Perspective on COVID-19

A Devotee-Researcher's Perspective on COVID-19: Cures and Cautions

By: Shyama Sakhi Devi Dasi (Shivani Agarwal, PhD) - 4.11 2020

Diagnosed Covid-19 cases and deaths as of October 30th, 2020.

 

Shyama Sakhi Devi Dasi (Shivani Agarwal, PhD Biotechnology, MSc Biochemistry) She is a Research Assistant Professor at the Department of Pharmacology and Regenerative Medicine, University of Illinois (UIC), Chicago, Illinois.

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277 days ago, none of us had heard of coronavirus and everything we did was not shrouded with the specter of COVID-19. We welcomed the new decade, filled calendars, planned events and trips centered around serving Krishna, celebrating festivals together, visiting the holy places and much more. Who could believe that offering prostrated respects to the deities, greeting each other with hugs would become a health hazard, walking past someone in a temple or store would induce so much of anxiety? How the world has changed? Will this continue for a long time? Is there light at the end of the tunnel? From my perspective as a medical researcher, here is what we know.

Current scenario and a brief background

As of October 3, 2020, COVID-19 has infected 34,666,560 people and killed 1,029,394 people worldwide, according to the Johns Hopkins University’s Center for Systems Science and Engineering. 

With the global pandemic in full swing, pharmaceutical companies, government researchers, and others are working to accelerate the development process for COVID-19 treatment. There are over 200 vaccine programs and treatments that are underway. This is an unprecedented effort. Whilst they are all striving for an effective vaccine or treatment, researchers all around the globe are still struggling to get there and to know what “effective” really means. In the field of allopathic medical research, there are currently no approved drugs specifically for the treatment of COVID-19. Researchers are exploring and studying either new drugs, or drugs that are already approved for other health conditions (called as drug repurposing), as potential antidotes for COVID-19. Because COVID-19 is a multi-armed virus, which attacks several organs thereby hijacking many different systems in the body, it is unlikely that any single drug will be fully effective. As per the leading virologists working in the field, the best treatment to combat the novel coronavirus is predicted to be a combination of different drugs. 

The treatments aimed to disarm COVID-19 are of two kinds based on their target. 

Targeting the virus

Anti-viral drugs target either the viral entry into the cells or prevent replication of the virus within the host post its entry. Anti-viral drugs include but are not limited to the use of "monoclonal antibodies". The monoclonal antibodies are synthetic antibodies, which are designed based on the antibodies found in the patients who have recovered from COVID-19.

Treating the symptoms

Drugs that have Immunomodulatory properties are presently in use to tackle the symptoms. Immunomodulators function by calming the immune system's over-reaction to the virus (a process known as "cytokine storm"), which is one of the leading causes of severe illness in some patients and many deaths reported so far.

Challenges in COVID-19 Research: Clinical trials and the Drug Approval Process 

Vaccine makers are focusing on the best vaccine design that is able to induce high amounts of neutralizing antibodies that are sufficient to either prevent the virus from entering the body or killing the virus post its entry. However, at present it s not clear as to how much neutralization is good enough and for how long the effect would last. If antibody levels aren’t high enough, the recipient might only be partially immune, which could benefit to some extent by preventing development of severe symptoms but still leave the person with the ability to infect others. Questions about safety, efficacy and longevity still loom. Though pharmaceutical companies want to take the easiest, least-complicated path towards drug approval, for most drugs and vaccines, real world applications are limited. This is because many trials exclude people with underlying health conditions and ironically the patients excluded are often those most at risk and most in need of treatments. This includes many who have co-morbidities or complicated variables that confound most of the results. It is unfortunate but true that it is almost always the case that the people who will ultimately use the drug are quite different from the people on whom the drug was tested. This is the reason why any drug used to treat COVID-19 is still considered investigational, and the true risks or effectiveness of these drugs will not be known until they are tested in the general population.

Use of immunosuppressants might seem to be a quite promising method, as they can calm the hyperactive immune system in COVID-19 patients, however, over-suppression raises the risk for other secondary infections. Figuring out when to give the drugs to patients is like “Goldilocks' conundrum”: The timing must be just right. Anti-inflammatory drugs should not be given to patients too soon because most people may not need the intervention. Given too soon, the drug would suppress or compromise the body’s natural immune system to respond effectively to the virus. Given too late, the drugs may not be effective anymore because the immunomodulators are better at preventing the cytokine storm, rather than reversing it. 

