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Coronavirus treatment recommendations could change daily

The problem doctors face is running studies during a pandemic.

AUSTIN, Texas — For months, doctors around the world have been rushing to find treatment options and a cure for patients testing positive for COVID-19, caused by coronavirus.

As countries worldwide received a wave of patients, a wave of studies and testing followed. Dr. David Fleeger, the president of Texas Medical Association and a hospital doctor in Austin, hopes study conclusions are released soon.

"The treatment could actually change tomorrow," Fleeger said. "There are multiple studies going on throughout country and, indeed, throughout the world looking at other treatments."

The studies primarily look at how different medications interact with the virus and the patient's immune system – does the virus grow, subside, stay the same? One medication being heralded as a treatment is hydroxychloroquine. The drug was developed and studied to help patients with malaria, lupus and rheumatoid arthritis.

Dr. Cliff Porter, who opened his own practice in October, compared the drug to aspirin in terms of how versatile it is.

"It hinders the virus from attaching to the molecules on your lung cells, called ACE2 receptors, but blocks that so the virus can’t get in the cell to start with, so that allows your body time," Porter said. "It also hinders the virus from replicating inside the cell."

Doctors say there has not been enough study to determine if hydroxychloroquine actually helps patients fight off COVID-19. Porter and Fleeger emphasized that's true. While there are 15 years of study on the drug, there have only been a few months of study on the virus.

"Six months from now we’re going to know whether it helps or it didn’t help," Fleeger said. "We’re going to know whether it helps enough to justify any complications or not."


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Porter added six months is too long for people to find out if the drug will work. Patients need treatment now. In that vein, the Food and Drug Administration approved the drug for emergency use during the spread of the coronavirus. It is not approved for use against the virus outside of this pandemic.

“If someone comes in with coronavirus and they don’t have any significant risk factors, I’m going to start hydroxychloroquine and maybe azithromycin for them," Porter said. "I think the potential for life-saving is so significant, in terms of medical research ethics, I think it would be inappropriate not to offer these types of treatment."

Fleeger, on the other hand, emphasized the only approved treatment for patients across the board is supportive treatment. The TMA president also noted the best treatment is prevention, calling on people to continue washing their hands and social distancing.

Porter agreed, but also discussed other drugs that are getting tested right now, like tocilizumab and remdesivir, but have not produced reliable results to be called treatments at this time.

Another point Porter made was the difficulty in finding treatments during a pandemic for so many different demographics.

"Some people with very advanced disease have medications, some people with very early disease have medications, so which one did it help," Porter asked. "Well, with small studies that’s hard to tell because there’s so many different therapies."

The problem doctors face is running studies during a pandemic. Normally, the "double-gold standard" of studies would mean studies are randomized and double-blind. Double-blind means neither the participant nor the doctor knows who received the medication – the only one with that knowledge is the person running the study. Those studies take months or even years to complete.

"In a pandemic, we don’t have that luxury," Porter said. "I think the medical, ethical standards, in my opinion, suggests we start early."


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