As Connecticut’s first confirmed coronavirus patient grew more ill, medical staff at Danbury Hospital consulted with the Centers for Disease Control and Prevention while considering a wide range of new treatments including vitamin C injections and off-label medications.
Ultimately, the patient, Christ Tillett of Wilton, received a cocktail of the malaria drug chloroquine and the HIV drug Kaletra. He got better.
What role — if any — the chloroquine cocktail played in Tillett’s recovery and the recoveries of others is one of the many questions experts at hospitals across the state and nation are trying to answer on the fly as coronavirus cases increase. It is a grand unplanned experiment playing out at hospitals across the U.S. and world that experts are hoping will arm health care teams in the coming weeks with better data and more effective treatments.
C. Michael White, department head and professor of pharmacy practice in the UConn School of Pharmacy, says that as new treatments are administered at hospitals, clinicians will be reporting outcomes back through public health channels. “Hopefully they’re getting their own kind of sense for what they think might be working better for them, but then they’re also sending the data back through the system so that epidemiologists and other people will be able to use that data to make better determinations,” he says.
Danbury Hospital, which is owned by Nuvance Health, declined to comment on specific treatments being offered, but Amy Forni, Nuvance Health’s manager of public relations emailed a statement saying, “Our clinical teams are looking into and utilizing different treatment options for COVID-19 patients that are aligned with the latest research and guidelines from the WHO, CDC, and other expert organizations.”
At Hartford HealthCare, some patients have received a mixture of the antibiotic azithromycin and chloroquine. Dr. Ajay Kumar, chief clinical officer at that hospital system says the patients who are receiving the treatment are generally those who are in “ICU or are not responding to supportive therapy.” He adds, “I cannot comment on the efficacy of what these cocktails has been so far.”
White, from UConn, says that under normal circumstances a new treatment “targeted against a virus or targeted against a bacteria could take seven to eight years in order to be able to come out and get to market.”
That is far too slow to help with the pandemic, so hospitals have begun using new treatments — mostly in patients with severe cases of the disease — that are unlikely to be harmful, but also are not clearly effective. The most talked about are drug cocktails involving chloroquine. A small and controversial study in France suggested that chloroquine could be used effectively to fight the disease, but that has not been demonstrated on a large scale yet.
“Right now the malaria combination has the strongest data set, even though it’s still very, very weak,” White says. “The data is promising but the data is certainly not proved.”
Widespread interest in the drug has also caused shortages for those who need it, as well as multiple deaths in Nigeria and one death in the U.S. from people taking forms of the drug without doctor’s instructions.
Other potential new treatments include vitamin C being administered by IV. “In really severe diseases one of the things that happens is that vitamin C levels end up getting used and your vitamin C levels end up dropping,” White says. “Based on that they’re hoping that if they can give people vitamin C injections that vitamin C may end up coming back and will end up being beneficial. … They don’t know right now whether or not the lower concentrations of vitamin C in severe infections is a marker of that severe infection or whether it is a contributor to that severe infection.”
Kumar at Hartford HealthCare does not believe there is enough existing evidence to warrant vitamin C treatments. “Vitamin C is not something I would consider a therapy for COVID-19 at this time,” he says. “It would not hurt but would not make anything different.”
Medical staff should have an idea which treatments work and which do not sooner than they normally would, White says. This is due to the sheer number of COVID-19 cases and that many of those suffering from the condition will be willing to try new medications.
“For a normal disease or disorder you would go and you would ask somebody, ‘Hey, you’re experiencing headaches, do you want to continue taking one of these other three or four options that you already have for migraines? Or do you want to take this other experimental therapy? And maybe 10 percent of people would be willing to give up their therapy that is already effective and move to your therapy, which may or may not be effective,” White says. “Here, since there’s no proven therapies, people are really, really incentivized to say ‘yes’ and allow you to use a therapy, even though it’s not proven because the outcomes of doing nothing may be poorer in those patients.”