The gold standard to determine whether a drug would work requires trials to be placebo-controlled, double-blinded and randomized. That means some patients will be randomized to receive a placebo instead of the treatment drug and neither researchers nor patients know who gets what. Typically, every drug to be approved by government agencies, like the US FDA, must go through rigorous trials (Phase I, II and III). Hydroxychloroquine was initially approved for an emergency use authorization based on early studies, but those studies were small and not randomized or blinded. The FDA has now retracted the drug's emergency authorization and multiple studies, including large, randomized ones, have shown no proven benefit from the drug in COVID-19 patients. 

Thus, without any available effective treatment so far, this disease demands us to be cautious moving forward. It seems that practicing excellent hygiene, physical distancing and wearing our masks rather than cutting corners, are still considered the best approved ways to prevent contact-based infection.

Efficacy of herbs, dietary supplements, or home remedies as an alternative or complementary to allopathic medicine

There is an active discussion about the potential of many dietary supplements like vitamins (B, C and D), minerals (Zinc, Selenium etc), antioxidants and anti-inflammatory compounds (berries, curcumin, licorice, turmeric, etc) in boosting one’s immune health and thus preventing coronavirus infection or helping in recovery.

So far government health organizations have not approved any herbal medicine for the treatment of COVID-19 despite the many claims about certain products being potentially used as immune boosters and anti-infectives to relieve one from COVID-19 symptoms. This is simply attributed to the fact that there have been no rigorous clinical trials for any of the products to prove their claim of efficacy even though some of them have shown to possess antiviral properties. 

Some dietary supplements or herbs may help boost one’s immune system in a way that one can build a good immune system to fight the infection, But until there is sufficient proof one should not depend on them completely for their ability to reduce the burden of infection and disease. 

As with all medicines, any decision on switching to dietary supplements should be strictly in compliance with a healthcare provider first (dosage and regimen), as some supplements may interact with certain medications or are inappropriate for some people due to their underlying condition.

Suggested safe and universal approaches to deal with the Pandemic

Rapid changes in recommendations, controversial news reports, information from unknown sources, or conspiracy theories can create uncertainty, panic and confusion. 

In general, COVID-19 control measures till date are limited to non-pharmaceutical methods. No specific treatments for COVID-19 exist right now. While health organizations say no medicines are yet available to prevent or cure the coronavirus, some simple remedies may alleviate mild symptoms and some precautions can protect one from contracting the disease. 

The most effective ways to protect yourself and others are:

Get tested immediately if you have symptoms before virus takes over your immune system
Isolation and quarantine if you are sick or have symptoms. 
Good personal hygiene--wash your hands frequently and thoroughly with soap or wipe with hand sanitizer 
Use of disinfectants to wipe clean the surfaces
Avoid touching your eyes, mouth, and nose
Wearing a mask or face covering in public places 
Cover your mouth when you cough by using the bend of your elbow or a tissue
Limit public gatherings and if it is unavoidable, maintain a distance of at least 6 feet from others
Avoid indoor spaces with crowds
Healthy lifestyle--daily physical exercise strengthens the upper respiratory system
Healthy eating 

***If you do contract COVID-19 and are advised to stay home or in the monastery (due to less severity of infection), here are some simple suggestions that might aid in quicker recovery. They are solely experiential not experimental. Information below is derived from the personal experiences of several patients who have recovered at home/monastery:

Getting enough rest
Staying well hydrated
Allopathic medicines that relieve fever and aches
Nasal decongestants, gargle and steam/vapor (reduces mucous, phlegm and clears sinuses)
Yoga, and breathing exercises (combats anxiety and calms the nervous system)
Stay in isolation

***Patients with more serious symptoms such as trouble breathing, shortness of breath, restlessness, chest pain, or bluish lips or face should seek emergency medical care without any delay. If you have any underlying condition, please note that even these simple home remedies can lead to fatal complications. 

The lives of our devotees are too precious, and we must not adapt to any relaxed approaches to this serious health risk.