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Cuba: From AIDS, Dengue, and Ebola to COVID-19 - Dissident Voice

Cuba: From AIDS, Dengue, and Ebola to COVID-19 - Dissident Voice


Cuba: From AIDS, Dengue, and Ebola to COVID-19 - Dissident Voice

Posted: 14 Apr 2020 12:12 PM PDT

Preparing for a pandemic requires understanding that a change in the relationship between people is primary and the production of things is secondary and flows from social factors. Investors in profit-based medicine cannot comprehend this concept. Nothing could exemplify it more clearly than Cuba's response to the corona virus (COVID-19).

The US dawdled for months before reacting. Cuba's preparation for COVID-19 began on January 1, 1959. On that day, over sixty years before the pandemic, Cuba laid the foundations for what would become the discovery of novel drugs, bringing patients to the island, and sending medical aid abroad.

For twenty years before the 1959 revolution, Cuban doctors were divided between those who saw medicine as a way to make money and those who grasped the necessity of bringing medical care to the country's poor, rural, and black populations. An understanding of the failings of disconnected social systems led the revolutionary government to build hospitals and clinics in under-served parts of the island at the same time it began addressing crises of literacy, racism, poverty, and housing.

By 1964, Cuba began creating policlínicos integrales, which were recreated as policlínicos comunitarios in 1974 to better link communities and patients. By 1984, Cuba had introduced the first doctor-nurse teams who lived in the neighborhoods they served. This continuing redesign of Cuban primary and preventive health has lasted through today as a model, allowing it to surpass the US in life expectancy and infant mortality.

It had an overarching concern with health care, even though it had never escaped from poverty. This resulted in Cuba's eliminating polio in 1962, malaria in 1967, neonatal tetanus in 1972, diphtheria in 1979, congenital rubella syndrome in 1989, post-mumps meningitis in 1989, measles in 1993, rubella in 1995, and tuberculosis meningitis in 1997.

The Committees for Defense of the Revolution (CDRs) became a key part of mobilization for healthcare. Organized in 1960 to defend the country, block by block if necessary, from a possible US invasion, the CDRs took on more community care tasks as foreign intervention seemed less likely. They became prepared to move the elderly, disabled, sick, and mentally ill to higher ground if a hurricane approached. They currently help in removal of mosquito breeding places during episodes of dengue fever, participate in health education programs, ensure distribution of children's vaccination cards, and help train auxiliary staff in oral vaccination campaigns.

AIDS in a Time of Disaster

Two whammies pounded Cuba in the late 1980s and early 1990s. The first victim of AIDS died in 1986, and Cuba isolated soldiers returning from war in Angola who tested positive for HIV. A hate campaign against Cuba claimed that the quarantine reflected prejudice against homosexuals. But the facts showed that (1) soldiers returning from Africa were overwhelmingly heterosexual (as were most African AIDS victims), (2) Cuba had quarantined dengue patients with no outcry, and (3) the US itself had a history of quarantining patients with tuberculosis, polio, and even AIDS.

The second blow landed quickly. In December 1991, the Soviet Union collapsed, ending its $5 billion annual subsidy, disrupting international commerce, and sending the Cuban economy into a free fall that exacerbated AIDS problems. A perfect storm for AIDS infection appeared to be brewing. The HIV infection rate for the Caribbean region was second only to southern Africa. The embargo simultaneously reduced the availability of drugs (including those for HIV/AIDS), as it made existing pharmaceuticals outrageously expensive and disrupted the financial infrastructures used for drug purchases. If these were not enough, Cuba opened the floodgate of tourism to cope with lack of funds. As predicted, tourism brought an increase in prostitution. There was a definite possibility that the island would succumb to a massive epidemic that would rival the effects of measles and smallpox which had arrived with European invaders to the New World.

The government response was immediate and strong. It drastically reduced services in all areas except two which had been enshrined as human rights: education and health care. Its medical research institutes developed Cuba's own diagnostic test by 1987. Testing for HIV/AIDS went into high gear, with completion of over 12 million tests by 1993. Since the population was about 10.5 million, that meant that persons at high risk were tested multiple times.

Education about AIDS was massive for sick and healthy, for children as well as adults. By 1990, when homosexuals had become the island's primary HIV victims, anti-gay prejudice was officially challenged as schools taught that homosexuality was a fact of life. Condoms were provided free at doctor's offices. I witnessed the survival of the education program during a 2009 trip to Cuba; the first poster I saw on the wall when entering a doctor's office had two men with the message to use condoms.

Despite high costs, Cuba provided antiretroviral (ART) drugs free to patients. One of the great ironies of the period was that those who screeched most noisily about Cuba's "anti-homosexual" quarantines remained silent as the Torricelli Bill of 1992 and the Helms-Burton Act of 1996, designed to "wreak havoc" on the island," seriously hindered the government's efforts to bring ART drugs to HIV victims.

Cuba's united and well-planned effort to cope with HIV/AIDS paid off. At the same time Cuba had 200 AIDS, cases New York City (with about the same population) had 43,000 cases. NYC residents were far less likely to have recently visited sub-Saharan Africa, where a third of a million Cubans had just returned from fighting in the Angolan war. When the HIV infection rate in Cuba was 0.5 percent, it was 2.3 percent in the Caribbean region and 9.0 percent in southern Africa. During the period 1991–2006, Cuba had a total of 1,300 AIDS-related deaths. By contrast, the less populous Dominican Republic had 6,000 to 7,000 deaths annually. In 1997, Chandler Burr wrote in The Lancet that Cuba had "the most successful national AIDS programme in the world." Despite having only a small fraction of wealth and resources of the United States, Cuba had implemented an AIDS program superior to that of the country seeking to destroy it.

Dengue and Interferon Alpha 2B

The mosquito-borne dengue fever hits Cuba every few years. Its doctors and medical students check for fever, joint pain, muscle pain, abdominal pain, headache behind the eye sockets, purple splotches, and bleeding gums. What is unique about Cuba is that its medical students leave school and go door-to-door making home evaluations.

Students from ELAM (Spanish acronym for the Latin American School of Medicine) come from over 100 countries and speak with a huge number of accents. They have no trouble walking through homes, looking for mosquito-attracting plants, and peering onto roofs to see if there is standing water.

