Fact Check My Feed: Which COVID-19 Treatments Are Backed By Science?

IRA FLATOW: This is Science Friday. I’m Ira Flatow. And now we return to a topic we’ve visited before, how to fact-check your coronavirus feed. Our Facebook, Twitter, and Apple news feeds are so overloaded with stories of the virus right now, it’s hard to separate truth from rumor. Add to that, we’re hearing how much scientists still don’t know about testing and treatment of COVID-19.

So this week, we’re continuing to dig into the evidence behind the speculation, the published studies and reports by scientists coming up with real data about this virus. And this time, we’re looking into the therapies for treating COVID-19 patients. For example, President Trump has publicly speculated about the benefits of using a tried and tested antimalarial drug, hydroxychloroquine to treat patients.

That endorsement has sent governors, doctors, and worried public scrambling to get their hands on the drug. But what is the evidence to back up the claim? And what about remdesivir, the antiviral drug that has been used to treat a handful of patients and is now the subject of several new drug trials?

Joining us once again to clarify the science behind the various possible treatments, Dr. Angela Rasmussen, Assistant Research Scientist and virologist at the Columbia Mailman School of Public Health.

Dr. Rasmussen, thanks for joining us again.

ANGELA RASMUSSEN: Thanks for having me back, Ira.

IRA FLATOW: And just a note to our listeners, because we are all practicing social distancing, we won’t be taking your calls today during this edition of Science Friday, which is being prerecorded. Let’s talk briefly first about the studies that have come out. Most of them are in preprint archive. What does that mean?

ANGELA RASMUSSEN: So preprint archives are a way that has been developed over the last couple of years for scientists to put their manuscripts out into the public domain prior to them undergoing peer review. And it’s really important that we have peer-reviewed articles, because we need to make sure that when something is being published and presented as authoritative scientific data that it has been reviewed by a group of other knowledgeable scientists who can assess the quality of that work on the types of controls that are used, what conclusions are being made from the work. But it’s also, that process can take a long time.

So the preprint servers are a way for people to get the data out there right now so that other people can analyze it, can take a look at it, and review it. But the problem with that is that when people who may not be as knowledgeable about the model systems that are being used or the science that’s being discussed read them, there can be misinterpretations because, again, they haven’t been through peer review, so they may not be 100% final.

IRA FLATOW: So to speak, the drug is not ready for prime time yet.

ANGELA RASMUSSEN: That’s correct. And that’s what we’re seeing from many of these drug studies. Many of them are very promising in that they show possible efficacy, but so far we haven’t seen any preprint articles that describe the type of clinical trial that’s needed to assess whether a drug is or is not effective against COVID-19.

IRA FLATOW: OK, let’s walk through some of these drugs. Let’s talk first about the drug remdesivir. It has been in the news for a few weeks, an antiviral that was tried on earlier viruses like Ebola. The news reports sound hopeful, but what does preliminary data show on this?

ANGELA RASMUSSEN: So preliminary data, as far as I’m aware, that has been published about remdesivir is either in vitro, meaning it’s done in cultured cells or is based on data from non-human primates that were infected with MERS-coronavirus, which is a related coronavirus that causes a similar type of disease. In the non-human primates infected with MERS, remdesivir was effective at reducing viral loads and clinical illness. So the theory is that remdesivir could potentially work as well for treating COVID-19.

Remdesivir is a fairly broad spectrum antiviral, so there’s no reason why it wouldn’t work against COVID-19, SARS coronavirus 2. But we also had promising data showing that it would work for Ebola. And in a clinical trial with Ebola virus disease patients in the Democratic Republic of Congo, it had no impact on clinical outcomes for those patients.

IRA FLATOW: So this really is just hopeful speculation, at this point, until we have real data to back it up.

ANGELA RASMUSSEN: That’s correct. I mean, certainly, it’s beyond speculation, I’d say, just because the data does indicate in a non-human primate model, which are usually thought of as sort of the gold standard for evaluating drugs in people, that the data with MERS does suggest that it can have an effect in vivo, in an animal, on a related coronavirus. But again, we won’t know until we complete a controlled randomized clinical trial.

IRA FLATOW: And can you give us any idea of what a timeline would be for this?

