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Medisina at Politika by Dr. Rey Pagtakhan  

Clinical horizons for hope

in the COVID-19 pandemic

by Dr. Rey Pagtakhan

March 30, 2020: It’s Day-120 of the COVID-19 pandemic. Although its official declaration was barely three weeks ago, the pandemic traces its beginning to the outbreak of pneumonia due to an unknown microbe in Wuhan, China on December 8, 2019. We now understand that while the team of medical scientists and doctors was still searching for the specific pathogen, it was already making its contagious travel even before it was identified and given its official name, “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” and the respiratory illness named “coronavirus disease 2019 (COVID-19).”

Crossing the three-quarter-million mark

To date, this globetrotting agent of acute respiratory distress and death has brought its virulence to more than three-quarter-million people, and counting, across 177 countries. It has claimed the lives of 36,211 patients (4.79 per cent) from the 755,591 total population sickened. In five countries, patient-count has exceeded 50,000: USA –148,089; Italy – 101,739; Spain – 85,195; China – 82,198; and Germany – 63,929. Of whom 25,398 succumbed to the disease: USA – 2,599 (1.76 per cent); Italy – 11,591 (11.39 per cent); Spain – 7,340 (8.62 per cent); China – 3,308 (4.02 per cent); and Germany – 560 (0.88 per cent). The Philippines has reported 78 deaths (5.04 per cent) from its cumulative total of 1,546 patients.

Canada’s situation and response

Canada has 70 deceased (0.96 per cent) from its total of 7,288 patients sickened. Of whom, one (1.56 per cent) is from Manitoba’s 64 total patients. The number of deceased in the five provinces with the most number of patients are: Quebec – 25 (0.73 per cent) of 3,430 patients; Ontario – 23 (1.35 per cent) of 1,706 patients; British Columbia –17 (1.92 per cent) of 884 patients; Alberta – 3 (0.45 per cent) of 661; Newfoundland and Labrador – 1 (0.68 per cent) of 148 patients.

All provinces have declared either a public health or state emergency or both for a14-day duration, and extendable by some. These emergency declarations have put in place the public health tools of social distancing: an enforceable ban on mass gatherings, closure of recreational facilities, withdrawal of non-essential public services, limits to travel, home quarantine, stay-home directives, and directives to maintain a two-metre distance between people. A breach of these measures incurs a fine and/or jail term.

Health Minister Paddy Hadju makes a weekly call to her provincial counterparts. This ensures the coordination and credibility of messaging, Canada-wide.

The federal government has kept its option on the National Emergencies Act open. Meanwhile, it has focused on imposing two-week self isolation upon arrival from international travel; providing a vital economic and funding package for citizens, businesses and the medical research community; and reinforcing the need to stay home and maintain physical distancing.

Clinical trials of drugs and a vaccine

To my estimation, the many public measures that have been put into action, stressful as they are to citizens, have helped in the overall fight against this pandemic and have produced the desired results – slowing and suppressing the spread of the disease and a surge of patients. These results will prevent an overwhelming burden on our health care system and give us time as we wait for two therapeutic necessities – vaccine and drugs.

A. Vaccine

Vaccines to promote immunity against COVID-19 would be ideal to have, but they take time to develop and be widely available.

“A vaccine trial in the US has now given a dose to its first participant…and might be available as early as Fall 2020,” the US National Institute of Allergy and Infectious Diseases announced on March 17. Indeed, many projects in addition to this first one are ongoing. One hopes at least one succeeds, and soon be available.

B. Drugs and other non-pharmaceutical treatments

Meanwhile, we search for pharmaceutical and non-pharmaceutical compounds. One of the first reports on a potential clinical trial of an anti-viral drug in China came from Montreal researchers on February 28th. We have not heard of a progress report yet. Reportedly also, the US Food and Drug Administration is expediting clinical trials of a blood plasma treatment for patients seriously ill in New York. The hope is that the antibodies in the recovered person’s blood will help the patient. Rockefeller University scientists are trying to refine the process.

“More than 500 clinical trials are already registered with the WHO…This is impressive but also concerning,” wrote Drs. Cheng, Lee, Tan and Murthy in the March 26, 2020 issue of the Canadian Medical Association Journal. Let me quote from their commentary, “Generating randomized trial evidence to optimize treatment in the COVID-19 pandemic,” to emphasize some key points:

“When faced with an unknown and frightening disease …some clinicians and patients will feel strongly compelled to try unproven therapies based on theory…animal models, clinical anecdotes…In the COVID-19 pandemic, experimental medications…have already been widely used…There is a strong ethical and clinical argument for replacing such “random” care with randomized care, in which patients are routinely randomly assigned to the most promising available option(s) or to control arm(s), so that evidence regarding the safest, most effective therapies may be generated in the shortest possible time…This strategy would allow clinicians to be satisfied that they are doing everything possible for their severely ill patients while contributing to new knowledge…Canada will start by evaluating lopinavir–ritonavir, compared with optimized supportive care…. As the pandemic evolves, the temptation to use unproven medications will be tremendous, but Canadian clinicians must maintain a commitment to the rigorous gathering of scientific evidence… so that we may quickly improve outcomes for all patients with COVID-19 worldwide.”

The four groups of drugs and combinations that have been chosen are: 1) remdesivir, 2) a combination of two drugs, lopinavir and ritonavir, 3) the two drugs plus interferon beta, and 4) hydroxychloroquine. The World Health Organization is coordinating this project. Ten countries are hosting the clinical trials. In the USA, New York-Presbyterian and Columbia University Irving Medical Center, and the University of Minnesota are pursuing their own clinical trials of hydroxychloroquine:

With many countries very quickly participating in robustly controlled randomized clinical trials, we could expect definitive results – effective and safe drugs versus non-beneficial and harmful drugs – as early as a few months from today.

These are our clinical horizons for hope.

Hon. Dr. Rey D. Pagtakhan, P.C, O.M., LL.D., Sc.D., M.D., M.Sc. graduated from the University of the Philippines College of Medicine and the University of Manitoba (UM) Faculty of Graduate Studies and Research and trained at the St. Louis Children’s Hospital-Washington University Medical Center. He is a retired lung specialist and professor of pediatrics and child health from the Children’s Hospital of Winnipeg and the University of Manitoba Faculty of Medicine. As Canada’s former Secretary of State for Science, Research and Development, he made a presentation on “The Global Threat of Infectious Diseases” at the G-8 Countries’ Science Ministers and Advisors Group Meeting held on June 13-15, 2003 in Berlin, Germany.

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