During a 1981 outbreak of dengue, expanded surveillance techniques included inspections, vector control education, spraying, and "mobile field hospitals during the crisis with a liberal policy of admissions." Cuba also increased testing for potential cases during a 1997 dengue outbreak. Increased testing of hospital patients was combined with surveillance data to produce predictions concerning secondary infections related to death rates. These campaigns, which combined citizen involvement with health care professionals and researchers, have resulted in reduced incidence of dengue and decreased mortality.

In 1981, Cuba's research institutes created Interferon Alpha 2B to successfully treat dengue. The same drug became vitally important decades later as a potential cure for COVID-19. According to Helen Yaffe, "Interferons are 'signaling' proteins produced and released by cells in response to infections that alert nearby cells to heighten their anti-viral defenses." Cuban biotech specialist Dr. Luis Herrera Martinez adds that, "its use prevents aggravation and complications in patients, reaching that stage that ultimately can result in death."

Since 2003, Interferon Alpha 2B has been produced in China by the enterprise ChangHeber, a Cuban-Chinese joint venture. "Cuba's interferon has shown its efficacy and safety in the therapy of viral diseases including Hepatitis B and C, shingles, HIV-AIDS, and dengue." Cuba has researched multiple drugs, "despite the U.S. blockade obstructing access to technologies, equipment, materials, finance, and even knowledge exchange."

Ebola and International Aid

AIDS and dengue were problems that affected the Cuban population; but Ebola Virus Disease (EVD) was quite different. Viruses that cause EVD are mainly in Sub-Saharan Africa, an area that Cubans had not frequented for several decades.

When the Ebola virus increased dramatically in fall 2014, much of the world panicked. Soon, over 20,000 people were infected, more than 8,000 had died, and worries mounted that the death toll could reach into hundreds of thousands. The United States provided military support; other countries promised money.

Cuba was the first nation to respond with what was most needed: it sent 103 nurse and 62 doctor volunteers to Sierra Leone. With 4,000 medical staff (including 2,400 doctors) already in Africa, Cuba was prepared for the crisis before it began.

Since many governments did not know how to respond to Ebola, Cuba trained volunteers from other nations at Havana's Pedro Kourí Institute of Tropical Medicine. In total, Cuba taught 13,000 Africans, 66,000 thousand Latin Americans, and 620 Caribbeans how to treat Ebola without themselves becoming infected.

This was hardly the first time that Cuba had responded to medical crises in poor countries. Only fifteen months after the revolution, in March 1960, Cuba sent doctors to Chile after an earthquake. Much better known is Cuba's 1963 medical brigade to Algeria, which was fighting for independence from France.

In the very first days of the revolution, there were insufficient medical staff and facilities in rural parts of Cuba that were predominantly black. It was perfectly natural for those who learned of lack of treatment and disasters that plagued other parts of the world to go abroad to assist those in need.

Revolutionary solidarity was often a collective family choice. Dr. Sara Perelló had just graduated from medical school when her mother heard Fidel say that Algerians were even worse off than Cubans and called on doctors to join a brigade to assist them. Dr. Perelló wanted to volunteer but was worried that her elderly mother suffered from Parkinson's disease. Her mother responded that Sara's sister and husband would help her as would the government: "Now the thing to do is go forward and don't worry about your mother, who will be well taken care of."

Cuban solidarity missions show a genuine concern that often seems to be lacking in health care providers from other countries. Medical associations in Venezeula and Brazil could not find enough of their own doctors to go to dangerous communities or travel to rural areas by donkey or canoe as Cuba doctors do. When Cuban doctors went to Bolivia, they visited 101 communities that were so remote that they did not appear on a map.

A devastating earthquake hit Haiti in 2010. Cuba sent medical staff who lived among Haitians and stayed months or years after the earthquake was out of the news. US doctors did not sleep where Haitian victims huddled, returned to luxury hotels at night, and departed after a few weeks. The term "disaster tourism" describes the way that many rich countries respond to medical crises in poor countries.

The commitment that Cuban medical staff show internationally is a continuation of the effort that the country's health care system made in spending three decades to find the best way to strengthen bonds between care-giving professionals and those they serve. Kirk and Erisman provide statistics demonstrating the breadth that Cuba's international medical work had reached by 2008: it had sent over 120,000 health care professionals to 154 countries; Cuban doctors had cared for over 70 million people in the world; and, almost 2 million people owed their lives to Cuban medical services in their country.

There is a noteworthy disaster when a country refused an offer of Cuban aid. After the 2005 Katrina Hurricane, 1,586 Cuban health care professionals were prepared to go to New Orleans. President George W. Bush rejected the offer, acting as if it would be better for American citizens to die than to admit the quality of Cuban aid. This decision foreshadowed the 2020 behavior of Donald Trump, who searched for a treatment for COVID-19 while pretending that Interferon Alpha 2B does not exist.

Contrasts: Cuba and the United States

These bits of history are background for contrasts between Cuba and the United States during the COVID-19 pandemic. Those of us old enough to remember that in the 1960s, we could still have a relationship with a doctor without an insurance company interceding can appreciate that social bonds between physicians and patients were eroding in the United States at the same time they were being strengthened in Cuba.

Testing. Since Cuba brought both AIDS and dengue under control with massive increases and modifications of testing, it was well prepared to develop a national testing program for COVID-19. Similarly, China was able to quickly halt the epidemic, not simply from lockdowns, but also because it quickly tested suspected victims, took necessary steps for isolation and treatment of those found to be positive, and tested case contacts who were asymptomatic.

It is no accident that the United States is a global leader in neoliberal efforts to reduce or privatize public services, proved incapable of mounting an effective testing campaign, and, by the end of March 2020 was on the way to leading the world in COVID-19 cases. In mid-March, the United States had been able to test 5 per million people, though South Korea had tested more than 3,500 per million.

Symptomatic of governmental incompetence in the United States was Trump's putting vice-president Pence in charge of COVID-19 control. It was Pence, who as Indiana governor, had drastically cut funds for HIV testing (urging people to pray), thereby contributing to an increase in infections.

Costs of care and medication. Medical care in Cuba is a human right with no costs for treatment and only very small charges for prescriptions. Pharmaceutical companies were some of the first industries nationalized after the revolution. US policies routinely hand over billions of tax dollars to Big Pharma, which routinely gets away with gouging citizens mercilessly.

