Are We Making Any Progress in Combating COVID-19?

By Ethan Garcia

In the world of psychology, the human reaction to an imminent threat depends heavily on the
situation and person involved. For example, someone with social anxiety may not perceive a physical
threat to be as dangerous as a social threat, such as how our primate ancestors, the rhesus macaque,
showcased in their cognitive bias to social threats. When presented with a dominant macaque
(imminent threat), they immediately fled, but when presented with their scent (distant threat), they
cautiously looked around for the source (Harrison, Ahn, Adolphs 2015). But what happens when this
danger spans multiple categories of threats? The same research paper, published on the US National
Institution of Health, says, “As a threatening situation becomes more imminent—immediate, close,
and dangerous—attack responses are chosen; as the immediate threat wanes, avoidant behaviors,
which are less costly to the organism, are adopted. Approaching actions (e.g., attack, negotiate) is only
taken when an organism is pressed by an imminent threat, with the exception of imminent but
escapable threats, which are avoided.” (Exploring the Structure of Human Defensive Responses from
Judgments of Threat Scenarios, Laura A. Harrison, Curie Ahn, and Ralph Adolphs 2, US National
Library of Medicine 2015) This manifests itself in today’s world with the ever-present coronavirus and
the threat it poses to our social networks, the economy, and our own physical health. Our cognitive
biases are working to both help us and hurt us (Lacey 2020) It is avoidable but inescapable until a
vaccine comes out. For now, besides defensive measures such as social distancing and wearing
facemasks, we are left with only one attack: to try out different forms of medicine. Coronavirus almost
serves as a case study for human nature in troubling times, as it affects everyone equally, disregarding
things we find to split us, such as class, race, and ethnicity. The problem is, mass panic from this threat
is leaving people to look for solutions that won’t necessarily work, or even finding ways to profit off of
false alternatives to treatment. However, we have found some ways to combat COVID-19. Here’s a
look at some of the biggest medical breakthroughs we’ve found so far to combat this common viral
enemy.
Before we get into the individual cures, we must understand that these medical workers are
working extremely hard in helping to combat coronavirus and are making great progress. Sometimes,
bureaucracy hinders them, and if they succeed well enough, that bureaucracy will be lifted in the name
of salvation. Big pharma also doesn’t have a track record of being very generous, but finding a cure at
an acceptable price could be extremely lucrative. Things like compulsory licenses, the creation of an
authorized generic, or even the bypassing of the intellectual property process could prevent the abuse
of the monopoly granted by a patent and ensure the spread of a possible cure or treatment method
(KEI contributor, 2019). 60 different existing and new drugs are already being tested, but there are two
important ones to recognize at the time of writing (Arnold 2020). These drugs face one major
problem: managing and meeting the supply and demand, and making sure greed doesn’t kill those in
desperate need of these medicines.
More recently, the Food and Drug Association granted “emergency use authorization” for
two antimalaria drugs: hydroxychloroquine and chloroquine, for treating COVID-19 (FDA EUA
contributor, 2020). Hydroxychloroquine, with a chemical name C18H26ClN3O, is a less toxic version
of chloroquine (which is the same thing minus the oxygen). 72% of physicians in Spain used the drug
to treat COVID-19 (O’Neill 2020). Unfortunately, there is not enough data to truly deem it effective
in the treatment of the novel virus. It has been used only on patients with compromised respiratory
systems and progression of symptoms to monitor side effects and is said to cut time of recovery, with
unknown possible side effects (McCauley 2020). But what exactly is hydroxychloroquine doing to
help combat our microbial enemy? It treats autoimmune diseases, meaning that it attacks diseases that
use the immune system against the body. It has a half-life of 3-4 hours after oral ingestion normally.
Exact mechanisms of action are unknown for hydroxychloroquine; however, we do know that the
