- With the COVID-19 vaccine likely more than a year away,
an influx of requests came in to explain
what other options we have to fight the novel coronavirus.
Today is April 1, 2020,
and we'll be talking about antiviral treatments.
In order to understand how antivirals will help
with COVID-19, we must first understand
how they affect your body.
Antiviral medications require a fine balance
between efficacy, or how well they work,
toxicity, and viral resistance toward the drug.
But unlike most antibacterial medications,
which work to directly kill the bacteria,
antiviral drugs don't necessarily try and kill
or destroy the virus.
Instead, they affect your own cells' machinery
in a variety of ways in order to minimize the virus' ability
to replicate or develop, and they can assist your body
in building an immune response as well.
- In order to see this in action,
let's look at the antiviral drug ribavirin,
which is used as a treatment for the small
enveloped RNA virus hepatitis C.
Once consumed, ribavirin has four main effects.
Outside of the cell, ribavirin can increase something called
Th2 cells, which increase protective immune responses.
Inside the cell, it's converted to ribavirin monophosphate,
or RMP, which depletes GTP, a molecule used for energy.
As GTP depletes, there is less energy available
for the virus to use.
RMP then continues to be phosphorylated twice,
becoming ribavirin triphosphate, or RTP,
and this is an important step,
because it directly inhibits the viral RNA polymerase,
an enzyme that helps replicate the viral RNA.
In fact, many antivirals use this process,
because if you can inhibit viral RNA polymerase,
you can stop its main mechanism to replicate itself.
Finally, RTP can act as a lethal mutagen
towards the viruses, ultimately making them defective.
- Now, ribavirin is only one type of treatment considered
for hepatitis C and is used based upon symptoms,
previous disease, or organ issues.
It can actually lead to hemolytic anemia
in around 10% of patients and cause other side effects,
like upper respiratory issues.
In fact, when it comes to fighting a virus,
there's often a mix of multiple treatments,
like antivirals, that are chosen based on the circumstance.
Showing you how this drug works is to highlight
the biological complexity of these drugs.
They work on many parts of the cell,
and some work better or worse, depending on symptoms,
or current physiological states.
Sadly, there's no such thing as a miracle cure,
or a fix-all drug that goes in and just shoots the virus.
There will always be nuances
and trade-offs with which antivirals will work.
- So, where are we at now in 2020?
Where are we at with these antivirals that we can use
to help with the novel coronavirus SARS-CoV-2?
You may have heard about the famous drug hydroxychloroquine
because she got mad headlines when Donald Trump tweeted
about COVID--19 saying, "hydroxychloroquine and azithromycin
"taken together have a real chance of being
"the biggest game changers in the history of medicine."
He likely tweeted this based on a study
from France of 36 coronavirus patients,
of which 20 were treated with hydroxychloroquine,
and some with the separate antibiotic.
It did work as a treatment for some patients,
but sadly others were admitted to the ICU and some did die.
As well, another study from China found hydroxychloroquine
had no effect at all, with another finding that
it had decreased fever in some.
Because research is happening right now at record speeds,
we are already starting clinical trials on chloroquine
and hydroxychloroquine, and in about four to six weeks
we will get these initial results,
finding out if it's doing something,
maybe it's doing nothing,
maybe it's actually causing damage in people
who are symptomatic of coronavirus.
Trump spoke way too early about this drug,
and sadly a couple actually having seen that
chloroquine was being chatted about on TV
consumed fish tank cleaner because it had chloroquine in it,
and this dose was too high and one of them actually died.
This is why it is important to remember that
when talking about medication you should always be listening
to medical professionals first.
As you saw with ribavirin earlier,
these antiviral medications are complicated.
They're biologically sophisticated things,
and so, it will take a while before a professional
can look at the results and decide if in fact chloroquine
or hydroxychloroquine is a game-changer.
Will it be our best option?
Possibly, will it have to be mixed with other drugs?
Also possible, and could it do nothing,
or even do more harm?
We'll have to wait and see.
Research during a pandemic happens fast,
and with small sample sizes.
So, one thing to always note is that any over-the-top claims
of miracle drugs should be questioned
until prolonged testing can occur.
To end on some good news, an early study in Petri dishes
found that chloroquine may help protect cells
from the coronavirus by decreasing the pH of a cell
when it is trying to fight the virus,
slowing down the replication cycle of the virus.
But again, more to come on that.
- Another antiviral drug being talked about
right now is Remdesivir.
Remdesivir inhibits viral mRNA polymerase,
which as stated earlier, is the enzyme
that synthesizes the RNA genome,
an essential part of the virus' replication system.
