Covid-19: What you need to know today

Does Hydroxychloroquine (HCQ) work as a cure against the coronavirus disease? As a prophylaxis? What about Remdesivir?

The volume of literature out there can be confusing – as can the near-realtime reporting on these, which means we are all blowing hot one day, cold the other.

Still, it isn’t as bad as, say, the situation with egg yolks, ghee, or coconut oil. One part of the problem is that many of us look for headlines in research, when we should ideally be looking for nuance (I think some of the recent reports in mainstream media on Remdesivir, for instance, are guilty of this).

Another is that science can only answer questions set for it – for instance, a study on whether HCQ has prophylactic benefits cannot answer questions on its therapeutic ability.

And a third is that research, especially clinical research, is an iterative and reductive process, where the result of one study doesn’t as much provide a readymade answer, as point to another direction of study that could.

With that lengthy preamble, let us revisit the original question – or both the original questions.

What of HCQ?

A paper published in the New England Journal of Medicine on June 3, based on a randomised trial, showed that the drug wasn’t effective as a prophylactic – post-exposure. “After high-risk or moderate-risk exposure to Covid-19, HCQ did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within four days of exposure,” the study’s authors wrote.

But an Indian study, by the Indian Council of Medical Research, reported by HT on June 1, showed that 80% of health care workers who were given at least six doses of HCQ were not infected by SarsCoV-2, the virus that causes Covid-19. “The main conclusion that can be drawn after analysing the data is that HCQ has beneficial effects in infection risk reduction from the fourth dose onwards,” HT reported the study’s co-author as saying. This probably suggests that the drug may work as a prophylactic in the strict sense of the term – pre-exposure. To be sure, the ICMR study is a pre-print one and yet to be peer reviewed.

That means we have still not heard the last on HCQ’s ability as a prophylactic.

As for its ability as a therapeutic, The Lancet is reviewing a study that dismissed this (because it seems based on dodgy data), and the World Health Organization, which suspended HCQ trials following the study, has said it will now revive them. And what of Remdesivir?

This, too, is an interesting story. In late April, WHO posted on its website, and then removed, a study that claimed the drug wasn’t effective in treating Covid-19. The study was later published in The Lancet. But the same month – roughly a week after the study was published and taken down, and on the same day on which it appeared in The Lancet – the US National Institute of Allergy and Infectious Diseases said that its own trial of the drug suggested that the drug helped Covid-19 patients recover faster. Soon after, on May 1, the US Food and Drug Administration approved the use of the drug as a treatment for Covid-19 (in certain cases).

Earlier this week, a Phase 3 trial of Remdesivir on moderately ill and hospitalised Covid-19 patients showed a positive impact on those who received the drug for five days (as compared to those who didn’t), although there was no appreciable difference between those who received the drug for 10 days and those who didn’t. The study didn’t include critically ill patients but it also didn’t include patients in the early stage of infection. Both questions – about the drug’s efficacy when it comes to treating the critically ill as well as the just-infected – merit further exploration.

Interestingly, the study itself was interpreted differently by different people. Gilead’s stock fell because the study showed that the drug may not be the miracle cure everyone is looking for, although many others saw the conclusion as one that held out some hope – at least for the moderately ill. Coincidentally, India’s drug regulator approved the use of Remdesivir as a treatment for Covid-19 a day after the study’s results were published.

Which is where things stand. No quick answers; several false turns; and more questions. Which is how science works.