drug raises the pH of lysosomes in human cells (Liu, J., Cao, R., Xu, M, 2020). Chloroquine does the
same to combat malaria, going into the parasite’s food vacuole and preventing it from properly
processing hemoglobin. It inhibits the conversion of heme to hemozoin, which leads the heme to lyse
the cell of the malaria parasite by chemically binding the heme and makes it clog up, ultimately giving
the equivalent of a toxic shock to the malaria cell (Wiser 2020). Hydroxychloroquine has a very similar
mechanism of action, or way it cures what it’s intended to. It stops the coronavirus because it raises the
pH of the vacuole in the cell which the virus uses to grow and replicate.
When present in the cell, antigen processing and presentation can’t proceed (which means that
the thing triggering an immune system response can’t be shown to the T cells that decide what to do).
This is because of the MHC, or major histocompatibility complex. The complex consists of some
proteins that make a curve for the coronavirus to attach to on the protein matrix that lies on the lipid
bilayer. Coronavirus works by attaching onto these curves so that they could insert their DNA into
the cells to be replicated and make more proteins as well as more copies of itself, which is how it
reproduces. When it does this cells go rogue. They are influenced and send too high of a response,
ultimately leading for corona in other parts of the body to take over other cells while the immune
system is concentrating its efforts on one area, leading to death eventually. Because it doesn’t connect,
the T cells cannot go rogue and initiate too high of a response that will let Coronavirus win because
the antigens don’t have enough to present to the T cells. The pH is too high, so naturally, only high-
affinity MHC is recycled to the top (DrugBank, 2020). Coronavirus can’t bind to the target cell easily,
the T cells don’t get presented to the coronavirus, and the immune system doesn’t overreact and leave
other virus microbes unwatched–which is where they cause serious damage. Hydroxychloroquine, on
top of stopping the ACE2 receptor from efficiently chemically interacting with coronavirus, basically
holds off the cells from doing too much and balances the immune system chemically for the human
body (DrugBank 2020). But it can only do so much, so symptoms still pervade, but a minor battle has
been won and the patient can expect a speedy recovery. However, these antimalarial drugs have a long
history of side effects and the clinical data is sparse (Rowland 2020). Further work is being done
quickly to see if these antimalarial drugs are safe and effective against COVID-19.
Another drug may be getting a second chance. Remdesivir is the new hope in helping allay our
worries that the virus is incurable at the moment. It fought off SARS and MERS very well and then
was adapted to try and stop Ebola virus. Some of the downsides of remdesivir include its side effects,
especially the possibility of liver injury from a spike in liver enzymes. The research data for remsdesivir
is also sparse and weak (Silverman 2020). Remdesivir (C27H35N6O8P) is structurally similar to a
nucleotide, being a nucleoside analog (similar in structure to adenosine but chemically mildly
different, and it has only the analogous part and a sugar), so it blends in and disrupts the production of
proteins through RNA transcriptions (because you can’t just add a nucleotide) (DrugBank
Contributor, 2020). In doing so, a virus can’t replicate itself once it gets into the body because of a
sneaky fake nucleotide, simulating the target amino acids that Sars-CoV hijacks the cell to make so it
can replicate one of 29 of its proteins (Corum, Zimmer 2020). It consequently creates a random
benign protein, and the disease can’t progress as easily. It’s delivered by injection into the veins or by
other methods that allow it to get into the bloodstream. A lot of data, including toxicity, is relatively
obscure. All in all, Remdesivir is a medicine to keep track of in these tumultuous times. It’s advanced
quickly into clinical trials because of its use in combating Ebola, and might see a future in combating
COVID-19. Below is a chart with all of the medical progress of treatment so far, including the two
aforementioned drugs. Currently, Mount Sinai Hospital has been successful in using blood antibodies
to attempt to clear the symptoms in a process called plasma transfusion.

