STEVE INSKEEP, HOST:
It took less than a year to develop COVID-19 vaccines, which is a remarkable timeline, but we still need drugs to treat people who get the virus, and that is going more slowly. Here's NPR science correspondent Richard Harris.
RICHARD HARRIS, BYLINE: If you want to see a scorecard on COVID drugs, you can check out two good sources. Expert panels are regularly updating treatment guidelines for both the National Institutes of Health and the Infectious Diseases Society of America. Raj Gandhi, an infectious disease doctor at Massachusetts General Hospital and the Harvard Medical School, is on both of those committees. Potential drugs are sorted into three basic categories - they work, they don't work, or there simply isn't enough information to know.
RAJESH GANDHI: So when these panels first started, essentially all the drugs were in the category of we don't have enough information. I still remember the first iteration of these guidelines that was true of pretty much every drug that was being talked about.
HARRIS: The panels have now concluded that some drugs should be avoided, like hydroxychloroquine, and that information is itself important. Others are still in the we don't know bucket. That includes monoclonal antibodies, even though they have emergency authorization to treat people with mild to moderate infections to keep them out of the hospital.
GANDHI: The early data is promising, but I think that definitive trials are ongoing, and I'm looking forward to seeing those results.
HARRIS: Gandhi hopes doctors who see the we-don't-know recommendation will steer patients toward clinical trials whenever possible and, if that's not practical, discuss the pluses and minuses of treatment. Rigorous data is the gold standard.
GANDHI: We need to double down on doing more of these trials and doing them even more rapidly. That's been one of the things that has advanced many fields in medicine. And it's certainly true of COVID-19.
HARRIS: One drug that has passed that test, at least in the United States, is remdesivir. It targets the virus and appears effective in shortening hospital stays for some of the sickest patients. The World Health Organization, relying on other data, actually recommends against its use. More impressive is the effectiveness of the steroid dexamethasone, which helps tamp down a dangerously overreacting immune system. Dr. Francis Collins, director of the NIH, is happy to see that.
FRANCIS COLLINS: Yes. Dexamethasone does appear to be lifesaving for those sickest patients, but it's a pretty big sledgehammer in terms of what it does to the immune system. Maybe there is something a little more subtle that would be even more effective with less in the way of side effects.
HARRIS: There are many studies underway right now to test out a bunch of potential candidates. This is one of the most eagerly watched areas of research, both by doctors looking for better treatments and investors hoping that one of these drugs will be a real moneymaker. Collins hopes that scientists and drug companies will ultimately develop medicines that completely stop the virus the way drugs to treat HIV have made that a manageable disease. That strategy will almost certainly involve multiple drugs, each targeting a different feature of the coronavirus.
COLLINS: If you really want the potent combination therapy that's incredibly effective against this coronavirus, we probably don't have that in front of us and we've got to go out and find it.
HARRIS: Scientists hoped they would find highly effective drugs that are already on the market for other purposes, but that doesn't look promising. Instead, these drugs need to be designed from scratch. Collins thinks that could take several years. He would like to find drugs that target not just this coronavirus but would work against any future coronavirus that starts spreading in people.
COLLINS: You would be in a much better position to deal with whatever's coming down the road. Heck, we might even cure the common cold because a lot of those are caused by coronaviruses, too. What a nice spinoff that would be.
HARRIS: In fact, that's often how research works. Studies in one area turn out to be key in addressing a very different question. Richard Harris, NPR News.
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