)
For comparison, seasonal influenza carries a death rate of 0.1%.
It’s too soon to say for sure, but it looks as if the COVID-19 mortality rate will be closer to that of flu, rather than the 3% originally reported.
For the rest of this article, I’ve enlisted the assistance of Dr. Judith James. James is the vice president of clinical affairs at the Oklahoma Medical Research Foundation and an internationally renowned immunologist and expert in, among other things, vaccines. Here’s what she had to say:
Finding new treatments
As Dr. Prescott said, there are currently no approved treatments for the new coronavirus. However, remdesivir, an investigational antiviral drug not yet approved the FDA, has shown promise in animal models of other serious coronaviruses.
On Tuesday, the National Institutes of Health began a clinical trial of this drug in Nebraska, and clinical trials are also underway in China. In addition, a small number of patients also have received remdesivir outside the clinical trials setting under what’s known as compassionate use, which allows the administration of a new, unapproved drug to treat a seriously ill patient when no other treatments are available.
Finally, doctors are trying a number of other medications — and combinations of medications — in a host of clinical trials around the world.
It’s impossible to put a timeline or odds of success on all of this work. But with the scope of this effort, the number of potential treatments at our disposal, and our knowledge of coronaviruses, there is reason for hope.
Developing a vaccine
Recent events also bode well for the development of a vaccine.
It took scientists less than 10 days from the moment the virus was first described to biologically “isolate” it. Researchers also succeeded — with similar speed — in decoding the virus’ genetic sequence, structure and ways that it infects cells.
This information will, in turn, provide critical building blocks for the development of treatment and prevention strategies, including a potential vaccine.
In fact, significant work by the NIH and a pharmaceutical industry partner already has led to the development of an experimental vaccine against the virus. Trials of that vaccine are scheduled to begin in April.
Other candidate vaccines are also in the works. While the process will take time, with our knowledge of coronaviruses and biomedical research expertise, developing a preventative vaccine stands as an attainable goal.