Additionally, 3D printing and computer technologies might be able to help satisfy our ever-
growing need for ventilators and other medical equipment by those in need. One example includes the
Indiana based manufacturer Mursix, who is using their technologies and resources to make
equipment. In order to meet this need, they use a 3D scanner, a recent investment that saves time and
therefore lives by allowing designers and engineers alike to create, design, and inspect parts before
production so they don’t waste time in the idea-to-production process, but more importantly, prevent
mistakes from happening that could inhibit functionality. Plastic injection with molding and
machines, as well as other components necessary, are being manufactured by Mursix as well (Mursix
2020). 3D printing is proving to save lives, too. Formlabs, a 3D printing company, is working to catch
the disease by using its 250 printers at its Ohio factory to make nasal swabs for testing, as well as testing
split tubing for more than one person to be able to use a ventilator. 3D printing is one way to alleviate
the pressure that comes with the time constraints and the demands of society. Guidelines and
regulations on this technology to make the manufacturing concrete and efficient are being produced
between multiple universities, to try and balance necessity and progress. They are using GitHub,
which is also supplementing the growing need for telehealth, a technology that is booming in these
times. Desktop Metal, another manufacturer, set up a donation page asking companies for extra metal
to be able to print. The digital manufacturer Carbon and a branch of Alphabet Inc., the parent
company of Google, are collaborating on face shields that are being tested in San Francisco. Prisma
Health, a healthcare non-profit, has already received emergency authorization from the FDA to use 3D
printers to manufacture splitter tubes, which can put 4 patients on a singular ventilator (Temple
2020). On that note, Tesla sent out 40 BPAP (Bilevel Positive Airway Pressure) machines, similar to
CPAP (Continuous Positive Airway Pressure) machines, which treat sleep apnea but with two
settings, essentially acting as a noninvasive, FDA-approved ventilator (Financial Times 2020). The
machines mechanically circulate air to constantly bring the user fresh, breathable air, and have a very
complicated process for the release of air. Multiple companies have shifted their role to manufacturing
these machines, including Protolabs, a manufacturer which is also working with the University of
Minnesota to find a cheaper alternative that uses a motor to pump DIY ambu bags. MIT has also been
working on this. Technology once futuristic and far-out is now starting to see widespread use,
especially under the Defense Protection Act, and we’ll soon see how it all plays out.
Finally, the development of vaccines is crucial as the medical world competes in race to find a
cure. Vaccines for COVID-19 (and other viruses) contain copies of the genetic material of the virus or
components of it, which allow the immune system to recognize these components to recognize the
virus and efficiently attack the virus. The two become chemically acquainted, and a proper response is
figured out during antigen processing and presentation without the virus hijacking the system and
causing the symptoms of COVID-19, which are explained by the channel Vox on YouTube. 1 These
vaccines are divisible into different categories of vaccines based on what component of the virus is
entering the body and being assessed by the immune system: its DNA, Live Attenuated Virus (virus
1 See https://www.youtube.com/watch?v=FVIGhz3uwuQ
with reduced power), Inactive, non-replicating viral vector (a tool that delivers the DNA without
replicating itself), a protein subunit of the virus (parts of the virus that make up the complex and mark
it to be marked by antibodies), replicating viral vector (a tool that delivers the DNA so it can replicate
in the body), the virus’ RNA, and a VLP (a molecule that resembles the virus in question), along with
5 unknown vaccines (Routley 2020). All of these are in preclinical testing. Notably, Moderna
Therapeutics, a biotechnology company that has the capability to ride out delays caused by the
coronavirus (Taylor 2020), skipped the animal testing phase and has been cleared by the FDA to work
on humans (Hahn 2020), using the RNA to create an immune response. It is also worth noting that
the University of Pittsburgh used a lab-made spike protein (the structure that binds to receptors) to
simulate the virus and provoke an immune response. This protein is a potential candidate for a vaccine
as it is scalable and versatile because this protein technique is similar to the one used in flu vaccines.
The industry is still evolving and adapting, and all of the medicine and tech covered in this article is
preliminary or novel. Here’s a chart mapping out what’s been stated as well as introducing other
competitors in the race for the vaccine.