Remdesivir has been clinically tested for Ebola,
but scientists have discovered that it has
a broad spectrum of antiviral activities.
Remdesivir clinical trials have already begun,
and we'll be waiting anxiously over the next few months
for the first wave of results.
The WHO has a four-armed clinical trial
looking at Remdesivir against an HIV drug combination,
against another HIV drug combination
with the antiviral interferon, against chloroquine.
The reason we can move right into clinical trials
with these drugs is because they've already
gone through rigorous testing in the past.
For example, during the Ebola outbreak,
Remdesivir went through pre-clinical trials in Petri dishes,
testing on mice, rhesus macaque monkeys,
before large-scale clinical trials,
in which all studies showed antiviral effects.
There are predicted to be 29 genes/ proteins
associated with the SARS-CoV-2 virus.
So, scientists are cross-referencing these genes
and proteins with other drugs on the market to see
if these other drugs might be able to help.
It's important that we continue all of this research
because the best therapies may actually end up being
a cocktail of drugs, and if the virus mutates,
the more knowledge, concepts, and drugs we have
at our disposal, the better.
- It usually takes around six years of research
to administer a new antiviral drug
for the general public to consume.
So, things right now are happening fast.
Four to six weeks is when we will see
if these original clinical trials of antivirals
are continuing to be promising.
But in the meantime, we all need to be,
say it with me, staying at home!
Read a book, learn a language, bake.
I literally have burn on my arm,
'cause I've been baking so much!
Become an influencer,
because you might have guessed it, it's easy.
Stay at home because we need to flatten the curve
in order to give time for the researchers to figure out
these antiviral medications, figure out a vaccine,
and we also need to be helping the medical professionals
and the front line workers, giving them time
to look after the sick properly.
At this moment, we fear that healthcare workers
are running out of personal protective equipment.
So, the least that we can do is stay in our dang houses.
Again, if we do not stay home,
if we do not physically isolate,
we're not only putting our own lives at risk,
we're putting other people's lives at risk,
including these front line healthcare professionals.
Also my beautiful, intelligent, and amazing,
at this moment, heroic sister is a front line worker.
She's actually a respiratory therapist,
which means that she runs ventilators in an ICU.
So, you bet that I am staying
in this frickin' house for her.
- [Mitchell] One thing to be optimistic about right now
is how scientists, researchers, and healthcare workers
are coming together by sharing research and information.
Epidemiologists, statisticians, nurses, doctors,
respiratory therapists, blood transfusion experts,
which is a fascinating other treatment we're working on
explaining in another video, are all using the internet
to share results, making a strong case
for open access scientific information.
Borders are falling, and we're seeing research
and the sharing of information happening at record speeds.
- As for antivirals ending COVID-19,
we have to stay at home and allow time for scientists,
researchers, and physicians to figure out
the best antiviral treatments to treat us.
I know right now, sadly, it feels like we're sitting at home
waiting and in many ways we are playing catch-up,
and one of the main reasons for this
that we need to focus on is because there's been
a lack of funding for scientists
and scientific research across the globe.
As science communicators, we continually see research,
scientific research, slashed, and scientists ignored,
and this is incredibly frustrating to reflect on right now
during a pandemic when we're all sitting at home,
waiting for science to fix this world issue.
Last year Donald Trump planned to cut funding
for the National Institute of Health.
This is the third year in a row that he planned to do this.
Can we not just start voting for politicians
who believe in science?
So, we'll say it now, and we'll say it again,
and that's that we need to vote for science.
We need to be electing politicians who understand,
believe in science, and who are willing to listen
to scientists when it comes to policy,
at all times, not just during a frickin' pandemic.
It's so important that we get this medication right,
because any hiccups could strain the public's trust
in the government and studies from Hong Kong found
that your ability to stay at home and quarantine effectively
directly correlated with your trust in the government.
This antiviral research will be extremely helpful.
Right now also though we need to increase the tracking
and the tracing of the virus, something that America
and the UK and Canada is falling behind on.
We need to figure out how we can test more.
- If you wanna hear us talk more in depth
about these antiviral treatments,
and all the conversations surrounding COVID-19,
our latest podcast "Sidenote" actually addresses it.
We'll link it over here, and in the description
for you to watch and listen to.
- And thank you for giving us lots of questions,
and lots of ideas for videos.
We are definitely thinking about
answering more of them in the coming few weeks,
and yeah, in the meantime, stay at home,
physically isolate, and we will see you next week
for a new science video.
- See you later.