There are no insurance companies in Cuba to add to medical expenses and dictate patient care decisions to doctors. Even if testing becomes free in the United States, people must still decide if they can afford treatment for COVID-19. Those who think that their insurance will cover their COVID-19 bills, "may receive a large out-of-network bill if the ER has been outsourced to a physician staffing firm that is not covered by the insurance."

Protecting Workers. When natural disasters halt work, Cuban workers receive their entire salaries for one month and 60 percent of salaries after that. Cuban citizens receive food allotments and education at no cost, and utilities are extremely low. Cuba was able to shift production in nationalized factories so quickly and was able to churn out so much personal protective equipment (PPE) that it could send it to accompany the medical staff going to Italy when it was the pandemic's center.

In the United States, there were nearly 10 million unemployment compensation claims by the end of the first week in April, and the country is not well-known for helping the unemployed by increasing taxes on the rich or reducing the military budget. There could be over 56 million "informal workers" in the United States who are not entitled to unemployment benefits. Forcing many US citizens to go to work because they cannot afford to go without basic necessities threatens the entire population with further spread of the pandemic. US health care workers have been short of PPE, including masks, gowns, gloves and test kits. Yet, President Trump is allowed to hold ventilators as "rewards" for states whose governors write that they appreciate him.

Comprehensiveness of Health Care. The Cuban revolution immediately reorganized the country's disconnected health services and today has an integrated system beginning with neighborhood doctor-nurse offices tied into community clinics linked to area hospitals, all of which are supported by research institutes. The health system is connected to citizens' organizations that have decades of experience protecting the country. This "inter-sectoral cooperation" is a keystone of health care. In Cuba, it would be inconceivable to have fifty different state policies that may or may not be consistent with national policies and may allow counties and cities within them to have their own procedures.

Instead of integrating plans for an effective approach to combating disease, the United States dismantles and/or privatizes whenever it can. Trump disbanded the pandemic response team, tried to underfund the pandemic prevention work of the World Health Organization, and sought to weaken nursing home regulations, the Center for Disease Control and Prevention, and the National Institutes of Health.

Lest anyone think that this is peculiar to Republicans, please remember that Democrats have long been in the forefront of neoliberalism and utilization of the "shock doctrine" approach that Naomi Klein described. Both parties have contributed to dismantling environmental rules so desperately needed.

Rebecca Beitsch reported on March 26 that "The Environmental Protection Agency (EPA) issued a sweeping suspension of its enforcement of environmental laws, telling companies they would not need to meet environmental standards during the coronavirus outbreak." Not wanting to be left out, "the oil and gas industry began asking the federal government to loosen enforcement of federal regulations on public lands in response to the coronavirus pandemic." They sought an extension of two-year permits and the ability to hold onto unused leases. If pandemics such as COVID-19 recur in the future, will added pollution and climate-related diseases weaken human immune systems, making them more vulnerable to infections?

If so, universal medical coverage would be essential to protection for tens of millions of Americans. A recipient of huge donations from medical and pharmaceutical companies, Joe Biden has supported efforts to undermine social security and "suggested he would veto any Medicare for All bill that the House of Representatives passed."

The Reality of Preparing to Deal with Medical Crises. Pascual Serrano noted that Cuba had already instituted the Novel Coronavirus Plan for Prevention and Control by March 2, 2020. Four days later it updated the Plan by adding "epidemiological observation," which included specific measures like temperature taking and potential isolation, to infected incoming travelers. These occurred before Cuba's first confirmed COVID-19 diagnosis on March 11. By March 12, after three Italian tourists were identified as having symptoms, the government announced that 3,100 beds at military hospitals would be available. Vulnerable groups such as seniors receive special attention. Cuba put a cohesive plan into motion that provides citizens with straightforward information, mobilizes workers to protect themselves and the country, and shifts production to necessary supplies.

At the same time, Donald Trump precautioned Americans to be wary of "fake news" about the virus. Then he said, "It will go away." On February 26, he falsely said the number of U.S. COVID-19 cases "within a couple of days is going to be down to close to zero." He claimed, "It's going to disappear thanks to what I did… " Then he told everyone they should go to church on Easter Sunday and that Americans should go to work even if they had the virus. Unquestionably, Trump's behavior contributed to the spreading of the disease. His statements were consistent with the desires of industry to resume business as usual.

While the United States produces a surplus of unnecessary junk, Cuba produces a surplus of health care professionals. Consequently, Cuba has 8.2 doctors per 1,000 people while the United States has 2.6 doctors per 1,000. While I was on a 2019 trip there, a recently graduated Cuban doctor told me that he only works about 20-25 hours per week. But during medical disasters, it could easily be 80-100 hours per week.

Education. Cuba has used mass education to effectively change behavior during epidemics. In 2003, Dr. Byron Barksdale pointed out how Cuba's six-week program for AIDS patients was "certainly a longer time than is given to people in the United States who receive such a diagnosis. They may get about five minutes of education." During dengue outbreaks, medical professionals who go to homes explain in detail why water must be drained or covered and what plants augment mosquito breeding.

The United States confronts health crises with "campaigns" that are grossly inadequate. TV ads run for a few weeks or months, and physicians may receive brochures to give to patients. There is nothing even approaching visits to every home to inspect how families can be contributing to their own illness and how to adopt behaviors to counter the disease.

Donald Trump's inconsistent rantings about COVID-19 are the epitome of miseducation campaigns. Climate denial has served as a dress rehearsal for COVID-19 denial. The Trump reign has been a practice session in stupefying millions into believing anything a Great Leader says no matter how ridiculous it is. His tweets have a pathological similarity to the intensely anti-intellectual perspective that is dismissive of education, philosophy, art, and literature and insists that scientific investigation should never be trusted.

The day before yesterday, they insisted that the world was flat. Yesterday, they believed that evolution was a theory from Satan. This morning, they insisted that heating of the globe is a fantasy designed to choke corporate expansion. How close must it get to midnight before those drunk with Trump's Kool-Aid are willing to see the facts of COVID-19 growth unfolding before their eyes?

International Solidarity. Cuba made international headlines the third week in March 2020 when it allowed the British cruise ship MS Braemar to dock with COVID-19 patients aboard. It had been turned away by several other Caribbean countries, including Barbados and the Bahamas, which are both part of the British Commonwealth. There were over 1,000 passengers on board, mainly British, who had been stranded for over a week. Braemar crew members displayed a banner reading "I love you Cuba!" Undoubtedly, Cuban officials felt okay letting the ship dock because its doctors had gained so much experience being exposed to deadly viruses like Ebola while knowing how to protect themselves.

The same week in March, a medical brigade of 53 Cubans left to Lombardy, one of the worst hit areas of Italy, the European country most affected by COVID-19. Soon they were joined by 300 Chinese doctors. A smaller and poorer Caribbean nation was one of the few aiding a major European power. Cuba had also sent medical staff to Venezuela, Nicaragua, Suriname, Grenada, and Jamaica.

Meanwhile, the US administration was refusing to lift sanctions on Venezuela and Iran, sanctions that interfered with these countries receiving PPE, medical equipment, and drugs. Yet, it continued sending thousands of personnel to Europe for military maneuvers. It manufactured a smear campaign against President Maduro of Venezuela, portraying him as a drug trafficker. Trump disgraced America by pandering to his most racist supporters by referring to COVID-19 as the "China virus."

As Cuba shared anti-virus technologies with other countries, reports surfaced that the Trump administration offered the German company CureVac $1 billion if it could find a remedy for COVID-19 and hand over exclusive rights "only for the USA." This meant endangering the lives of Americans in two ways. By trying to monopolize a drug that had not yet been developed, Trump was trying to distract attention from the existing Interferon Alpha 2B which China was already including among thirty treatment drugs for the disease. By continuing the sixty-year-old blockade, Trump hampered Cuba from receiving supplies for the development of new anti-COVID-19 medications.

What Do Researchers Look For? When Cuban labs created Interferon Alpha 2B to treat dengue, it was just one of many drugs researched to investigate treatments, especially those that would help people in poor countries. Its use of Heberprot B to treat diabetes has reduced amputations by 80 percent.

Cuba is the only country to create an effective vaccine against type-B bacterial meningitis. It developed the first synthetic vaccine for Haemophilus influenza type B (Hib), as well as the vaccine Racotumomab against advanced lung cancer. Cuba's second focus has been to manufacture drugs cheaply enough for poor counties to be able to afford them. Third, Cuba has sought to work cooperatively, with countries such as China, Venezuela, and Brazil, in drug development. Collaboration with Brazil resulted in meningitis vaccines at a cost of 95¢ rather than $15 to $20 per dose. Finally, Cuba teaches other countries to produce medications themselves, so they do not have to rely on purchasing them from rich countries.

In virtually every way, corporate research has been the opposite of that in Cuba. Big Pharma spends millions investigating male pattern baldness, restless legs, and erectile dysfunction because these could reap billions in profits. The COVID-19 pandemic promises to bring in super-profits, and governments are acting to make sure that happens. At the same time Trump was making promises to the German CureVac company, his administration was looking into giving exclusive status to Gilead Sciences for developing its drug remdesivir as a potential treatment for COVID-19. US taxpayers would dole out millions to create a medication that could be too expensive for them to buy.

Though Donald Trump is the nadir of national chauvinism countering global cooperation, it is important to remember that it is the market system that pushes research into investigations that yield the greatest profit instead of where it will do the most good.

Future Pandemics. Cuba's dengue epidemic in early 2012 seemed odd because outbreaks usually happen in the fall and are over by December. It is rare for them to last into January and February. Climate change is making local conditions more suitable for the mosquitoes that are vectors for dengue. During the last half-century, Cuban health officials have calculated a thirty-fold increase of the Aedes aegypti mosquito, the main vector.

Corporate media regularly tells us that COVID-19 is "unprecedented," as if nothing like it will happen when it subsides because, after all, nothing like it has happened before. Not really. Claiming that COVID-19 is the "worst pandemic" to ever hit this continent is either saying that smallpox had no effect on Native Americans or that Native American deaths are irrelevant to medical history.

Many Americans may be receiving a one-time "stimulus check," which will not recur every time bills need to be paid and will be infinitesimally smaller than sums bestowed upon corporations. But people don't need a "stimulus" to pay $100-$1,000 for a test. They don't need a one-time cash payment to cover $200-$2,000 for vaccination. They don't need $1,200 for partial reimbursement of a $30,000 COVID-19 bill. They don't need dribbling financial "aid" to pay for bills that go on without end. People need medical testing, treatment, and vaccination for all as a collective human right.

Though creating tests, treatments, and vaccines are essential parts of fighting disease, they will not be sufficient in a society suffering from a pandemic of profit-gouging. The restructuring of social relationships is critical not only to unleash the creative power to invent new things such as necessary medicines, but also to ensure those things benefit all who need them.

Potential Coronavirus Treatments Researchers Are Examining - TIME

Posted: 14 Apr 2020 11:25 AM PDT

In early April, about four months after a new, highly infectious coronavirus was first identified in China, an international group of scientists reported encouraging results from a study of an experimental drug for treating the viral disease known as COVID-19.

It was a small study, reported in the New England Journal of Medicine, but showed that remdesivir, an unapproved drug that was originally developed to fight Ebola, helped 68% of patients with severe breathing problems due to COVID-19 to improve; 60% of those who relied on a ventilator to breathe and took the drug were able to wean themselves off the machines after 18 days.

Repurposing drugs designed to treat other diseases to now treat COVID-19 is one of the quickest ways to find a new therapy to control the current pandemic. Also in April, researchers at Vanderbilt University enrolled the first patients in a much-anticipated study of hydroxychloroquine. It's already approved to treat malaria and certain autoimmune disorders like rheumatoid arthritis and lupus but hasn't been studied, until now, against coronavirus. Yet the medication has become a sought-after COVID-19 treatment after first Chinese doctors, and then President Trump touted its potential in treating COVID-19. The data from China is promising but not conclusive, and infectious disease experts, including Trump's coronavirus task force scientific advisor Dr. Anthony Fauci, aren't convinced it's ready for prime time yet in America's emergency rooms and intensive care units.

But doctors facing an increasing flood of patients say they don't have time to wait for definitive data. In a survey of 5,000 physicians in 30 countries conducted by health care data company Sermo, 44% prescribed hydroxychloroquine for their COVID-19 patients, and 38% believed it was helping. Such off-label use in using a drug approved to treat one disease to treat another is allowed, especially during a pandemic when no other therapies are available. A similar percentage said remdesivir was "very or extremely effective" in treating COVID-19. (Although remdesivir is not approved for treating any disease, the Food and Drug Administration granted special authorization for doctors to use it to treat the sickest COVID-19 patients.)

That explains the unprecedented speed with which the hydroxychloroquine study—and others like it—are popping up around the world. There are no treatments proven to disable SARS-CoV-2, the virus that causes the disease, which means all the options scientists are exploring are still very much in the trial-and-error stage. Still, they are desperate for anything that might provide even a slim chance of helping their patients survive, which is why studies are now putting dozens of different therapies and a handful of vaccines to the test. The normal road to developing new drugs is often a long one—and one that frequently meanders into dead ends and costly mistakes with no guarantees of success. But given the speed at which SARS-CoV-2 is infecting new hosts on every continent across the globe, those trials are being ushered along at a breakneck pace, telescoping the normal development and testing time by as much as half.

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The newly launched Vanderbilt study, led by the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health, will enroll more than 500 people who have been hospitalized with COVID-19 and randomly assign them to receive hydroxychloroquine or placebo. It would be the first definitive trial to test whether hydroxychloroquine should be part of standard therapy for treating COVID-19, and its lead scientist expects results in a few months.

The sense of urgency is pushing other researchers at academic institutes as well as pharmaceutical companies to turn to their libraries of thousands of approved drugs or compounds that are in early testing and screening to see if any can disable SARS-CoV-2. Because these are either already approved and deemed safe for people, if any emerge as possible anti-COVID-19 therapies, companies could begin testing them in people infected with the virus within weeks. Other teams are mining recovered patients' blood for precious COVID-19-fighting immune cells, and because the virus seems to attack the respiratory system, scientists are also finding clever ways to stop it from compromising lung tissue.

These are all stop-gap measures, however, since ultimately, a vaccine against COVID-19 is the only way to arm the world's population against new waves of infection. Established pharmaceutical powers like Johnson & Johnson, Sanofi and Glaxo SmithKline are racing shoulder-to-shoulder to with startups using new technology to develop dozens of potential new vaccines, with the hope of inoculating the first people next year—none too soon before what public health officials anticipate might be another season of either the same, or potentially new, coronavirus.

"We know these viruses reside in animal species, and surely another one will emerge," says Dr. David Ho, director of the Aaron Diamond AIDS Research Center and professor of medicine at Columbia University, who is heading an effort to screen antiviral drug compounds for new COVID-19 treatments. "We need to find permanent solutions to treating them, and should not repeat the mistake that once an epidemic wanes, interest and political will and funding also wanes."

Let the Immune System Do the Work—Plasma, Antibodies and More

It's an old-school approach that dates back to the late 19th century, but the intuitive logic behind using plasma from recovered patients—technically called "convalescent plasma"—as a treatment might still apply today. Plasma treatments have been used with some success to treat measles, mumps and influenza. The idea is to use immune cells extracted from the blood of people who have recovered from COVID-19 and infuse them into those who are infected, giving them passive immunity to the disease, which could at least minimize some of its more severe symptoms.

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It's part of a broader range of tactics that utilize the body's own immune response as a molecular North Star for charting the course toward new treatments. And by far, antibodies against the virus are the most abundant and efficient targets, so a number of pharmaceutical and biotechnology companies are concentrating on isolating the ones with the strongest chance of neutralizing SARS-CoV-2.

In late March, New York Blood Center became the first U.S. facility to start collecting blood from recovered COVID-19 patients specifically to treat other people with the disease. Doctors at New York's Mount Sinai Health System are now referring recovered (and willing) patients to the Blood Center, which collects and processes the plasma and provides the antibody-rich therapy back to hospitals to treat other COVID-19 patients.. It's not clear yet whether the practice will work to treat COVID-19, but the Food and Drug Administration (FDA) is allowing doctors to try the passive immunity treatment in the sickest patients on a case by case basis, as long as they apply for permission to use or study the plasma an investigational new drug. "If we can passively transfuse antibodies into someone who is actively sick, they might temporarily help that person fight infection more effectively, so they can get well a little bit quicker," says Dr. Bruce Sachais, chief medical officer at New York Blood Center Enterprises.

The biggest drawback to this approach, however, is the limited supply of antibodies. Each recovered donor has different levels of antibodies that target SARS-CoV-2, so collecting enough can be a problem, especially if the need continues to surge during an ongoing pandemic. At the Maryland-based pharmaceutical company Emergent BioSolutions, scientists are trying to overcome this challenge by turning to a unique source of plasma donors: horses. Their size makes them ideal donors, says Laura Saward, head of the company's therapeutic business unit. Scientists already use plasma from horses to produce treatments for botulism (a bacterial infection), and have found that the volume of plasma the animals can donate means each unit can treat more than one patient (with human donors, at this point, one unit of plasma from a donor can treat one patient). Horses plasma may also have higher concentrations of antibody, so "the thought is that a smaller dose of equine plasma would be effective in people because there would be higher levels of antibody in smaller doses," says Saward. By the end of the summer, the company expects its equine plasma to be ready for testing in people.

Scientists are also looking for other ways to generate the virus-fighting antibodies produced by COVID-19 patients. At Regeneron, a biotechnology firm based in New York, researchers are turning to mice bred with human-like immune systems and infected with SARS-CoV-2. They're searching hundreds of antibodies these animals produce for the ones that can most effectively neutralize the virus. By mid-April, the company plans to start manufacturing the most powerful candidates and prepare them (either solo or in combination) for human testing—both in those who are already infected, as well as in healthy people, to protect from getting infected in the first place, like a vaccine.

It's not just people and animals that can produce antibodies. Scientists now have the technology to build what are essentially molecular copying machines that can theoretically churn out large volumes of the antibodies found in recovered patients. At GigaGen, a San Francisco-based biotech startup founded by Stanford University professor Dr. Everett Meyer, scientists are identifying the right antibodies from recovered COVID-19 patients and hoping to use them as a template for synthesizing new ones, in a more consistent and efficient way so a handful of donors could potentially produce enough antibodies to treat millions of patients. "What GigaGen's technology does is almost Xerox copy a big swath of the human repertoire of antibodies, and then takes those copies and grows it in cells [in the lab] to manufacture more antibodies outside of the human body," says Meyer. "So we can essentially keep up with the virus." If all goes well and the FDA gives its green light, the company intends to start testing their antibody concoctions in COVID-19 patients early next year.