ANGELA RASMUSSEN: That depends somewhat on when these trials started. I know that as early as January, there was discussions about beginning a remdesivir trial in China. There was quite a lot of controversy, actually, because there were some patent issues with the actual chemical that remdesivir is and some stuff going on with the Chinese government and the patent system.

So I think that those trials have been going on. I don’t know at what point they will decide that they have collected enough trial data from enough patients to publish. But I would imagine that the timeline is going to be as accelerated as possible. So I would guess probably sometime within the next eight weeks.

IRA FLATOW: That sounds optimistic. Terrific. Let’s move on to the next drug. Last week, President Trump said the antimalarial drug hydroxychloroquine showed, quote, “tremendous promise in treating the virus.” Where’s he getting that information from?

ANGELA RASMUSSEN: That’s largely based on a couple of different studies that were preprints. Actually, two preprints and one study that was a press conference given by a Chinese government official. So there was a study in China, recently done, looking at chloroquine phosphate that was a controlled trial in which they compared patients who were treated with chloroquine phosphate, which is a very closely related chemical to hydroxychloroquine, and looked at outcome for those patients.

And it’s available as a preprint, but it’s only– the full paper is in Chinese, so you need to use Google Translate to read it. But in that study, it showed no difference between the treatment groups. So that suggested that chloroquine wasn’t effective. However, the caveat there is that it was a very small trial with only 30 patients total.

Also, there was a study out of France that’s available in a preprint that looks at hydroxychloroquine with azithromycin, which is an antibiotic. And I don’t know what the rationale was for including azithromycin, other than to potentially discourage secondary bacterial infections. But that study did show that hydroxychloroquine and azithromycin could potentially treat coronavirus.

However, what’s important to note about that study is it was very small, only 20 patients, and there was no control group. So it’s very difficult to assess efficacy, if not impossible to assess efficacy, when you don’t have a control to compare it to. So while that data, again, is promising, we can’t make any conclusions about hydroxychloroquine and/or azithromycin until that’s evaluated in a more rigorous clinical trial.

IRA FLATOW: Let’s move on to some other topic and related case. The White House is saying, quote, “Well if it doesn’t hurt, why not try it?” So are there any side effects of taking hydroxychloroquine as a preventive treatment?

ANGELA RASMUSSEN: So there are side effects. Some people can have some fairly serious cardiac side effects from taking those drugs. In addition, one other harmful thing that’s not really related to side effects but has to do with the availability of that medication is that hydroxychloroquine is used to treat other conditions, rheumatoid arthritis and lupus.

And people who are taking that have reported that in some places there are now shortages. So it actually is harmful using an untested drug, even if there are no side effects, when you could be taking those drugs away from people who are already taking them and already need to take them for an unproven reason.

In addition, I’ve also read that there may be potential drug interactions between azithromycin and hydrochloroquine that could be quite serious, so that’s another thing to consider. It’s definitely not correct to say that there’s no harm in trying because these drugs are safe. Chloroquine has been used for a long time, and its safety profile is well-understood, but that doesn’t mean that it’s completely risk-free to take the drug.

IRA FLATOW: So are there studies combining the two that we’ll find out these things?

ANGELA RASMUSSEN: So the World Health Organization is coordinating a variety of clinical trials of hydroxychloroquine, I think that’s with azithromycin, as well as remdesivir, as well as the HIV protease inhibitors that have been also suggested to work, although a recent study suggests that they don’t. So those trials are all underway at multiple sites across the country and around the world.

IRA FLATOW: Let me go to a tweet from Lisa, who asks, “how about convalescent transfusions? This very old treatment sounds promising, at least until a vaccine is developed.” I think she’s talking about antibody treatments, which go way back, right?

ANGELA RASMUSSEN: They do. So everybody’s familiar with blood transfusions, plasma transfusions. The plasma is the part of your blood that’s the liquid part with no cells in it, and that’s where your antibodies are when you separate blood in the laboratory. So the idea here is to take plasma from people who have survived and recovered from COVID-19, assuming that they will have antibodies in their blood that can inactivate the virus. Taking that plasma and putting it into a patient who is sick may be able to help reduce their viral loads and reduce the severity of their disease.

IRA FLATOW: And this is being seriously considered, correct?

ANGELA RASMUSSEN: Yes. I believe that trials are going to start imminently. For a while, we were playing catch-up. A number of groups around the world have been trying to develop assays to identify patient antibodies and to characterize the immune response that those antibodies provide.

