Around 100 clinical trials are in the works to treat COVID-19, the illness caused by the SARS-CoV-2 coronavirus, in China, with other trials starting in Japan, Thailand, and England. The virus has killed 1,772 people and infected more than 70,000 in China, according to the World Health Organization, with estimates of up to 200,000 infections, based on computer modeling by Trevor Bedford of Fred Hutchinson Cancer Research Center and his colleagues.
One of the trials already underway is in Shanghai, where doctors are taking blood plasma from patients who were sickened by the virus and recovered and infusing it into patients who are still ill. “We are positive that this method can be very effective in our patients,” Lu Hongzhou, co-director of the Shanghai Public Health Clinical Centre, tells Reuters. A World Health Organization (WHO) official says the therapy is a “very valid” one to test, as long as the infusion is administered at just the right time to boost the ill patient’s immunity.
In Japan, doctors plan to use HIV antiretroviral drugs to treat patients infected COVID-19. The Japanese government is “currently conducting preparations so that clinical trials using HIV medication on the novel coronavirus can start as soon as possible,” Yoshihide Suga, the chief cabinet secretary, tells The Guardian. Limited evidence suggests the therapy could see some success. HIV drugs have reduced levels of coronaviruses such as those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), in animal studies. And, doctors in Thailand treated a 70-year-old Chinese woman with a combination of HIV and flu antivirals; she reportedly recovered 48 hours after treatment.
These drugs are being tested alongside 1,000-year-old traditional treatments, such as the Chinese herbal medicine shuanghuanglian, which contains extracts from the dried fruit lianqiao (Forsythiae fructus).
The WHO is closely monitoring the trials and assisting with developing protocols so that the results of different experiments can be compared. Standards are being set for using a placebo treatment, measuring a person’s recovery or decline, and establishing other requirements so the trials have consistent structure, WHO chief scientist Soumya Swaminathan tells Nature. “Getting the clinical trials straight is a priority, since if we get information on what is working and not working, we can benefit patients now.”
Despite researchers’ best efforts, recruiting eligible patients into these clinical trials may not be as easy as drugmakers had anticipated. A clinical trial to test an antiviral drug produced by Gilead needs 700 patients to do the appropriate statistical analyses, yet in 10 days, only 200 individuals have been registered so far, according to The Wall Street Journal.
Another concern is that researchers will go to immense effort to begin these clinical trials only to see the scientific efforts dwindle after the outbreak ends. “I worry this will be the same situation as during SARS,” Shibo Jiang, a virologist at Fudan University in Shanghai, tells Nature, “where the work starts, then stops.”