In early phases of the coronavirus pandemic, a number of countries—many in the Asia-Pacific region—managed to pursue a policy of “zero Covid,” keeping the virus at bay with a combination of strict border controls, lockdowns and other restrictions. Australia, New Zealand, Taiwan, Singapore and China all closed their borders in 2020, and those limited few allowed to cross the border were forced into strict hotel quarantines with extensive testing. Outbreaks were stamped out early, meaning that residents could live in relative freedom while case numbers soared internationally.
This strategy worked well in the beginning of the pandemic. The countries that pursued Covid zero have on the whole seen lower per capita death rates, shorter and more flexible lockdowns, and faster economic recoveries than their counterparts who sought to dampen the spread of the virus with softer measures. The highly transmissible Delta variant and the advent of widespread vaccination campaigns, however, have completely changed the game. As a result, only a few countries, such as New Zealand and China, are still pursuing zero Covid at all costs. Most other countries are attempting to live with the virus, a shift which will require an expanded arsenal of medicines to treat the disease.
Time for zero Covid may be over
It is hard to tell how long the remaining zero-Covid countries can hold out given the monumental social and economic costs of continually pushing caseloads to nil. In China, for example, footage of a 4-year-old boy in a white hazmat suit went viral on social media last week; carrying a backpack half the size of his body, he was entering quarantine alone since his Covid-negative parents were not allowed to accompany him. Many have slammed the measures as unnecessarily harsh, not to mention psychologically damaging.
In contrast, a number of other countries have already begun to transition to a new stage of living with the virus. In Singapore, where some 80 percent of the population is now fully vaccinated against Covid-19, the government has moved away from border closures and lockdowns, and toward a policy of tracking and treating clusters instead. As Australia’s vaccination rate has accelerated to record levels, Prime Minister Scott Morrison has called on residents to prepare to “come out of the cave.”
Endemic Covid requires effective treatments
In some countries, the virus may already be endemic. Countrywide surveys in India, for example, indicate that as many as 67% of Indians have developed Covid-19 antibodies separately from the national vaccine roll-out. Some researchers have argued that the country may even have achieved herd immunity just in time for the coming third wave.
At this point, it seems inevitable that Covid will eventually become endemic across the globe. When that happens, the tools needed to fight the virus won’t be the same as those which characterized earlier phases of the outbreak, such as strict lockdowns and border closures. While regulators around the globe are contemplating booster shots—the U.S. FDA just approved a third Pfizer dose for elderly people and those at high risk, the focus will likely shift to mitigating symptoms and avoiding severe cases of Covid in those patients who inevitably continue to contract the disease. The development of effective medical treatments, then, will be key for this stage; fortunately, there are already several promising candidates.
Repurposing existing medicines: Rigel’s fostamatinib shows promise
A phase II study recently published in the journal Clinical Infectious Diseases, for example, has shown that the oral spleen tyrosine kinase (SYK) inhibitor fostamatinib, manufactured by California-based Rigel Pharmaceuticals, prompted meaningful improvement in hospitalized Covid patients. The drug is currently marketed in the U.S. as Tavalisse and in Europe as Tavlesse, and has already been approved by regulators for the treatment of chronic immune thrombocytopenia (ITP), raising hopes that it might be a promising treatment for inflammatory complications from Covid-19.
The Phase II trial of fostamatinib was highly encouraging. The hospitalized Covid patients treated with Tavalisse saw a clinically significant improvement compared to those treated only with standard of care, demonstrating a lower mortality risk and spending less than half the median number of days in ICU and significantly fewer days on oxygen. The drug is now being studied in multiple Phase III trials, including a study led by the National Heart Lung and Blood Institute, as well as one led by Rigel and supported by a $16.5 million grant from the U.S. Department of Defense.
While the fact that fostamatinib had already proven to be well-tolerated and safe for use against other diseases has allowed it to move quickly through trials, some leading pharmaceutical manufacturers have started from the drawing board in developing a host of potential new drugs to tackle the Covid-19 virus.
Bespoke coronavirus treatments: Pfizer and Merck in the lead
Earlier this month, Pfizer and Merck announced new trials of experimental oral antiviral drugs to treat the disease. According to Pfizer, the company’s latest mid-to-late-stage trial is set to enroll 1,140 non-hospitalized adults who have tested positive for coronavirus, but who are not at risk of severe illness. Participants will be given Pfizer’s pill, known as PF-07321332, as well as a low dose of ritonavir. The latter is currently already used in treatments for HIV infection.
As for Merck’s latest round of trials, participants will take the experimental antiviral drug molnupiravir. Researchers plan to study the drug’s efficacy in preventing Covid-19 among adults in the same household as an individual diagnosed with symptomatic coronavirus infection. Merck and partner Ridgeback Biotherapeutics have already begun a late-stage trial of the molnupiravir in non-hospitalized patients to assess any reduction in risk of hospitalization or death.
Based on current trends, it seems inevitable that the world is heading toward a state of “endemic Covid.” Some countries’ efforts to continue pursuing zero Covid, while admirable, are missing the light at the end of the tunnel: the development of effective treatments may see us out of this pandemic sooner than we dare hope.
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