Florian Krammer at the Mount Sinai School of Medicine and Marion Koopmans, Bart Haagmans at Erasmus Medical Center in the Netherlands have both developed ELISAs which is the type of assay that looks for these antibodies that are specific to SARS coronavirus 2. Those assays both are out in preprint right now. They both appear to be very specific and sensitive for those types of antibodies. So we are now going to be able to start screening patients and begin these trials in treating patients which, in New York, can’t come a moment too soon.

IRA FLATOW: Could we be screening the general public also for people who have had it, and recovered it, and maybe not even know it? I mean, there are limited numbers of tests. I don’t imagine there are enough tests to go about doing that.

ANGELA RASMUSSEN: Yeah, that’s a type of study called a sero-surveillance study, and that is almost certainly going to be done. And it’s especially important for COVID-19 to do that because the testing capacity has been so low that there are probably thousands, if not even millions possibly, of cases that were unrecognized and undiagnosed at the time that we really need to identify in order to determine how prevalent this virus was in our community. That’s especially relevant if this becomes something that’s seasonal and that we’re dealing with regularly. We need to know who has immunity to the virus so that we can inform people the proper way about what they should be doing.

IRA FLATOW: I’m Ira Flatow. This is Science Friday from WNYC Studios. In case you’re just joining us, I’m talking with Dr. Angela Rasmussen, Assistant Research Scientist and virologist at the Columbia Mailman School of Public Health.

“What about”– here’s another tweet that came in– “what about high-dose vitamin C? I see posts that this is being tested in New York City. A doctor in Florida is offering IV vitamin C treatments to boost immune systems.” What do you say, Doctor? Any truth there?

ANGELA RASMUSSEN: Well, there is truth that people are talking about this as a potential therapy. And I know that some hospitals– a hospital system in New York has reported that they are actually doing this, where they’re infusing people with high-dose vitamin C. In general, vitamin C is pretty safe.

Where this is a problem is– it’s not clear to me anyways– that the high-dose vitamin C infusions are being done as part of an actual clinical trial to look at whether or not it’s effective. They’re pretty much just saying, well, it’s probably not going to hurt, so let’s give this a try based on some studies from almost 10 years ago that suggests that vitamin C reduces the duration of common cold symptoms. We just don’t know if that’s the case.

IRA FLATOW: Yeah. So much to ask, so little time. We’re also seeing reports about using HIV treatment, some data published in The New England Journal?

ANGELA RASMUSSEN: Yeah, a study was done because some groups in Thailand have reported that using these protease inhibitors successfully treated one patient who recovered from COVID. Previously, they’d been shown in vitro to be active against original SARS coronavirus. So they decided to try these in 200 patients in China.

And the long story short is that there was no significant difference in clinical outcomes, so no patients survived in excess compared to control patients. So that suggested that those drugs didn’t work. But I believe that those drugs are being still looked at in these WHO clinical trials that are ongoing to look at it in a larger set of patients.

IRA FLATOW: And one final question, do you think it’s the job of research scientists to push back about vague or incorrect information that may be coming out of the government, or that people just don’t understand, or reading it on social media?

ANGELA RASMUSSEN: I think that’s very important. And this week, we’ve seen at least one situation that exemplifies that. There was a couple in Arizona that took some fish tank cleaner because it had chloroquine phosphate in it.

And the surviving woman– the man died, the woman survived– she said to the media that they did that because the president had recommended in his press briefings that chloroquine was a miracle drug, and a game changer, et cetera. So it can be very, very harmful for incorrect, inaccurate information to be passed down by the government because they have so much authority and credibility. So it’s critical that scientists speak up when things like that happen because it literally can save lives.

IRA FLATOW: Dr. Rasmussen, Thank you for speaking up with us today, and good luck to you.

ANGELA RASMUSSEN: Thank you so much, Ira. It was a pleasure being here.

IRA FLATOW: Nice to have you. Dr. Angela Rasmussen, Assistant Research Scientist and virologist at the Columbia Mailman School of Public Health. And if you have a question or a suggestion for future topics you’d like us to fact-check surrounding the coronavirus, you can tweet us @SciFri with the hashtag #factcheckmyfeed.

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