Scientists from Seattle’s Fred Hutchinson Cancer Research Center and the University of Washington say the search for COVID-19 treatments should widen its focus from hospitalized patients to people who are just starting to experience symptoms.
They’re calling for a shift in strategy in an article published in Open Forum Infectious Diseases. “A golden opportunity to intervene early is being missed,” they write.
There’s already been some success in the hunt for drugs that can treat COVID-19. Preliminary results suggest that an experimental antiviral drug called remdesivir can reduce the recovery time for hospitalized patients, while a low-cost steroid known as dexamethasone can reduce the death rate among patients who experience respiratory distress.
But the researchers from the Seattle area, which was ground zero for America’s coronavirus outbreak, say the hunt should be expanded beyond hospitals.
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“Without a vaccine, the best way to keep people out of the hospital and potentially dying from COVID-19 is to diagnose and treat early,” Joshua Schiffer, a physician and researcher in Fred Hutch’s Vaccine and Infectious Disease Division, said in a news release. “We’ve seen similar strategies for other infectious diseases like HIV, Ebola and influenza significantly lower transmission rates and mortality, and believe it would have the same types of benefits for COVID-19.”
Schiffer and his co-authors say the golden opportunity for intervention comes between the onset of symptoms — such as a cough, fever or shortness of breath — and the need for hospitalization. That stretch of time lasts about a week, on average.
The researchers lay out a plan for taking advantage of the opportunity, starting with widespread availability of testing. That was a problem during the early stages of the pandemic, but testing capacity is now on the rise. The Seattle Coronavirus Assessment Network, or SCAN, is currently using a system for self-collection of samples at home for research purposes.
“Early testing is an absolute critical component of this,” Schiffer told GeekWire in an email. “The solution to early testing will be dependent on the location. In some cities, this could mean home testing. In others, testing could be available at public tents, pharmacies and clinics.”
Schiffer said widespread testing should be done at locations with at-risk populations, such as senior living centers, prisons, military bases and crowded work environments. Public health officials have been struggling with that part of the strategy, but Schiffer said it’s worth the effort.
“While the cost and logistics of implementing early test and treat seem challenging, they are far less per person than managing a single day of hospitalization,” he said.
In addition to early testing, the researchers call for the development of small-scale, rapid-response outpatient studies that use viral-shedding metrics and symptoms to assess the risk of disease progression. Such therapeutics could include antiviral drugs such as remdesivir, favipiravir and selinexor, as well as a growing list of antibody formulations.
“Ideally, parallel studies would be conducted with each of these agents to provide clinicians with comparative efficacy, toxicity and dosing convenience data to optimize early treatment,” the researchers write. They say such studies should focus on minority populations, particularly in underserved communities, due to the fact that such populations have been disproportionately affected by the pandemic.
Once effective therapies have been discovered, there should be methods to deliver them safely to the homes of people who test positive for the virus. SCAN’s process for delivering coronavirus specimen collection kits — which relies in part on couriers from Amazon Care, a healthcare program for Amazon employees in the Seattle area — could provide a model for home delivery of coronavirus treatments.
“In the age of Amazon.com, this goal is achievable,” the researchers say.
In addition to Schiffer, the authors of the review article published by Open Forum Infectious Diseases, “An Early Test and Treat Strategy for SARS-CoV-2,” include Christine Johnston, Anna Wald and Lawrence Corey.