A drug used to treat people with HIV, the virus that causes Aids, is being trialled in patients in China as a possible therapy against the coronavirus.
News that HIV drugs are being deployed in hospitals, however, has led to panic buying on the black market by people who fear they are ill or are going to get sick. They have been obtaining the drug, Kaletra, from generics companies in India and even from people with HIV in China willing to sell or donate their own stocks.
Kaletra, a combination of two anti-HIV drugs, lopinavir and ritonavir, has been used on patients in a trial in China since 18 January. The aim is to test it in about 200 patients, whose condition will be carefully monitored. Their outcomes will be compared with those of similar people with the same degree of illness who have not been given the drug.
There are no proven treatments for the new coronavirus, nor the others that caused the earlier outbreaks of Sars (severe acute respiratory syndrome) in 2002 and Mers (Middle East respiratory syndrome) in 2012. There are still cases of Mers. In Saudi Arabia, where they are largely concentrated, there is already a trial of Kaletra, combined with another drug, interferon, but because of the small number of Mers cases it will take a long time to come to conclusions.
What is the virus causing illness in Wuhan?
It is a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.
What other coronaviruses have there been?
New and troubling viruses usually originate in animal hosts. Ebola and flu are other examples – severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals.
What are the symptoms of the Wuhan coronavirus?
The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.
Is the virus being transmitted from one person to another?
Human to human transmission has been confirmed by China’s national health commission, and there have been human-to-human transmissions in the US and in Germany. As of 7 February, the death toll stands at 636 inside China, one in Hong Kong and one in the Philippines. Infections inside China stand at 31,161 and global infections have passed 280 in 28 countries. The mortality rate is 2%.
Two members of one family have been confirmed to have the virus in the UK, and a third person was diagnosed with it in Brighton, after more than 400 were tested and found negative. The Foreign Office has urged UK citizens to leave China if they can.
The number of people to have contracted the virus could be far higher, as people with mild symptoms may not have been detected. Modelling by World Health Organization (WHO) experts at Imperial College London suggests there could be as many as 100,000 cases, with uncertainty putting the margins between 30,000 and 200,000.
Why is this worse than normal influenza, and how worried are the experts?
We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2%. However, this is likely to be an overestimate since many more people are likely to have been infected by the virus but not suffered severe enough symptoms to attend hospital, and so have not been counted. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.
Should I go to the doctor if I have a cough?
Unless you have recently travelled to China or been in contact with someone infected with the virus, then you should treat any cough or cold symptoms as normal. The NHS advises that people should call 111 instead of visiting the GP’s surgery as there is a risk they may infect others.
Is this a pandemic and should we panic?
Health experts are starting to say it could become a pandemic, but right now it falls short of what the WHO would consider to be one. A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed in about 25 countries outside China, but by no means in all 195 on the WHO’s list.
There is no need to panic. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern, and says there is a “window of opportunity” to halt the spread of the disease. The key issues are how transmissible this new coronavirus is between people and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact.
Sarah Boseley Health editor and Hannah Devlin
Gilead, a company that makes HIV drugs, has announced it will trial its drug remdesivir in the coronavirus outbreak. The drug was tested during the Ebola outbreak in the Democratic Republic of Congo in 2018, but the Congolese authorities announced it was not sufficiently effective against the virus.
The new trial of remdesivir will be gold standard, investigating how well it works in both moderately and severely ill patients compared with others given a placebo.
Peter Horby, professor of emerging infectious diseases and global health at Oxford University, said it was impossible to predict whether any of the drugs would be effective against the coronavirus.
“Nobody honestly knows. Most drugs that go into trials prove to be not effective. It is the more common outcome. One should be very cautious,” said Horby, who pioneered drug trials in the massive Ebola outbreak in west Africa.
If drugs are not given under strict trial conditions, he said, “we end up where we were after the 2009 [influenza] pandemic.” More than 40,000 people were treated for influenza by doctors with experimental drugs, mostly oseltamivir, better known as Tamiflu, which is licensed for seasonal flu but not for use in an epidemic. The crucial data on their condition and the difference the drugs made compared with other drugs or no drugs was not collected.
“People gave it [Tamiflu] because they thought there was no harm. You end up with large numbers of people being treated without the evidence you could have got. Trials are absolutely critical or you end up in limbo. The Chinese are really taking that on board,” said Horby. They could have some answers within three or four months, he said.
But fear of the coronavirus has prompted many people to seek their own supplies of Kaletra, also known as Aluvia, which is drug company AbbVie’s off-patent version of lopinavir/ritonavir and the only one approved for sale in China – even though there is no evidence at the moment that it can help treat those who fall sick.
HIV patients have been offering their pills on Chinese social network Weibo.
“We felt like we were organised for a military mission,” said one of them, Andy Li, who has the nickname Brother Squirrel because he hoards stocks of his drugs. Hundreds of messages flooded in when they offered the pills, leaving him barely any time to sleep or eat in the first three days, he said.
“There are so many people in need of the drug, and I don’t want to waste time,” Li told Reuters. “Time is life.”
Others have seen a money-making opportunity, and have been buying stocks from India. Gatsby Fang, a Chinese cross-border buying agent, said he sold each bottle for 600 yuan (£66) each, earning 200-300 yuan in profit on each. His stock was sold out within two days. Some clients ordered 600 tablets at once, he said.
Until the trial results are in, most patients will receive supportive care in hospital, which means fluids and support for their breathing, if they need it, and for other organs if they begin to falter. Most healthy people’s immune systems fight off the virus and they recover.
Meanwhile, UNAids says it is important that people with HIV continue to take their own medication and do not take risks by giving or selling their tablets to other people.
“UNAids stresses the importance of people on HIV treatment adhering to treatment and for access to adequate supplies of antiretroviral medicines to continue without interruption. People living with HIV must not be put under any pressure to go without or give up their medication,” it said in a statement.
