Mar 19, 2020 11:00 PM

Trump focuses attention on possible coronavirus treatments

Posted Mar 19, 2020 11:00 PM
FDA Commissioner Dr. Stephen Hahn during Thursday's Coronavirus task force media
FDA Commissioner Dr. Stephen Hahn during Thursday's Coronavirus task force media

WASHINGTON (AP) —President Donald Trump focused attention on possible treatments for the new coronavirus on Thursday, citing potential use of a drug long used to treat malaria and some other approaches still in testing.

At a White House news conference, Trump and Food and Drug Administration Commissioner Dr. Stephen Hahn cited the malaria drug chloroquine, along with remdesivir, an experimental antiviral from Gilead Sciences, and possibly using plasma from survivors of COVID-19, the disease the new virus causes.

Those treatments are among several being tested that might ease symptoms but do not stop the virus from spreading.

Also on Thursday, Swiss drugmaker Roche said it was working with the U.S. government to start a study of Actemra, a drug used now for rheumatoid arthritis and some other conditions, against the coronavirus.

"We're looking at drugs that are already approved for other indications" as a potential bridge or stopgap, Hahn said, while also doing rigorous studies to see if the drugs truly make a difference versus usual care, and if they are safe when used for a new purpose.

“We want to make sure this is done well and right,” he said.

No drug is specifically approved now for treating COVID-19.

Chloroquine and a similar drug — hydroxychloroquine, sold as Plaquenil by French drugmaker Sanofi and in generic form — are available now and can be used off-label in the United States. They may interfere with the coronavirus being able to enter cells, and some scientists have reported possible encouraging signs in test-tube and other small studies.

German drugmaker Bayer has said it would donate 3 million tablets of its chloroquine drug, Resochin, for use against coronavirus. That drug was never approved in the U.S., so Bayer is working with federal agencies to get an emergency-use authorization.

Chloroquine and remdesivir are among the drugs the World Health Organization said would be tried in a five-part international study announced Wednesday.

Already approved drugs are tempting for doctors to use off label, but formal studies are needed to see if they truly work for a new purpose or disease, said Dr. Ross McKinney Jr., chief scientific officer for the Association of American Medical Colleges, which represents about 400 major teaching hospitals across the country.

Chloroquine may look promising in a test tube, but “I'm skeptical it will be effective” in patients, he said Thursday in a call with reporters.

Remdesivir interferes with virus reproduction and has shown some promise in lab and animal studies against other coronaviruses that cause similar diseases, MERS and SARS.

It's being tested in at least five separate experiments, and Gilead also has given it to several hundred severely ill patients in the U.S, Europe and Japan under "compassionate use" provisions. That includes three of the first dozen COVID-19 patients in the United States. They recovered, but it's impossible to know whether they would have anyway without the drug.

On a podcast Wednesday with a medical journal editor, the National Institutes of Health's Dr. Anthony Fauci said China had enrolled several hundred people in its two remdesivir studies but is having trouble recruiting more because many patients just want the drug and are unwilling to take a chance on being randomly assigned to a comparison group that just gets usual care.

It would be great if an independent monitoring board could look at results so far and see if there are signs of safety or effectiveness, Fauci said.

"We desperately need the data" on this and other drugs being tested in rigorous scientific studies, Fauci said. "We've got to be able to determine if they work and if they're safe."

Apart from the studies in China, Fauci's agency is running a study of remdesivir that aims to recruit 400 patients in the U.S. and elsewhere. That study is "adaptive," meaning it will allow scientists to add other drugs under the same testing umbrella as time goes on. Gilead also has said it will do two studies testing remdesivir treatment for five or 10 days in about 1,000 hospitalized patients primarily in Asia.

Remdesivir "does look like it could be promising," said Dr. Daniel Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital in Boston. In animal tests, it was "quite effective at preventing infection" and reducing severity of illness and damage to the lungs when given early enough in the course of illness, he said.