Researchers at Rockefeller University are following another clue from the human body's virus-fighting defenses. They discovered in 2017 that human cells make a protein called LY6E that can block a virus's ability to make copies of itself. Working with scientists at the University of Bern in Switzerland and the University of Texas Southwestern Medical Center, they found that mice genetically engineered to not produce the protein became sicker, and were more likely to die after infection with other coronaviruses, including SARS and MERS, compared to mice that were able to make the protein. "If the mice have the protein they pretty much survive," says John Schoggins, associate professor of microbiology at the University of Texas. "If they don't have it, they don't survive…because their immune system can't control the virus." While these studies haven't yet been done on SARS-CoV-2, given its similarity to the original SARS virus, there's hope a therapy based on LY6E might be useful.

Ideally, Schoggins is hoping to start testing LY6E's potential in infected human lung cells, which SARS-CoV-2 appears to target for disease. The closest mouse model for coronavirus, created to study the original SARS virus, has been retired since research on that virus dwindled after cases wanted following the 2003 outbreak. "There wasn't the need to keep the mouse around, and that tells us a lot about the state of our research," says Schoggins. "We don't really work on thing unless everyone's hair is on fire."

It's not just immune cells that make good targets for new drugs. Other companies are looking at broader immune-system changes triggered by stress—during cancer, for example, or infection with a new virus like SARS-CoV-2—that end up making it easier for a virus to infect cells. Drugs that inhibit these stress-related changes would act like molecular gates slamming shut on the cells that viruses are trying to infect.

Because SARS-CoV-2 preferentially attacks lung tissue and causes cells in the respiratory tract to launch a hyperactive immune response, researchers are exploring ways to tame that aggressive response by dousing those cells with a familiar gas: nitric oxide, often used to relax blood vessels and open up blood flow in hospital patients on ventilators who have trouble breathing. While working on a new, portable system for delivering nitric oxide developed by Bellerophon Therapeutics to treat a breathing disorder in newborns, Dr. Roger Alvarez, an assistant professor of medicine at University of Miami, got the idea that the gas might be helpful for COVID-19 patients as well. One symptom of the viral infection is low oxygen levels in the lungs, and nitric oxide is ideally designed to grab more oxygen molecules from the air with each breath and feed it to the lungs. "With this system, patients don't need to be in the ICU [Intensive Care Unit] at all," he says. "The patient can be in a regular hospital bed, or even at home. So you save the cost of the ICU and from a resource standpoint, you save on needing nursing care, respiratory therapists and other ICU monitoring."

In theory, if this system could be used for COVID-19 patients with moderate symptoms, it could keep those patients from needing a ventilator—a huge benefit in the current context where ventilator shortages are one of the biggest threats to the U.S. health care system. So far, Alvarez has received emergency use authorization from the FDA to test a version of his system on one COVID-19 patient at the University of Miami Health System. That patient improved and is ready to go home. "It's great news and gives me the information to say that this appears at least safe to study further," he says, which is what he plans to do with the first small trial of nitric oxide for COVID-19 at his hospital.

Repurposing and Recycling Malaria, Flu, Cancer Drugs and More to Treat COVID-19

When it comes to developing a new antiviral treatment, it doesn't always pay to start from scratch. There are dozens of drugs that have become life-saving therapies for one disease after their developers accidentally discovered that the medications had other, equally useful effects. Viagra, for example, was originally explored as a heart disease drug before its unintended effect in treating erectile dysfunction was discovered, and gabapentin was developed as an epilepsy drug, but is now also prescribed to control nerve pain.

Within weeks of COVID-19 cases spiking to alarming levels in China, researchers at Gilead in Foster City, Cal., saw an opportunity. A drug the company had developed against Ebola, remdesivir, had shown glimmers of hope in controlling that virus in the lab—and also showed promise as a tool to treat coronaviruses like those that caused SARS and MERS. In fact, says Merdad Parsey, chief medical officer of Gilead, "We knew in the test tube that remdesivir had more activity against coronaviruses like SARS and MERS than against Ebola." So it wasn't entirely surprising that when the company began testing it in people during last year's Ebola outbreak in the Democratic Republic of Congo, the results were disappointing. "The early studies against Ebola weren't as encouraging in people as they were in animals. So we were basically on hold with the drug, waiting to see if there would be another [Ebola] outbreak to see if we could test it earlier in the infection," says Parsey.

Then COVID-19 happened. As the infection roared through Wuhan, China—the original epicenter of the disease—researchers there reached out to Gilead, knowing that the company had released data suggesting that remdeisivir had strong antiviral effects in lab studies against coronaviruses. They launched two studies of the drug in the sickest patients.

In mid-January, a man in Everett, Wash., who had recently visited Wuhan, checked into a clinic after a few days of feeling sick. He quickly went from having a fever and cough to having difficulty breathing because of pneumonia. Concerned that the man was worsening by the day, his doctor contacted the U.S. Centers for Disease Control; suspecting this might be a case of COVID-19—and knowing there was no proven treatment for the infection—experts at the agency suggested he try an experimental therapy, remdesivir.

The CDC team felt relatively confident about the drug's safety, if not its effectiveness, since Gilead had studied it extensively in animal models and, in the early trials in people, it didn't lead to any serious side effects and appeared safe. They were also aware of the company's promising data with human cells against the original SARS.

For the Washington patient, the experimental drug might be a lifesaver. A day after receiving remdesivir intravenously, his fever dropped, and he no longer needed supplemental oxygen to breathe. About two weeks after entering the hospital, he was discharged to self-isolate for several more days at home.

