Common Symptoms of COVID-19

Typical Symptoms

The most prevalent symptoms associated with COVID-19 include fever, dry cough, and general fatigue. However, it is important to note that some individuals may remain asymptomatic.

Severe Symptoms

Severe manifestations of COVID-19 can include shortness of breath, persistent chest pain, and high fever. Patients exhibiting these severe symptoms may necessitate hospitalization and could require supplemental oxygen to aid their breathing.

Clinical Trials for COVID-19 Treatments

Due to the widespread occurrence of COVID-19 globally, there has been an urgent push for human clinical trials to evaluate potential treatments for this disease. One notable treatment is remdesivir, marketed under the brand name Veklury, which has been authorized or approved in approximately 50 countries for temporary use against COVID-19.

Mechanism of Action of Remdesivir

Remdesivir is classified as an antiviral drug, functioning by disrupting the viral replication process. The genetic material of SARS-CoV-2, the virus responsible for COVID-19, is composed of RNA. This RNA is essential for the virus’s replication and requires an enzyme known as RNA-dependent RNA polymerase (RdRp).

In the body, remdesivir is converted into a nucleoside analog called NTP, which replaces the naturally occurring nucleotide ATP in new RNA strands. This substitution hinders the viral polymerase’s ability to produce new viral RNA, thereby inhibiting the virus’s reproduction within an infected individual.

Administration and Monitoring

Remdesivir is typically administered intravenously. The U.S. Food and Drug Administration (FDA) has stipulated that its use should occur in a hospital environment or a healthcare setting capable of providing equivalent care, allowing for close patient monitoring.

Remdesivir Clinical Trials

Before the emergence of the COVID-19 pandemic, most studies on remdesivir were conducted using cell and animal models to investigate its efficacy against coronavirus strains like MERS and SARS. Human studies were limited until the COVID-19 outbreak necessitated rapid initiation of trials to assess safety and effectiveness for severely symptomatic patients.

One significant clinical trial, published in the New England Journal of Medicine, was a double-blind, randomized, placebo-controlled study involving 532 adults hospitalized with lower respiratory tract infections due to COVID-19. Results indicated that patients receiving remdesivir experienced quicker recoveries compared to those in the placebo group, defined as either being discharged or no longer requiring supplemental oxygen.

The National Institutes of Health (NIH) noted that while there appeared to be a reduction in all-cause mortality in patients treated with remdesivir, the findings could not definitively rule out chance as a factor. Other studies suggested potential benefits; however, it was unclear if remdesivir could serve as a standalone treatment, particularly in more severe cases.

Conversely, a trial conducted by the World Health Organization found no conclusive evidence that remdesivir reduced mortality rates, the need for ventilation, or the duration of hospitalization among COVID-19 patients. This study involved 405 hospitals across 30 countries and included 2,750 patients treated with remdesivir for ten days.

Potential Risks Associated with Remdesivir

As with many medications, remdesivir may cause side effects. The FDA has identified potential symptoms, including fever, elevated liver enzymes indicating liver damage, and changes in blood pressure and heart rate.

Access to Remdesivir

Many countries have begun to authorize or approve remdesivir for use in hospitalized COVID-19 patients. Health Canada has granted emergency use authorization, contingent upon Gilead Science Canada maintaining the drug’s safety, quality, and efficacy. The drug is restricted to patients aged 12 and older, weighing at least 40 kg, who are hospitalized with severe COVID-19 symptoms, including pneumonia.

Recently, the FDA approved remdesivir for similar use in hospitalized COVID-19 patients, marking it as the first drug authorized for COVID-19 treatment in the United States. This approval is based on findings from three randomized, controlled clinical trials involving patients with mild to severe symptoms, including the aforementioned study published in the New England Journal of Medicine.

References

Amirian, E. S., & Levy, J. K. (2020). Current knowledge about the antivirals remdesivir (GS-5734) and GS-441524 as therapeutic options for coronaviruses. One Health, 100128.

Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., … & Finberg, R. W. (2020). Remdesivir for the treatment of Covid-19—final report. The New England Journal of Medicine. doi: 10.1056/NEJMoa2007764

Gilead. (2020). About veklury. Retrieved from https://www.gilead.com/purpose/advancing-global-health/covid-19/about-veklury

Government of Canada. (2020). Remdesivir authorized with conditions for the treatment of patients in Canada with severe COVID-19 symptoms. Retrieved from https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/73621a-eng.php

National Institutes of Health. (2020). Final report confirms remdesivir benefits for COVID-19. Retrieved from https://www.nih.gov/news-events/nih-research-matters/final-report-confirms-remdesivir-benefits-covid-19

U.S. Food and Drug Administration. (2020). FDA approves first treatment for COVID-19. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-covid-19

Wang, Y., Zhang, D., Du, G., Du, R., Zhao, J., Jin, Y., … & Hu, Y. (2020). Remdesivir in adults with severe COVID-19: A randomised, double-blind, placebo-controlled, multicentre trial. The Lancet, 395(10236), 1569-1578. doi:10.1016/S0140-6736(20)31022-9

World Health Organization. (2020). Coronavirus disease (COVID-19). Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19