"It interferes with the enzyme that reproduces the genetic material of the virus" and acts at an earlier step than protease inhibitors such as lopinavir and ritonavir, which are used now to treat HIV and also are being tested against the new coronavirus, Kuritzkes explained.

The HIV drugs gave disappointing results, failing to shorten illness in a study of 199 severely ill hospitalized patients in China, scientists from that country reported Wednesday in the New England Journal of Medicine.

Some other studies testing the HIV drug combo are still underway.

The Roche drug, Actemra, is used now for rheumatoid arthritis and some other conditions. It targets interleukin-6, which plays a role in inflammation. Roche's U.S. subsidiary, Genentech, said Thursday that it was working with the FDA to start a 330-patient study on hospitalized COVID-19 patients in April.

Regeneron Pharmaceuticals says it will lanch a study of Kevzara, its rheumatoid arthritis drug that also targets interleukin-6, against the coronavirus.

A Japanese company, Fujifilm Toyama Chemical, says tests suggest its drug favipiravir, used to treat the flu in Japan, shows promise against the coronavirus, though no large studies of that have been published yet.

Other companies are developing monoclonal antibodies, proteins that specifically fight the coronavirus. Antibodies or combinations of them were tried against Ebola, and doctors think a similar approach may help against the new virus.

Finally, some doctors have urged collecting plasma from people who have survived COVID-19, because they should have made natural antibodies to the virus that could be given to people to help their immune systems fight it off.

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Mar 19, 2020 11:00 PM
UPDATE: What Kansans need to know about the COVID-19 coronavirus
Health officials say one way to stop the spread of the new coronavirus is to wash your hands for at least 20 seconds. Celia Llopis-Jepsen / Kansas News Service

Kansas News Service

The new coronavirus is spreading quickly around the world, including across Kansas, and setting off a range of responses.

The Kansas News Service is boiling down key developments in the state and updating the status regularly here. To read this information in Spanish, go here. This list was last updated at 2:10 p.m. March 31.

CASES AND DEATHS

430 cases, including two from out of state (see map for counties)

9 deaths (4 in Wyandotte County, 3 in Johnson County, 1 each in Sedgwick and Crawford counties)

NOTE: These figures only include cases confirmed with lab tests and do not represent the real, unknown total. Community transmission is occurring in parts of Kansas.

STATEWIDE ORDER TO STAY HOME

Gov. Laura Kelly is instituting a statewide stay-at-home order as of 12:01 a.m. March 30. It will last until at least April 19. Stay-at-home orders allow people to take care of essential activities (such as grocery shopping or going to work) as well as exercise outside, but otherwise keep to themselves. 

The state’s stay-at-home order supersedes at least 13 county-by-county orders. Should the state’s order lift before a county’s is through, the county can choose to keep its own in effect.

SHOULD I SELF-QUARANTINE?

For the whole state: The Kansas Department of Health and Environment (KDHE) is now mandating home quarantine for 14 days if you've traveled to the places listed below. If you come down with symptoms (such as a fever of 100.4 degrees or higher, coughing or shortness of breath) during those 14 days, contact your health care provider and explain your potential COVID-19 exposure.  

  1. Louisiana or anywhere in Colorado on or after March 27.
  2. States with known widespread community transmission (California, Florida, New York and Washington) on or after March 15.
  3. Illinois or New Jersey on or after March 23.
  4. Eagle, Summit, Pitkin and Gunnison counties in Colorado (if your visit was March 8th or later).
  5. Cruise ships or river cruises on or after March 15. Anyone previously told to quarantine because of their cruise ship travel should also finish out their quarantine.
  6. International destinations on or after March 15. Anyone previously told to quarantine because of their international travel should also finish out their quarantine.

TESTING AVAILABILITY

As of March 27, Kansas health secretary Lee Norman said the state lab was handling 175 samples a day. But Kansas will receive more equipment within about a week that will let it handle 700 to 1,000 samples daily, though shortages of specialized supplies such as nose swabs may still hamper work at times. 

