Are there drugs available that can treat Coronavirus? Is there a link with Statins? What about private testing for the virus? Our doctors answer these questions and more.
In this update:
- Drugs in the news
- The latest treatment guidelines
- A speculated link with Statins
- Private testing for COVID-19
- CT screening
There has been lots of coverage in the media about Chloroquine & Hydroxychloroquine, two very common drugs, which look like they may have the potential to treat and/or prevent the transmission of COVID-19.
The initial reports from China where the treatments were first used were very encouraging, although the small size of the first trial, with just 30 patients, meant that the results were open to a huge degree of question. The second trial which followed had a greater cohort of patients (130), however, it is still too small for doctors to base lasting guidelines upon.
The risks may outweigh the benefits
Although there is significantly increasing worldwide demand for the drugs, the evidence to support their widespread use remains incomplete and it is still possible they could do more harm than good. It is vital that the efficacy and safety of these drugs be evaluated through quality research before their role can be determined.
A substantial study has started in Spain with over 3,000 participants, which hopes to accurately gauge whether the drugs are of any clear benefit as both an option to treat symptoms and as a prophylactic to prevent transmission. However, the results will not be known until May at the earliest and more likely June.
Many reports gaining prominent attention in the media are being sourced from material published online by medRxiv (a joint venture supported by Yale University, the BMJ and others) where preliminary reports from trials can be published. However, any articles you see referencing content from medRxiv should be viewed with caution. The site is explicit about saying reports have not been peer-reviewed before being published and should not be used to guide health practises or presented as fact.
Peer-review is a fundamental and essential step in making sure that published information is accurate. Skipping peer-review could be described as the scientific equivalent of letting unlicensed drivers hit the fast lane of the motorway.
A good example of where peer-review shows value is regarding the recent coverage of a well-known drug used to treat HIV, Kaletra (Lopinavir – Ritanovir). Huge amounts of media attention have been focussed on the drug as a potential treatment for COVID-19, commonly when combined with Chloroquine or Hydroxychloroquine. However, a randomised and controlled study (the gold standard of assessment) with a good cohort size found no benefit from using the drug when compared with standard treatments.
Advances in treating patients
Despite the huge amount of information becoming available about the virus – which is rapidly becoming a problem in its own right as there is such a huge volume of emerging data for doctors to keep track of – significant steps are being made to support patients.
With new information being made available across countries, rapidly improving guidelines for treating patients in hospital are being widely shared, which will start to improve outcomes and save lives.
As COVID-19 is caused by an entirely new type of coronavirus, much still remains unknown about what factors may contribute to more severe disease or indeed what may improve patient outcomes if infected with the virus.
There have been suggested links between common treatments for high blood pressure and heart disease that could increase the severity of the disease. It is important to stress that any link remains unproven. Expert groups amongst the medical profession (British Cardiovascular Society and British Heart Failure Society) have reviewed the current scientific information and agree there is a lack of evidence to speculate that these drugs increase the chances of severe COVID-19 infections. What is clear is that stopping these medications could be dangerous and therefore the guidance remains that patients should continue taking them.
Is there a link with Statins?
The same processes in the body that are hypothesised by some clinicians to be potentially increasing the severity of the disease are now also being linked with statins. Conversely, studies conducted during the MERS and SARS outbreaks have hypothesised that statins could potentially improve survival.
Clearly more needs to be understood about how the virus affects receptors in the body that may be linked to better or worse outcomes and how exactly medications such as statins are implicated in those pathways.
Statins are regularly taken by many thousands of people in the UK to help prevent heart disease. If the potential link is picked up by mainstream media, they are likely to be alarmist in any coverage, which is far from helpful. It is incredibly important to stress that there is no proven link, just a hypothesis, which will be proved or disproved as more evidence is found. A call has been issued to all existing trials to improve the recording of existing drug therapies alongside other trial data.
What has become clear from data so far, is that individuals with a history of cardiovascular disease and diabetes are more vulnerable to severe disease if infected with COVID-19 and the guidance therefore supports the optimal management of such conditions.
Because the pandemic is such a rapidly evolving situation, the guidelines may well change as more evidence becomes available, for example, with the recently changing guidance to use paracetamol in preference to ibuprofen to treat symptoms whilst we await clearer scientific evidence.
Private testing for COVID-19
Testing for the virus continues to advance rapidly and more providers are offering tests for COVID-19 privately. We urge patients and clients to exercise extreme caution as, although some providers reference that the laboratory being used is UKAS Accredited (which is a good thing), this certification does not necessarily apply to the specific test used and the risk of false positives or false negatives remains ever present.
Whilst there is any degree of uncertainty about the accuracy of the tests, alongside the severe shortage of tests available for frontline health workers, we do not believe it is currently appropriate to offer the test privately.
CT scanning to diagnose COVID-19
It is also possible that screening tests for the disease using existing equipment such as CT scanners may start to be offered in the coming weeks and months. Again, we advise extreme caution in these areas because, although scanners are being used to help diagnose the disease, there are huge areas of uncertainty. An article published recently in The Lancet highlights the problems and risks involved in CT screening for the disease, concluding it is potentially dangerous.
Our doctors remain at hand to provide support and advice. If you have any questions about the disease, or how it may affect your business, please just get in touch.