PHN Explores: Scientists say the best treatment for COVID-19 may be a cocktail of medicines (From The Boston Globe)
PHN Content By Mat Edelson
Why You Should Care
If you get Covid-19, there’s only one FDA approved treatment (Redemsivir). But the drug has potential drawbacks: It’s not a cure, it may not work for everyone, and it will probably be in short supply for some time. That means we need multiple drug options. Fortunately there are literally thousands of drug studies on-going worldwide. These including examining combination treatments or the so-called ‘cocktail’ approach which has worked well with other viral diseases such as HIV.
The best experiments combine inspiration, ingenuity, and experience. This Boston Globe story highlights many studies, including a trial with Covid-19 patients recently published in a major medical journal, The Lancet. In this study, Hong Kong researchers looked at three antivirals drugs that each had shown some effectiveness in humans and/or animals infected with other coronaviruses. These included SARS (Severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome).
The researchers gave their drug cocktail* to patients with what they called mild to moderate cases of Covid-19. From the beginning of treatment, those patients were virus-free in a median of 7 days versus a median of 12 days in the control group.
As important, the drug combination appeared safe; there wasn’t a serious single adverse side effect reported among the 86 patients.
*Since you asked, the drug cocktail consisted of interferon beta-1, lopinavir-ritonavir, and ribavirin. What’s interesting is that the Hong Kong researchers wrote that, back in 2003, they used the combination of lopinavir-ritonavir and ribavarin on SARS patients. That drug cocktail dropped both the death rate and the need for what the researchers called “intensive respiratory therapy” in hospitalized patients.
Dr. Barry Bloom, professor, public health, Harvard T.H. Chan School of Public Health; past president, American Association of Immunologists
Coming up with vaccines and drugs to take on Covid-19 are clearly key to getting our economy up and running again. In this Goldman Sachs podcast, Dr. Barry Bloom is joined by two other health experts; Dr. Ezekiel Emanuel, chair of the department of medical ethics and health policy at the University of Pennsylvania, and former FDA commissioner Dr. Mark McClellan, founding director of the Duke-Margolis Center for Health Policy at Duke University. Listen here
Bonus Bonus Biscuit
(SKIP THIS IF MATH GIVES YOU A HEADACHE)
We don’t know about you, but back in high school, we had a heck of a time understanding the math term median. It’s easy to confuse median with the term average (also known as the mean).
So why do researchers like using median numbers? Is it just to mess with the rest of us? Not really. Median numbers often reduce the impact of a single ‘outlier’ case on a study result involving many patients. In other words, medians yield a number that’s much closer to the experience of the vast majority of the group.
The median, as it’s used here, is the time it takes half (or 50 percent) of a given study group to achieve a result. So…say 20 patients are put on an antiviral drug. If half (10) of them were virus-free in 5 days or shorter, and 50 were virus-free in 5 days or longer, the median would be 5 days to being virus-free.
But imagine a researcher had been using the average number instead of the median number to measure this same group. And let’s say, within this same group of 20 patients, their recovery broke down as follows:
- 10 patients who all became virus-free on day 4,
- 9 more who all became virus-free on day 6, but;
- 1 person who didn’t became virus-free until day 200 (and, yes, that can happen).
On average, it would take 14.7 days until a patient became virus-free. And that’s a pretty misleading number, considering that 19 of the 20 patients were virus-free by day 6. Hence, researchers often prefer to forsake averages for medians.
(What, don’t trust our math? Harrumph! 294 total days for all the patients to be virus-free divided by by 20 patients = 14.7 days per patient. We’ll be here all week solving math puzzles; don’t forget to tip your wait staff and bartender on the way out).
Here’s a CNN piece on the Hong Kong study: Triple drug therapy helps coronavirus patients recover more quickly, study finds
Here’s the Hong Kong researchers’ study, peer-reviewed and published in The Lancet: Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial