Corona analysis – Making sense amongst the deluge of data

The whole world is currently, reading, hearing, and seeing about the developments in addressing the damaging effects of the covid-19 virus, and the info-pandemic is equally overwhelming. Confusion prevails in the treatment paradigm, clinical and anecdotal data of successful treatment and failures, recovery and timelines being promised for an effective therapy and prevention.

This is the first time in the lives of several generations that a calamity of this nature has affected the whole world. People in different geographies have faced calamities like – Tsunami, cyclones, drought, fire, terrorist attacks, etc where the effect was felt in small pockets. COVID-19 has turned the world upside down. Every aspect of our lives has been affected- How we interact with each other, work together, travel, etc. Decisions being taken right now will transform our future and will affect people all around the world for years to come.

The speed and ability of the virus to mutate and its unique behaviour inside humans of different genotype, varied immunity levels, diverse climate & environment pose grave challenges. Infection, recovery, and mortality rate disclosed in different countries, is proof of the differences in varied response to varied treatment.  Thus, it is no-brainer that “One size will not fit all” therapeutic approach will emerge.

We have narrowed our initial analysis of the COVID pipeline available in the public domain and complied some therapeutic approaches which could be used as a practical, affordable drug for early or mild stages of infection. For the ICU patients, doctors are struggling to manage the situation “testing and trying” as the outcome is dependent on several factors and require stringent monitoring and management.

  1. The first strategy for the treatment of COVID-19 is the repurposing of existing drugs that have already been shown to be safe in humans. This strategy can make COVID-19 treatment faster, affordable, and accessible. Drug makers and universities around the world are evaluating them in clinical trials, as everyone wants a piece of pie of this opportunity. Antivirals and Antiprotozoal have shown some promise and in the pipeline of repurposed drugs for COVID-19 treatment.
    1. Affordability of COVID-19 treatment is a prime concern. In developing nations like India, Favipiravir, a generic version of Fujifilm’s Avigan if efficacious, would be an effective and affordable solution and a finer alternative to the costlier patented Remdesivir of Gilead Sciences whose efficacy is not great.
    2. More than 75 novel drugs including antivirals, antibodies and peptides are in preclinical or discovery stage in COVID-19 pipeline, but is it really a need of a time to focus on developing novel drugs when large number of repurposed drugs can be taken into consideration for the COVID-19 treatment?
  2. Novel formulations and combinations of small molecule-based drugs – Many of the drugs have shown promise in preclinical, in vitro studies but failed to demonstrate similar efficacy in beating the virus in the clinic. One possible reason is poor bioavailability in human studies. Thus, new formulations, combinations are being explored. Data is expected from these studies by 3Q CY2020.
  3. Vaccines – Nucleic acid based (mRNA, DNA), recombinant protein based, viral vector based, live attenuated.
  4. While biologics such as Actmera/ tocilizumab can buffer against the cytokine immune response in critical patients, they are still unaffordable for the common patient in India. Plasma and antibodies isolated from recovered patients are a good option, but volumes may be limiting the availability.

Different Types of Vaccines and Key Products in the Clinical Development

Source: Company Reports, ProGrow Pharma Research

India, alike other countries, is also trying hard to control SARS-CoV-2 spread and its associated mortality with all the available resources.  The government has also been promoting the prophylactic role of combination of some drugs like HCQ, Homeopathy and ayurvedic therapies to boost the immunity. There are underlining efforts by the scientific community and pharmaceutical companies to develop and manufacture vaccines, drugs, and diagnostic kits locally to combat COVID-19.

The doctors, treating the critically ill patients, do not have the luxury of waiting for full clinical trial results, and they must make a decision from their own and shared experience.  If supporting devices, critical instruments (defective/poor quality ventilators, safety gears) and sanitisation issues are addressed, they will be handsomely rewarded by the smile of a recovered patient and country.

Indian Pharma is also leaving no stones unturned and working on combinations of old new drugs to give the nation some therapies ASAP.  In less than six months of spreading coronavirus outbreak, India has identified six local vaccine candidates for COVID-19.  These candidates are divided into four vaccines categories- mRNA, attenuated, inactivated and adjuvant.

Apart from local vaccines, Indian companies are collaborating with foreign companies and universities for COVID-19 vaccine development, e.g. SII, Bharat Biotech, Bharat Serums and Vaccines (BSV). At least 10 drugs are being repurposed and being evaluated for the treatment of COVID-19. On the diagnostic front, Indian companies are developing low-cost COVID-19 diagnostic kits.

Key Attributes listed below are Essential for Broad Adoption and Compliance of anti COVID therapies in India