That set off a rush for remdesivir as cases in the U.S. went from a trickle to a flood, and doctors grasped for anything to treat quickly declining patients. Gilead initially offered the drug on a compassionate use basis, a process that allows companies, with the FDA's permission, to provide unapproved drugs currently being studied to patients who need them as a last resort. These programs are designed for one-off uses, and companies usually receive two to three requests a month from doctors . But in this case, Gilead was flooded with requests for remdesivir at the beginning of March. And because each one is evaluated on a case-by-case basis to ensure that each patient is eligible and that the potential risks of trying an untested drug don't outweigh the benefits, a backlog developed and the company couldn't respond to the requests in a timely way, says Parsey. So on March 30, Gilead announced it would no longer provide remdesivir through that program but through an expanded access program instead. Doctors can get access to the drug for their COVID-19 patients via dozens of clinical trials of remdesivir, two of which Gilead initiated. One is focused on patients with mild symptoms and one involves those with severe symptoms. The National Institutes of Health is currently heading another large study of the drug, at multiple centers around the country.

A pharmacist shows a bottle of the drug hydroxychloroquine on April 6, 2020, in Oakland, Calif.

Ben Margot—AP

Finding a new purpose for existing drugs is ideal; they are likely already proven safe and their developers have a substantial dossier of information on how the drugs work. That's what happened with hydroxychloroquine, a malaria drug developed after the parasite that causes the illness became resistant to the chloroquine, a drug discovered during World War II and since used widely to fight the disease. As researchers studied hydroxychloroquine in the lab in recent decades , they learned it can block viruses, including coronaviruses, from infecting cells. In lab studies, when researchers infected human cells with different viruses and then bathed them in hydroxychloroquine, those cells could generally stop viruses like influenza, SARS-CoV-2, and the original SARS virus, another type of coronavirus, from infecting the cells. "The problem is that what happens in the lab often doesn't predict what happens in a patient," says Dr. Otto Yang, from the department of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at the University of California Los Angeles. In fact, in the case of influenza, the drug wasn't as successful in stopping infection in animals or in people. Similarly, when scientists brought hydroxychloroquine out of the lab and tested it in people, the drug failed to block infection with HIV and dengue as well.

That's why doctors are approaching hydroxychloroquine with healthy skepticism when it comes to COVID-19 and are only using it on the sickest patients with no other options. Doctors at a number of hospitals, including Johns Hopkins, the University of California Los Angeles, and Brigham and Women's, for example, are starting to use hydroxychloroquine to treat patients with severe COVID-19 symptoms when they don't improve on current supportive treatments. It's not ideal, but "If someone is sick in the ICU you try everything possible you can for that person," says Dr. David Boulware, a professor of medicine at the University of Minnesota, who is conducting a study of hydroxychloroquine effectiveness both in treating those with severe disease and in protecting health people from infection.

Other researchers are attempting to trace the same path with other repurposed drugs, including a flu treatment from Toyama Chemical, a pharmaceutical division of the Japanese conglomerate Fujifilm, called favipiravir, which Chinese researchers used to treat patients with COVID-19. More rigorous studies of both remdesivir and favipirivir against SARS-CoV-2 are ongoing; all researchers can say at this point is that they are worth studying further, and that they appear to be safe.

Even cancer drugs are showing promise as COVID-19 treatments, not by neutralizing the virus but by healing the damage infection does to the immune system. The Swiss pharmaceutical giant Novartis, for example, has ruxolitinib (sold under the trade name Jakavi), which was approved by the FDA in 2011 to treat a number of different cancers, and is designed to tamp down an exaggerated immune response—which can be caused by both tumor cells and a virus. In the case of SARS-CoV-2, a hyperactive immune response can trigger breathing problems, called a "cytokine storm," that require extra oxygen therapy or mechanical ventilation. In theory, ruxolitinib could suppress this virus-caused cytokine storm. Novartis is making its drug available on an emergency use basis for doctors willing to try it on their sickest patients.

Eli Lilly is also testing one of its anti-inflammatory drugs, baricitinib, in severe COVID-19 patients. Like ruxolitinib, baricitinib interferes with the revved up signalling among immume cells that can trigger the inflammatory cytokine storm. According to president of Lilly Bio-Medicines Patrik Jonsson, there are even early hints from case studies of doctors treating COVID-19 patients that the drug may target the virus too, which could mean that it helps to lower the viral load in infected patients. The company is working with NIAID to confirm whether this is the case in a more rigorous study of severe COVID-19 patients, and expects to see results by summer.

Finding the Needle in the Drug Haystack—Where New Coronavirus Therapies Are Born

It wasn't immediately obvious that baricitinib could potentially treat COVID-19; it took an artificial intelligence effort by UK-based BenevolentAI to scour existing medical literature and descriptions of drug structures to identify baricitinib as a possible therapy.

Such machine learning-based techniques are making the search for new therapies far more efficient than ever before. Chloroquine, hydroxychloroquine's parent, came out of a massive war-time drug discovery effort in the 1940s, when governments and pharmaceutical companies combed through existing drug libraries for promising new ways to treat malaria. With computing power that is orders of magnitude greater now, it's now possible to single out not just existing drugs with antiviral potential, but entirely new ones that may have gone unnoticed.

When Sumit Chanda first heard of the mysterious pneumonia-like illnesses spiking in Wuhan, China, he had "an eerie feeling" that the world was about to face a formidable viral foe. He had spent his entire career studying all the clever and devilish ways that bacteria, viruses and pathogens find hospitable hosts and then take up residence, oblivious to how much illness, disease and devastation they may cause. And as director of the immunity and pathogenesis program at Sanford Burnham Prebys Medical Discovery Institute in San Diego, Chanda knew that if the mystery illness striking in China was indeed caused by a new virus or bacteria, then doctors would need new ways to treat it—and quickly.

So, he and his team started canvassing a 13,000 drug library, which is funded by the Bill and Melinda Gates Foundation and created by Scripps Research. "Our strategy is to take existing drugs and see if they might have any efficacy as an antiviral to fight COVID-19," he says. "The advantage of this approach is that you can shave years upon years off the development process and the studies on safety. We want to move things quickly into [testing] in people." In a matter of weeks, he has narrowed down the list of potential coronavirus drug candidates, and because these are already existing drugs and approved for treating other diseases, they are relatively safe, and can quickly be tested in people infected with SARS-CoV-2.

Chanda's team isn't the only one taking advantage of this approach. Researchers at numerous pharmaceutical companies, biotech outfits and academic centers are screening their libraries of drugs—both approved and in development—for any anti-COVID-19 potential.

