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What we have learned about treating COVID-19 one year into the pandemic

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From dexamethasone to remdesivir to bamlanivimab, Canada is using a variety of treatments for COVID-19 patients.  – Dec 1, 2020

Over the course of the year spent living with the COVID-19 pandemic, scientists and doctors around the world have banded together to tackle the virus that has changed daily lives around the globe.

Read more: Coronavirus therapeutics — A look at COVID-19 treatments in Canada

And as most eyes are glued to the lightning-speed development of vaccines, advances are also being made in another key area: treatments for the virus.

From the approval of new medications to learning lessons about the best use of ventilators, front-line workers have built on their knowledge about the virus with each passing day.

A year in, those lessons have saved lives.

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Coronavirus: Early data shows COVID-19 vaccine having impact on hospitalizations, death rates in Canada – Feb 18, 2021

As the COVID-19 pandemic first hit its peak, the death rates spiked in May 2020 – when 222 people died in a single day. By the time the second wave had taken its toll on the country, the most deaths reported in a single day was 268, in late December.

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But while there were just shy of 500 per cent more COVID-19 cases during the peak of the second wave compared to the first, the death rates were only 20 per cent higher at that time than they were in the spring.

Much of that can be attributed to progress being made when it comes to COVID-19 treatments.

One year into the COVID-19 pandemic, Global News has dug into what progress has been made in treating this virus – and where the future of treatments might be headed.

Steroids

A huge leap forward was taken in the summer of 2020, when medical professionals realized that using dexamethasone on their patients made a noticeable difference in the outcomes of COVID-19.

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Dexamethasone is an anti-inflammatory steroid that can be given orally or intravenously.

Read more: Treating critically ill coronavirus patients with steroids reduces risk of death, study finds

In a June study, a clinical trial of more than 2,000 people in the U.K. found the drug reduced death rates by about a third in COVID-19 patients who needed ventilation – and by a fifth in those who required supplemental oxygen.

“(Dexamethasone is) probably the most widespread use of a medication in conventional medical circles. It really helps. It just helps prevent people progressing to more severe illness, helps people recover faster, shortens their duration of stay,” said Dr. Isaac Bogoch, an infectious disease specialist.

“There’s been other drugs that have come and gone. But I’d say that (dexamethasone) is by far the most widely used medication and probably has had the most significant impact.”

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Coronavirus: WHO praises U.K.’s findings on potential benefit of steroid dexamethasone – Jun 22, 2020

Dr. Zain Chagla, who is also an infectious disease specialist, echoed Bogoch’s comments. He said that dexamethasone is “our best evidence-based drug” when it comes to fighting off the worst outcomes of COVID-19.

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“We’ve all seen an incredible response from this,” Chagla said, calling the steroid a “very cheap and easy intervention.”

He said that the drug is also portable, meaning that congregate care settings – like long-term care facilities – can treat patients on site.

“That has revolutionized how we treat COVID-19,” Chagla said.

New drugs approved

While finding new uses for old drugs has been a boon to doctors as they treat COVID-19, there have also been efforts to craft new drugs that can help combat the virus.

Read more: Remdesivir not recommended for hospitalized coronavirus patients, WHO says

To date, two new COVID-19 drugs have been approved – though experts say they haven’t made the difference that the world was hoping they would.

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“I think most people who care for patients infected with COVID-19 who are hospitalized would agree that (dexamethasone is) probably the mainstay in terms of drugs that we use to care for people,” Bogoch said, though he added that “other drugs are used certainly from time to time.”

The first new drug, remdesivir, is an antiviral drug that was conditionally authorized for use by Health Canada on July 27, 2020 with the goal of treating patients with severe symptoms.

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Canada also approved another drug on Nov. 20: the coronavirus antibody treatment called bamlanivimab. Canada has secured up to 26,000 doses of the drug, which works by being directed against the spike protein of SARS-CoV-2 and is designed to block the virus’s attachment to and entry into human cells, according to the U.S. FDA.

Read more: Canada secures 26K doses of coronavirus antibody treatment – here’s how it works

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In layman’s terms, if you have COVID-19 and are at high risk of seeing the virus get serious, this drug is supposed to lessen the severity of your outcome before the disease progresses.

That presents its share of problems, Chagla explained.

“It’s actually a therapy that needs to be given before people get to hospital and very early in their disease course. It’s an intravenous drug, and so to get health-care teams to actually administer this into a patient’s home, or to bring a low-risk patient that can manage at home into an emergency room to get this administered, is a lot trickier than it sounds,” he said.

As a result, “there hasn’t been a lot of uptake of this drug,” Chagla added.

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Dr. Bonnie Henry answers why B.C. is still holding clinical trials for certain COVID-19 drugs – Feb 8, 2021

Medical professionals have also found that remdesivir has been less helpful than initially hoped. Canada has a supply of up to 150,000 vials of the drug, but its efficacy is uncertain.

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Despite some promising results emerging in two major clinical trials in Canada, by late November, the WHO had advised against the use of the drug in patients who are hospitalized with COVID-19. There was no evidence that this drug improved survival rates, it said.

“We’ve used some of it locally and across the country. It may get certain people out of hospital faster. And it certainly had some impact, but certainly not as much as corticosteroids,” said Chagla.