This pandemic is an ever-shifting, constantly changing, and deadly obstacle that we as a human
race must overcome. Collective individual efforts are the only way to avoid catastrophe and avoid
having our names put in the history books as reckless people who poured gas on the flame and
promoted a fast pandemic with many deaths by disregarding the cautions laid before us. In that sense,
staying pessimistic is a desirable way to look at the future for the safety of others. If we can overcome
this, we look ahead to a bright future where we could possibly tackle daunting issues such as climate
change if we continue this trend of contribution to a collective effort. The medical industry is reacting
fast. The best we can do to mirror their efforts and complement their hard work with doing what
we’ve been told to. This pandemic might serve millions of case studies on medicine, biology, human
history, psychology, and economics in the future with the way we’re reacting to this pandemic. Our
absence outside lets nature recover, history is repeating, consequences of our interference with the
environment are presenting themselves, and humans are reacting to the pandemic biologically and
psychologically. Who knows? There’s light at the end of the tunnel, and some of it is coming from
medicine that might develop in the future.

References

Arnold, C. (2020, April 1). Coronavirus treatment: What drugs could work and when can we
get them? New Scientist. https://www.newscientist.com/article/mg24532760-900-
coronavirus-treatment-what-drugs-could-work-and-when-can-we-get-them/

Background FAQ on Glivec (imatinib) compulsory license in Colombia. (2016, May 19).
Knowledge Ecology International. https://www.keionline.org/book/background-faq-on-
glivec-imatinib-compulsory-license-in-colombia

Bailey, V., & Guttendorf, Z. (n.d.). [Treatments]. VisualCapitalist.

https://www.visualcapitalist.com/every-vaccine-treatment-covid-19-so-far/

Bailey, V., & Guttendorf, Z. (n.d.). [Vaccines]. VisualCapitalist.

https://www.visualcapitalist.com/every-vaccine-treatment-covid-19-so-far/

DrugBank Contributor. (2020, March 13). Remdesivir. DrugBank.

https://www.drugbank.ca/drugs/DB14761#BE0003801

DrugBank Contributors. (2020, April 9). Hydroxychloroquine. DrugBank. Retrieved March

31, 2020, from https://www.drugbank.ca/drugs/DB01611#reference-A192546

Elon Musk promised ventilators. These are BPAP machines. (2020, April 1). Financial Times.
https://ftalphaville.ft.com/2020/04/01/1585782924000/Elon-Musk-promised-ventilators--
These-are-BPAP-machines-/
FDA. (2020). Emergency use authorization. U.S. Food and Drug Administration. Retrieved
April 10, 2020, from https://www.fda.gov/emergency-preparedness-and-response/mcm-
legal-regulatory-and-policy-framework/emergency-use-authorization

Hahn, S. (2020, March 31). What we at the FDA are doing to fight COVID-19. CNN.
https://www.cnn.com/2020/03/30/opinions/fda-coronavirus-vaccine-testing-hahn/

Harrison, L., Ahn, C., & Adolphs, R. (2015, August 21). Exploring the structure of human
defensive responses from judgments of threat scenarios. PubMed Central (PMC), US Library of
Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546605/

Corum, J., & Zimmer, C. (2020, April 3). Bad news wrapped in protein: Inside the coronavirus
genome. Retrieved from
https://www.nytimes.com/interactive/2020/04/03/science/coronavirus-genome-bad-news-
wrapped-in-protein.html

Lacey, A. (2020, March 27). Can the public be trusted in a pandemic? Wired.
https://www.wired.com/story/hed-can-the-public-be-trusted-in-a-pandemic/

Liu, J., Cao, R., Xu, M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is
effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 6, 16 (2020).
https://doi.org/10.1038/s41421-020-0156-0

McCauley, T. (2020, March 31). Michigan doctors see success in COVID-19 treatment but say
more clinical trials are needed. WWMT. https://wwmt.com/news/local/michigan-doctors-
see-success-in-covid-19-treatment-but-say-more-clinical-trials-are-needed

Mursix. (2020, March 24). Muncie's Mursix corporation ramps up to assist medical industry
for COVID-19 — Muncie journal. Muncie Journal.
https://www.munciejournal.com/2020/03/muncies-mursix-corporation-ramps-up-to-assist-
medical-industry-for-covid-19/

O'Neill, N. (2020, April 7). Hydroxychloroquine rated ‘most effective’ coronavirus

treatment, poll of doctors finds. Retrieved from
https://nypost.com/2020/04/02/hydroxychloroquine-most-effective-coronavirus-
treatment-poll/
Routley, N. (2020, April 1). Every vaccine and treatment in development for COVID-19, so
far. Visual Capitalist. https://www.visualcapitalist.com/every-vaccine-treatment-covid-19-so-
far/

Rowland, C. (2020, March 30). FDA authorizes widespread use of unproven drugs to treat
coronavirus, saying possible benefit outweighs risk. Washington Post.
https://www.washingtonpost.com/business/2020/03/30/coronavirus-drugs-
hydroxychloroquin-chloroquine/

Silverman, E. (2020, March 25). New paper about a Gilead drug to combat coronavirus has
analysts skittish. STAT. https://www.statnews.com/pharmalot/2020/03/13/gilead-
coronavirus-covid19-clinical-trials/

Taylor, N. P. (2020, March 30). COVID-19 causes Moderna to pause a clutch of clinical trials.
FierceBiotech. https://www.fiercebiotech.com/biotech/covid-19-causes-moderna-to-pause-a-
clutch-clinical-trials

Temple, J. (2020, March 27). How 3D printing could save lives in the coronavirus outbreak.
MIT Technology Review. https://www.technologyreview.com/s/615420/3d-printing-
coronavirus-covid-19-medical-supplies-devices/

Wiser, M. (2019, October 21). Mechanisms of drug action and resistance. Tulane University.
https://www.tulane.edu/~wiser/protozoology/notes/drugs.html