At Columbia University, Dr. David Ho, who pioneered ways of creating cocktails of drugs to make them more potent against HIV, is scouring a different library of virus-targeting drugs to pluck out ones that could be effective against SARS-CoV-2. Altogether, he has some 4,700 drugs (approved and in development) to look through, and he believes there is a strong chance of finding something that might be effective against not just SARS-CoV-2 but any other coronavirus that might pop up in coming years. The key, says Ho, is to be prepared for the next outbreak so the work on finding antiviral drugs doesn't have to start from scratch. "We know these viruses reside in animal species," he says. "We predict in the coming decade there will be more [outbreaks]. And we need to find permanent solutions. We should not repeat the mistake we made after SARS and after MERS, that once the epidemic wanes, the interest and the political will and the funding also wanes. If we had followed through with the work that had begun with SARS, we would be so much better off today."

From the Obvious to the Not So Obvious

But today, we are in the midst of a pandemic, and scientists are eager to leave no potentially promising technology untried. Banking on the growing body of science looking at how newborn babies are able to avoid life-threatening infections in their first days in the world, researchers at New Jersey-based Celularity are investigating how placental cells, rich with immune cells that protect the baby in utero, might also become a source of immune defense therapy against COVID-19. It's part of a broader strategy of cell-based treatments that scientists are beginning to explore for treating cancer as well as infectious disease.

On April 1, the company received FDA clearance for its placental cell treatment, based on a group of immune cells called "natural killer cells" that circulate in the placenta, and are designed to protect the developing fetus from infection. They are programmed to recognize red flags typically sent up by cells infected with viruses like SARS-CoV-2, and destroy them. After the 2002-2003 SARS epidemic, researchers in China found that people who had more severe symptoms of that disease also had deficient populations of natural killer cells.

The FDA green light means the company can launch a small human study using placental natural killer cells against COVID-19. Dr. Robert Hariri, Celularity's founder and CEO, wants to test them first in people who are infected, to see if they can stop the infection from getting worse. "Our approach is to flatten the immunologic curve," he says. "Our hope is to decrease the size of the viral load and keep it below the threshold of serious symptomatic disease until the patient's own immune system can be revved up and respond." If those studies are encouraging, then the company will look at how natural killer cells might be used to "pre-charge" the immune system to prevent infection with SARS-CoV-2 in the first place.

Vaccines: The Ultimate Protector

As effective and critical as these therapies might be, they are a safety net for the best weapon against an infectious disease: a vaccine.

The main reason that a new virus like SARS-CoV-2 has such free license to infect hundreds of thousands of people around the world is because it's an entirely new enemy for the human immune system — making the planet's population an open target for infection. But a vaccine that can prime the body to build an army of antibodies and immune cells trained to recognize and destroy the coronavirus would act as an impenetrable molecular fortress blocking invasion and preventing disease.

Unfortunately, vaccines take time to develop—years, if not decades. Scientists at Johnson & Johnson are currently working on a vaccine using fragments of the SARS-CoV-2 spike protein, an easy protein target that sprinkles the surface of the virus like a crown (hence the name "coronavirus," from the Latin for "crown"). The company loads the viral gene for the spike protein into a disabled common-cold virus vector that delivers the genetic material to human cells. The immune system then recognizes the viral fragments as foreign and deploys defensive cells to destroy it. In the process, the immune system learns to recognize the genetic material of the virus, so when the body is confronted by the actual virus, it's ready to attack.

Given the manufacturing requirements to build the vaccine, and the studies in animals needed to get a hint of whether the vaccine will work, however, J&J's project is unlikely to come to fruition until mid-2021. "We plan to have the first data on the vaccine before the end of the year," says Paul Stoffels, chief science officer at J&J. "I would hope that in the first half of next year, we should be able to get vaccines ready for people in high risk groups like health care workers on the front lines."

That timeline is already accelerated quite a bit compared to vaccine research in non-pandemic contexts. But new technology that doesn't require a live transport system could shrink the time to human tests even further. Working with the National Institute of Allergy and Infectious Diseases, Moderna Therapeutics, a biotech based in Cambridge, Mass., developed its mRNA vaccine in a record 42 days after the genetic sequence of the new coronavirus was released in mid January. Its system turns the human body into a living lab to churn out the viral proteins that activate the immune system.

Researchers at Moderna hot wired the traditional vaccine-making process by packing their shot with mRNA, the genetic material that comes from DNA and makes proteins. The viral mRNA is encased in a lipid vessel that is injected into the body. Once inside, immune cells in the lymphatic system process the mRNA and use it like a genetic beacon to attract immune cells that can mount toxic responses against the virus. "Our vaccine is like the software program for the body," says Dr. Stephen Hoge, president of Moderna. "So which then goes and makes the [viral] proteins that can generate an immune response."

Because this method doesn't involve live or dead viruses—all it requires is a lab that can synthesize the correct genetic viral sequences—it can be scaled up quickly since researchers don't have to wait for viruses to grow. Almost exactly two months after the genetic sequence of SARS-CoV-2 was first published by Chinese researchers, the first volunteer received an injection of the Moderna vaccine. The company's first study of the vaccine, which will include 45 healthy participants, will monitor its safety. Hoge is already gearing up to produce hundreds and thousands of more doses to prepare for the next stage of testing, which will enroll hundreds of people, most likely those at high risk of getting infected, like health care workers.

If those results aren't as promising as health experts hope, there are other innovative options in the works. At the University of Pittsburgh, scientists who had been developing a vaccine against the original SARS virus have switched to making a shot against the new one. Their technology involves hundreds of microneedles in a band-aid like patch that deliver parts of the coronavirus protein directly into the skin. From there, the foreign viral proteins are swept into the blood and into the lymph system, where immune cells recognize them as invaders and develop antibodies against them. After seeing animals inoculated with their vaccine develop strong antibodies against SARS-CoV-2, the team is ready to submit an application to the FDA to begin testing in people.

What's different about these new coronavirus efforts is the fact that they aren't all designed to control SARS-CoV-2 alone. Recognizing that this coronavirus is the third in recent decades to cause pandemic disease, scientists are focusing on building therapies, including vaccines, that can quickly be adapted to target different coronaviruses that might emerge in coming years. "We hope these new technologies become the kinds of things we build in our tool kits that as humans will allow us to respond in a much more accelerated way to the next pandemic," says Moderna's Hoge. "Because we expect continuing threats from viruses in the future."

Contact us at editors@time.com.

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