Coronavirus Epidemic Update 11: Antiviral Drugs, Treatment Trials for nCoV (Remdesivir, Chloroquine)

welcome to another MedCram coronavirus
update the deaths have gone from four hundred and twenty seventh four hundred
ninety three and that’s an increase of about fifteen percent that’s a little
bit less than it’s been in the last couple of days normally it’s been
running in the eighteen to twenty percent confirmed infections has gone to
twenty four thousand five hundred and sixteen that’s up around nineteen
percent and then we’ve got recovered yesterday was at six hundred and fifty
seven today up to nine hundred and six and I think we should see that these
numbers are gonna continue to increase because we’ve gotten through a number of
weeks of illness with these patients okay we’re gonna talk about some of the
quick items in the news and then we’ll get to the big topic which has been new
drugs that are being looked at to treat the corona virus pneumonia and lung
diseases okay quick items in the news first of all testing in the United
States has typically been done by the CDC up to this point well now they are
going to distribute those two specific local labs so that those labs can
process some of these tests that would be done perhaps on a more regular basis
this is the swab up to this point there have been eleven positive out of a
hundred and seventy eight tests that have been performed there’s another
eighty two tests that are outstanding right now and we’ll see what the results
of those show yesterday we talked about the diamond princess about 3700 are on
board and this is floating off the coast of Japan and it looks as though there
are ten positive on board based on the stories that are coming out remember
this was a ship that had sailed and it was found out that there was a man that
was on this ship in late January and ten of them are positive already on
the ship unclear if it was a direct result of this man that had tested
positive earlier thirdly there is another dashboard out there I know we’ve
had some positive feedback with the Johns Hopkins dashboard I wanted to make
you aware of another dashboard that I thought was very clean I had a lot of
good information on it and so we’ll put a link in the description okay so
there’s this letter to the editor to nature nature’s a big journal very
prestigious this is February the 4th that this was published and it is
describing the medications specifically REM D severe and chloroquine and why
this is important so let’s talk about REM dis aver first going back there were
a number of medications that were looked at during the SARS and MERS outbreak
both of which by the way are coronaviruses there were medications
that they had tried like revive ayran obviously they had tried REM des aver as
well and these were shown to be efficacious in stopping viral production
in vitro so the key there is the word in vitro in vitro
means in a petri dish in a test tube not necessarily in a human being and this is
where a lot of tests are done at first now what they did do is they looked at
this medication called REM des aver and they tried it in Ebola and the reason
why they did this was because it worked in Ebola it worked in vitro in Ebola and
they said hey maybe we can try this in Ebola patients or in people who are in
proximity to people with the Ebola virus so that they don’t get Ebola and so when
they tried it it didn’t work okay people still got Ebola so that’s an
example where a medication works in vitro but not in vivo nevertheless
before they could take this medication REM des aver to market before they could
even try it in these patients they had to make sure that it was safe and so the
safety tests have already been done on REM this aver we know that it’s a
relatively safe medication to use in patients the problem was it
just didn’t work in vivo in patients in real life
but it did work in vitro against a bunch of viruses so enter in now the corona
virus 2019 and you’ve got a situation where people are dying and there’s an
epidemic why not try REM the severe well the first thing you’ve got to want to do
is to make sure this medication actually works against not the SARS not the MERS
not Ebola but the actual corona virus 2019 and so that’s what they did they
actually tried it in cells that were infected with the current strain of the
corona virus from Wuhan China now how does this medication work what does it
do so you’ve got the cell and you’ve got the virus and the virus has to fuse with
the cell and it goes inside the cell and when it does that it basically dumps its
RNA into the cell and uses the cellular machinery to reproduce more RNA well for
those of you who are aware of what RNA is or DNA for that matter it’s basically
just a code and you know the DNA code for instance is like a T G C and this
can go on and on and on with however RNA instead of having the T’s those T’s
become use so instead of T’s you’d have a u G C you you okay that’s the only
real difference of course it’s usually a single-stranded and DNA is usually
double-stranded so what happens is that these nucleotides are lined up one after
the other and there are you know T and RNA is that come in and help put the
nucleotides in the correct order and this is done using different polymerases
well what this medication does is it resembles one of the A’s except it
doesn’t allow the next one to come on whatever that happens to be so the virus
comes in to the cell and it says aha I’m taking you over and you’re just going to
start to produce more RNA viruses like me and so the machinery starts to go
along and as soon as it gets to an A this medication gets
put in and boom it’s done there’s no more polymerization the strand cannot
continue and so this arrests the production of virus well the good news
is is that they found that this worked well in the new 2019 strain of the
corona virus and so here you’ve got a medication that has already been tested
on human beings for safety it’s available it’s there you just don’t have
a good FDA indication because it doesn’t work on Ebola and you don’t have a SARS
outbreak currently but now you’ve got this corona virus outbreak so what do
they do even though they don’t have any evidence that it’s going to work and
usually we only give medications to people when we have evidence that it
works they use it for something called compassionate use in other words look
this patient’s going to die let’s give them this medication see if it works so
they did that they did that in the first patient in the United States that came
down with the virus and it was in Washington State and within a day
this patient started feeling better and within three or four days the fever
completely went away and we’ve got a number of articles that talk about this
and we’ll put those in the links so this could be a big breakthrough here if this
works but remember want to make sure that you understand that this medication
has never worked in vivo so we don’t know if it’s gonna work so
what they’re planning on doing here coming up very shortly is they’re
actually going to undergo a trial in China where they give some people
placebo and they give others this REM death bear and see whether or not it
works we should know by the end of April whether or not this thing is going to
work now as you can imagine this has caused some store the company is Gilead
that makes this and I’m sure if you look at their stock prices that are probably
going up in the hopes that this thing works and that the epidemic can be
abated so the other drug that they looked at in the same letter to the
editor in that study was chloroquine now chloroquine is been around for a
very long time it’s a generic medication it’s been used in malaria for years in
fact so much so that you actually have chloroquine resistant areas they also
found that this worked really well as well so how does that work well you’ve
got the cell you’ve got the virus there’s a special pH that these
lysosomes have to be before these things can merge and what chloroquine does is
it raises the pH of those lysosomes preventing these things from merging so
it’s possible that you could prevent viral particles from infecting other
cells and now these are just two drugs that are being looked at there’s the pen
aver and Ratana ver these are other medications that are being used in fact
these were used in Thailand and they were thought to improve the problem is
with any of these medications that are used for compassionate use if you use
them and the patient gets better you don’t know if that was the reason why
they got better or if it was some other reason they got better that’s why you
need to do a randomized placebo-controlled trial okay so this is
the latest hot-off-the-press information regarding corona virus if
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