Reviewing the data: How close is Malaysia to a COVID-19 cure?
Drug names = key smashes i.e. Remdesivir (look it up)
As you probably already know, there is no current cure or vaccine for COVID-19, and the current treatments for those suffering are for the management of symptoms and comorbidities. However, it looks like there are better things on the horizon; labs worldwide are working on a potential vaccine and local ongoing research has suggested there are more comprehensive methods of treatment that make our odds against the virus look far more promising.
Here is a referenced review of Malaysia's current progress with a vaccine and other comprehensive drug treatments:
What are vaccines?
First thing’s first, vaccines are used to provide immunity against one or several diseases. They can either be inactivated where they contain killed virus particles, or live where they contain attenuated (weakened) viruses—either way, these strains cannot cause disease.
The way your immune system works is either by innate or adaptive immunity. Innate immunity simply refers to the cells in your body that are built to fight anything and everything that isn’t you (such as foreign pathogens like bacteria and viruses). Your adaptive immunity is way more specific—it takes more time to react but is indispensable when it comes to pathogens like COVID-19 that sneakily escape your innate immune system. Plus, when it’s all said and done, your adaptive immune system has memory (it remembers what just infected you for a long while after) to protect against subsequent infection or disease, lest you fall prey again.
Vaccines simply stimulate the adaptive response, without the hassle of you needing to become ill (or at least too ill) in the first place. Of course, they also only work on people who have not been previously infected.
What’s the hold up with the COVID-19 vaccine?
The catch is that vaccines take a long time to develop; usually around 5-10 years, though this timeline may be compressed in the case of a COVID-19 vaccine (considering the circumstances). They need to undergo several stages of rigorous clinical trials, with the final product passing several criteria to be approved for administration. It has to be safe (duh), produce protective immunity in a very high proportion of the people it’s administered to (otherwise what’s the point, right?), generate long-lasting immunity to the pathogen (otherwise we’d all need repeated doses) and be cost-effective.
On the note of cost, money is a huge issue—research is incredibly expensive, and nothing can be done without funding. In the reality we live in, big pharmaceutical companies who can afford to fund such research have little motivation to do so because of the lack of incentive; public corporations, on the other hand, may have the motivation but often lack the funding. Plus, an added complication to the vaccine race is that we are not sure whether past infection with COVID-19 and subsequent recovery even ensures immunity. That’s not to say that we’re going nowhere, though–according to the World Health Organisation, there are over seventy separate teams involved in the global race towards a COVID-19 vaccine, with three already proceeding to human trials.
CanSino Bio is the first to have advanced their vaccine development into Phase 2 (out of four) of clinical trials, meaning that their vaccine so far has been declared safe for use in humans and can now be tested for its efficacy. Locally, we have begun trialling existing vaccines against COVID-19: The Institute for Medical Research Malaysia (IMR) has collaborated with Malaysian Vaccines and Pharmaceutical Sdn Bhd (MVP) and University Malaya’s Tropical Infectious Diseases Research and Education Centre (TIDREC) after studies showed that the novel human coronavirus shared high genetic similarity with the Avian Infectious Bronchitis virus (IBV). Therefore, the existing vaccines for the poultry coronavirus may be effective against COVID-19 with a few tweaks, which is what the study will hopefully establish. If successful, the vaccine will move into clinical trials soon, but we are yet to hear any news or see the results of the study as it is still ongoing.
Where is Malaysia with possible treatments right now?
Based on a review article published this month, data from other similar viral epidemics like SARS and MERS indicate that immunotherapy is likely to yield effective and suitable solutions for COVID-19. Apart from vaccines, immunotherapy also includes monoclonal antibodies, which are laboratory-produced antibodies used to restore and enhance the function of the immune system. They can have a wide range of functions, treating anything from cancers, rheumatoid arthritis, psoriasis and, of course, viral infections.
In Malaysia itself, four hospitals are due to trial the rheumatoid arthritis drug Tocilizumab, a monoclonal antibody better known by its trade name Actemra, in treating patients with severe cases of COVID-19 (note: severe, as in critical). In fact, the drug has been used in several independent clinical trials globally, with promising results.
Professor Datuk Dr Adeeba Kamarulzaman, the Dean of the Faculty of Medicine at Universiti Malaya and associate professor at Yale University stated that: “We know that approximately 80% of COVID-19 patients have mild to moderate symptoms and will recover, however, 15% progress to severe disease and another 5% will develop critical illness, with death occurring in between 1-3% of patients.”
“What is becoming clear is this: in this small group of patients, a dangerous overreaction of their immune system, known as a cytokine storm, overwhelms the patient resulting in respiratory failure followed by multi-organ failure. So, in these patients, ironically, it is their own immune response to the virus that kills them,” she added.
In simple terms, the cytokine storm causes the immune system to evoke a severe inflammatory response, which is what leads to lung failure and leaves the patient in critical condition. The cytokine storm itself is caused by the interleukin-6 (IL-6) pathway, which the drug blocks, turning off the inflammatory response before it begins, therefore saving the patient.
The study is promising, having already raised RM450,000 for its development, however a total of RM 1.5 million will be needed for the trial to progress. If you would like to contribute to the fund, contact Dr Adeeba.
In addition to Tocilizumab, the Director General of Health of Malaysia has announced that we have joined the World Health Organisation’s (WHO) “Solidarity Trial”; an effort to test the effectiveness of several drugs in treating COVID-19, including combinations of Remdesivir, Lopinavir/Ritonavir, Interferon beta, Chloroquine and Hydroxychloroquine. These compounds all work by preventing viral replication. The research will be headed by Dr Chow Ting Soo, the Infectious Disease consultant at Pulau Pinang Hospital, who will be working with a team of infectious disease physicians and pharmacists.
What about the lack of PPE?
There is, as mentioned, a lot of research going into potential vaccines and novel treatments that aim to either kill the virus or stop its reproduction within the body. That said, it’s no doubt that prevention is better than a cure, and that’s why research has also gone into improving our protective measures against the virus.
With the global surgical mask shortage urging fashion brands and communities to step up and make up for the supply, a group of researchers from India has employed the use of medicinal plants capable of viral inactivation in their three-layered masks to help prevent the spread of the virus. Of course, until it’s made widely available we’ll have to stick to what we know: stay inside and practise good hygiene.
How can I help to speed up the development process?
All in all, when it comes to a vaccine or any other miracle cure, we’re still far off. That means it’s more important than ever to adhere to the MCO guidelines to help flatten the curve and reduce the number of patients in critical hospital care, thus reducing the burden on our hospitals and buy some time for researchers.
Author’s note: The COVID-19 situation is an emerging, rapidly evolving situation. All theories, references and articles included in this essay are correct as of April 2020. All images in text sourced from @covid19quilt on Instagram. For the latest research click here and for the latest updates click here.