Norman said there’s enough capacity in the state, now that testing has ramped up through commercial labs and hospitals. State testing is reserved for high-risk groups, such as sick nursing home residents and health care workers. Others can ask their doctor or nurse practitioner to order through private labs.

What Kansas still lacks is enough testing material to study COVID-19 rates among people without symptoms.

KANSAS HAS DECLARED A STATE OF EMERGENCY. WHAT DOES THAT MEAN?

It gives the state government more power to marshal resources and triggers the state's response plan. The state Legislature has extended Kelly's declaration through May (and can extend it), with the aim of giving her the ability to make certain decisions when lawmakers aren’t in session.

On March 22, Kelly eased state rules to expand the use of telemedicine, to temporarily license more health workers and to allow heavier trucks on Kansas highways hauling relief supplies. On March 23, she ordered a ban on evictions if a tenant was unable to pay because of the coronavirus crisis. And she extended the income tax filing deadline to July 15, in line with a delay for filing federal tax forms.

HOW ARE UNIVERSITIES RESPONDING?

K-State, University of Kansas and Wichita State: All of them will go fully online for the end of the school year. Students at K-State and KU will need special exemptions to remain in dorms.

Other colleges: Washburn and Fort Hays State are online. Newman University expanded spring break for two weeks (March 14 to March 29). Johnson County Community College will close campus from March 14-29, and all courses will restart online March 30. Pittsburg State started break a day early and will resume classes indefinitely online on March 30.

HOW ABOUT K-12 SCHOOLS?

Gov. Laura Kelly and Kansas Education Commissioner Randy Watson have shut down all K-12 schools, public, private and parochial, for the rest of the 2019-20 school year. They had initially issued a strong recommendation that schools close March 16 through 20. 

Some county health departments had already issued similar orders. 

A Kansas State Department of Education task force has issued guidance to school districts on how to continue some amount of student learning. 

WHAT’S BEEN CANCELED OR SUSPENDED?

The governor’s executive order temporarily banning landlords from evicting businesses or residential tenants is effective until May 1. That same order put in a moratorium on any mortgage foreclosures through the same period.

The governor mandated on March 23, through an executive order, that gatherings be restricted to less than 10 people.

Kansas state workers: Access to the Statehouse is limited to official business only, and lawmakers went on break early. Kelly wanted most state employees to stay home for at least two weeks starting March 23.

State prisons: The Kansas Department of Corrections ended visitation at all state facilities, and will “re-evaluate on an ongoing basis.” It urges families to talk to inmates through email, phone calls and video visits. 

Electric companies: Evergy, which serves 950,000 customers in Kansas, will not disconnect residential or business services for an unspecified amount of time due to the “unprecedented challenge” of coronavirus that “may result in customers facing unexpected or unusual financial strain.”

Casinos: All four state-owned gaming facilities will close at the end of business on March 17, and remain so until at least March 30.

Public events: Many events and public places around the state have been canceled until at least the end of March. 

Sports: The Kansas State High School Athletics Association canceled the state basketball tournament midway through it. And the Big 12 suspended spring sports until March 29.  

HOW BAD IS THE VIRUS? 

COVID-19 usually causes mild to moderate symptoms, like a fever or cough. Most people with mild symptoms recover in two weeks. More severe cases, found in older adults and people with health issues, can have up to six weeks’ recovery time or can lead to death.

HOW CAN YOU AVOID IT?

  1. Wash your hands for at least 20 seconds. Frequently.
  2. Cover your coughs.
  3. If you’re an older Kansan or medically fragile, put off any vacations and limit your trips to the grocery store or any public space.
  4. Stay home if you are sick — this goes for all ages.

FOR MORE INFORMATION ON COVID-19

Kansas Department of Health and Environment: http://www.kdheks.gov/coronavirus/

The Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.