A RACE FOR A CURE FOR COVID-19*

By Dr. Philip Salem

April 9, 2020

In critical times, such as the one the world is going through today, one would need courage, hope, and knowledge. Scientific research, which is the main tool for making new knowledge, is our redemption. This is the only way to discover a cure for COVID-19, and to win the war against this pandemic.

We are late in our attempt to find a treatment for COVID-19. Consequently, more than 80,000 people have already died. More than four months ago, and since the first outbreak of this disease in China, it was clear that this enemy was not waging a war against China itself, or against any other country, but rather waging a war against all people, against all mankind. However, we had hoped that doctors and scientific researchers from all over the world would grasp this opportunity and jump over the closed geographical borders, to work together and find a cure for this disease as quickly as possible. As medicine does not recognize geographical borders; It rises above geography, nationalism, politics, and religion. It rises to man.

Amidst this darkness that envelopes the world, and the panic that imprisons more than a third of humanity in its homes, we see a dim light from afar. The international organizations, such as the World Health Organization (WHO), and the major institutions for scientific research in the world, have just started clinical trials to develop a new treatment for this disease. However, we must remember that between the greed of the pharmaceutical companies to make a profit on one side, and the scientist’s lust for fame on the other side, objectivity may evaporate and the truth may disappear. Thus, I shall try to evaluate as objectively as possible the clinical trials which are already in progress. In the past fifty-two years, I have witnessed the development of new drugs and treatments for cancer diseases. Also, I have witnessed the development of new drugs for microbial infections as these infections pose major threats to cancer patients and remain the most important cause of death from cancer. This new research on coronavirus aims to overcome the disease through two strategies: The first is to discover a drug that kills the Coronavirus directly. In the second strategy, the objective is to strengthen and enhance the immune system in the patient’s body, in order for this system to become capable of destroying the virus itself.

In the first strategy, research focuses on four drugs:

•       Hydroxychloroquine (HC)

•       Chloroquine (CL)

•       Azithromycin (Z pak)

•       Remdesivir (RD)

These drugs are conventional and we know a lot about them particularly about their toxicity profiles.  (HC) and (CL) have been used for decades to treat Malaria and other Chronic Diseases. (Z pak) is an antibiotic against viruses and it is usually used in infections like the common cold and the flu. (RD) is an anti-viral agent usually used for the treatment of  HIV infections. On March 29, the Food and Drug Administration (FDA) had officially given the green light for research to evaluate the efficacy of (CL), (HC), and (Z pak). This means, without a doubt, that the FDA had reviewed data suggestive but not conclusive that these drugs are effective in the treatment of Coronavirus. Some studies conducted in France had indicated that patients who received treatment with the combination of (HC) and (Z pak) had achieved better results compared to patients who did not receive such treatment. This combination was also used in the treatment of patients in the city of Kansas, US, and the results were similar to those of France. However, these studies are not definitive as they were carried out in haste, and the number of patients treated is small. Also, we had learned from China’s experience that patients who received  (HC) and (CL) for diseases other than Malaria, like Lupus Erythematosus and Rheumatoid Arthritis did not develop COVID-19. The question here is whether these drugs were indeed capable of protecting patients from the Corona infection. Based on these positive, but only suggestive, indications, the FDA launched a new scientific research trial to enroll a total of 1100 patients in New York City, and to treat them with the combination of  (HC) and (CL). Last week the World Health Organization (WHO) announced the SOLIDARITY project. It is a huge scientific research project, in which many countries all over the world will participate and treat thousands of patients. This project focuses on studying the effectiveness of four kinds of treatments. These four treatments are considered by WHO as the best among all treatments available for now. These treatments are:

1. Remdesivir(RD) alone.

2. The combination (HC) with (CL).

3. The combination of lopinavir and ritonavir. These two drugs are usually used in the treatment of AIDS.

4. The third combination plus Interferon-beta.

This protocol was designed with the utmost speed, and its objective is to determine within a very short period of time the effectiveness of these treatments. Also, the French organization for medical research, INSERM, has followed the example of WHO and has launched another project called DISCOVERY. In this new project, 3,200 patients from European countries will be treated with the same drugs as the SOLIDARITY project. A few days ago, Britain initiated several trials to evaluate the efficacy of the anti-viral drug Remdesivir, as this drug is manufactured by the British pharmaceutical Gilead Sciences.

In the second strategy, a new approach has been used. It is the treatment with immunotherapy. Immunotherapy has radically changed the landscape of the treatment of cancer. Let us hope that it will do the same for the treatment of infectious diseases. While the studies that we talked about used conventional medications, immunotherapy uses new tools and exploratory methods, including infusing patients with plasma taken from a person who was infected and achieved a cure from the disease. Hypothetically this plasma should contain antibodies against the virus and these antibodies could be used in the prevention and treatment of COVID-19. Consequently, technology companies are using new methods for developing these antibodies in the lab in big quantities for the treatment of patients. Another approach is Stem Cell Therapy where the patient receives his/her own stem cells extracted from his/her blood . There are also other methods that will strengthen and enhance the immune system so that this system will be capable of conquering the disease.

This is a simple exposé of the scientific landscape of research on a new treatment for coronavirus, from China to Europe to the United States. But let me ask four simple questions.

1. Do we have definitive evidence that a drug is now available for the treatment of  COVID-19? The answer is, NO.
2. Are there some indications that would make us believe that some of these treatments we have talked about in this article, might be helpful? The answer is, YES.
3. How long do we have to wait to know something which is scientifically valid and proven? The answer is a few weeks,  Four to Six.
4. What do we tell the patient who is infected and who is threatened by death today? shall we tell him let us wait? The answer is NO. We tell him to explore with his doctor the possibility of receiving treatment with the combination of (HC) and (Z pak). I fully understand that this treatment might be associated with minor side effects; But I believe that the harm that may result from using this treatment, is much less than the damage that may result from not using it.

The world is going through very difficult times. Times unimaginable by the human mind. But we will survive. To survive, we need patience, faith, and science. We reject the slogan raised by the world which calls for “social distancing”. We believe that there had been no day in the past that we needed each other more than today. During these times we need to embrace each other in brotherhood, human warmth, and humility. We need to return to ourselves, to our humanity. Tolstoy says in his book “Master and Man” “ One should not wait until he is close to death to embrace the peasant working for him in the field”. such an embrace is our deliverance from the death that stares at us. Consequently, I want to raise another slogan “physical distancing” instead of “social distancing”. This is to emphasize the value of human cohesion and human bonding.

We also hope that we have learned from this experience that God is one, Man is one, and Earth is one. We hope we have learned that health is the most important thing a person may possess. And that the most important human right is the right to health because this right is the right to life. One should be alive first to exercise all other human rights. There is no human right that should supersede the right to health. We also hope that a new world order will emerge from the womb of this hell, a new order that respects God, man, and values. We hope that a new United Nations will also emerge. A United Nations that is capable of establishing peace in the world and which is respectful of human rights. Consequently, the United Nations should seriously consider reforming the UN Charter of the Declaration of Human Rights. This Charter should be changed in a manner where the right to health should be the most important and sacred human right. All other human rights which are already established in the Charter fade compared to the right to health. There is no life without health.

This is a global war. A war against all of us. A war against man.  I kneel and pray. Tomorrow the sun will rise. Tomorrow man will win.

*This editorial was published in Arabic, in Annahar Newspaper in Beirut on Thursday, April 09, 2020