Lessons learned

The milestones in treating COVID-19 haven’t just been reached in the form of learning what drugs are effective against it. Some of the most significant strides were made by figuring out what not to do, according to experts.

“There are a lot of treatments that came off the table when the evidence came out, and that probably has also revolutionized how we treat COVID-19. Before, in March, it was a mishmash of give this, that or the other,” Chagla said.

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“Now we actually have a standardized protocol… skipping all those other drugs, which may actually have been causing some harm, and getting to corticosteroids probably has benefited patients a whole lot more than patients that were being cared for in March and April.”

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B.C. government defends decision not to use COVID-19 treatment yet – Feb 8, 2021

Bogoch added that while people tend to feel “disappointment” when studies of potential COVID-19 treatments turn out to be negative, that shouldn’t necessarily be the case.

“It’s really, really important to conduct the right clinical trials and generate the most high-quality and high-calibre evidence you can to help guide clinical decision making. Otherwise, you’re going to be left using perhaps substandard or non-effective treatment,” Bogoch explained.

Read more: Preliminary research finds hydroxychloroquine doesn’t help COVID-19 patients

He said that while many drugs were on the list as prospective treatments to help improve COVID-19 outcomes in patients, “most of those never made it.”

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“Most of those were found to be not that effective, or not effective whatsoever, and aren’t used. It’s still a big deal. It’s still important because it prevents us from using those; we can focus our energy and our attention elsewhere,” Bogoch said.

In addition to learning that they shouldn’t waste any time when it comes to administering a corticosteroid, like dexamethasone, doctors also learned other lessons – including that ventilators didn’t necessarily need to be used as frequently.

“From data we got from China and other places, we ventilated a lot of people early thinking that was going to save their lives, because we saw the oxygenation issues in the in people that had it,” said Chagla.

Read more: What is a ventilator, and why do some coronavirus patients need one?

He added that there was an additional pressure to put patients on ventilators because other technologies, such as CPAP machines or high-flow oxygen, create a risk of aerosols and airborne spread of COVID-19.

“At the beginning of the pandemic, when (personal protective equipment) was low and we weren’t sure whether or not this was worth it to expose people, we didn’t know about disease transmission as much, we really did encourage people to get ventilated very quickly as well to minimize that risk of infecting others or creating spread,” Chagla said.

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As medical professionals learned more about how to keep themselves and their patients safe, Chagla said practices began to improve.

“I certainly think that’s helped a lot of patients where we’ve done everything for them, give them high flow oxygen, tried using everything while they’re still awake and not on a ventilator — as we know, when patients get on ventilators it often takes a while to get them off, or they die on them,” Chagla said.

“I think there’s lots of patients that have turned around, that have had less complications of things like muscle weakness from being on a ventilator for weeks and weeks and weeks that have made it out of hospital quicker because we haven’t had to necessarily put them on a ventilator as quick.”

A sigh of relief

Overall, the infusion of knowledge into the world of COVID-19 treatments hasn’t just helped the lives of COVID-19 patients – it has allowed medical professionals to take a breath as well.

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“Day one, there was obviously a lot of anxiety,” said Chagla.

“We were hearing from China (about) a number of health-care workers that got infected, and so that was tough on people. We, as health care providers, we have the duty to care. But we obviously never want to be the ones that are the consequences of that duty to care.”

Read more: ‘Security blanket’ — Coronavirus vaccines offer hope to health workers, families

But over the course of the last year, Chagla said health-care workers “got very comfortable with dealing with COVID.” He added that vaccines have been a “saviour” for health-care workers in recent months.

“I think there’s just been such a sigh of relief there, to say, OK, this is going to be a part of normal, but it’s not going to affect my day-to-day home life,” Chagla said.

“It’s really something I can leave at work, and care for patients there.”

Overall, he said the advances in treatments and vaccines for COVID-19 have been “absolutely incredible.”

“I’ve never seen anything like this,” Chagla said.

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The future of COVID-19 treatments

Bogoch said there are “lots” of ongoing clinical trials that are currently looking at COVID-19 treatments.

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“We have some that work, that are helpful, but there certainly is room for improvement on that front,” Bogoch said.

In a statement sent to Global News, a spokesperson for Health Minister Patty Hajdu said the government is investing in “the best COVID-19 treatments available.”

“Over the last year, our understanding of COVID-19 has continued to evolve, as have the available treatments,” said Cole Davidson, Hajdu’s press secretary.

Read more: Hope, doubt loom as human clinical trials begin on Calgary-made COVID-19 vaccine

He added that the government has infused $46 million into research looking into possible treatments for COVID-19 through the Canadian Institutes of Health Research, as well as $3.5 million to prop up Canada’s participation in a WHO clinical trial, which is aimed at identifying optimal treatments for hospitalized COVID-19 patients.

“Researchers leading this study and others are continuing the search for safe and effective treatments for COVID-19,” Davidson said.

In the next year, there is going to be a “frontier” when it comes to “home treatments for COVID-19,” Chagla said.

“There’s going to be more hospital treatments, just knowing the inertia and how fast things are progressing,” he added.

“I think we can be very proud of where we are now and have a lot of hope in the future.”

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— With files from Global News’ Saba Aziz

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