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Disease and treatment

Solely focusing on new treatments does not save most lives among people with COVID-19

New technological advances and advanced antiviral drugs are not what prevents most patients with COVID-19 from dying. Old-fashioned and well-established methods save their lives, but getting support for research in this field is difficult.

Only a hermit in a desert with no human contact for 6 months could be unaware that the whole world has been struck down by the greatest health crisis in more than a century.

The whole world focuses on saving humanity from COVID-19, and billions and billions of euros, dollars and yen are being used in clinical trials of everything from antiviral drugs to advanced vaccines.

People may therefore very easily believe that antiviral drugs and expensive medicine will provide salvation from the effects of COVID-19. However, the problem is, according to Professor Anders Perner from Rigshospitalet, not that simple. Completely different approaches might save many more lives than remdesivir or other experimental drugs ever will.

“There is a huge focus on and unimaginable amounts of venture capital available for investing in new biotechnology solutions to manage the COVID-19 crisis. People and society expect that if we just spend enough money on inventing something new, then we can defeat this virus, but the truth is that we should instead look elsewhere if we want to save lives,” says Anders Perner, Professor, University of Copenhagen and Staff Specialist, Department of Intensive Care, Rigshospitalet.

Anders Perner has highlighted this problem in an editorial in Intensive Care Medicine.

Well-proven treatments save more lives

Anders Perner thinks that we generally have an unrealistic idea of how lives are currently being saved in intensive care units throughout the world, where people with COVID-19 stretch the capacity of hospitals to the limit and sometimes beyond.

Remdesivir and other experimental drugs do not save most lives; old-school and well-tried-and-tested treatments do.

These include oxygen, ventilator therapy, corticosteroids, blood-thinners, antibiotics, nutrition and fluid therapy, close observation, intensive nursing care, hygiene and rehabilitation.

These completely standard treatments may not be breaking news but save the lives of thousands of people with COVID-19 every day, and millions of lives for patients in general.

“These interventions are never hyped, but when a drug company announces a possible new drug that has not even been tested in clinical trials on humans, this grabs everyone’s attention, even though that drug will never save as many people’s lives as the standard treatments,” explains Anders Perner.

Hard to get research grants for life-saving treatment

So what is the real problem?

According to Anders Perner, the problem is that this excessive focus on new treatments diverts the focus from possible improvements in standard intensive care and nursing.

One example is that oxygen therapy saves more lives among people with COVID-19 than any other type of treatment. Nothing comes even close.

Nevertheless, it is difficult to get research on the agenda that can determine when, how much and for how long people with COVID-19 should receive oxygen therapy to optimize the effectiveness.

“When you think about how many lives oxygen therapy saves, it is ridiculous that we do not carry out more targeted research on how to use oxygen optimally. Imagine if we could optimize oxygen therapy enough to enable us to save 10% more lives. We could save thousands of lives that way, and the discoveries would benefit all patients admitted to an intensive care unit – not just those with COVID-19,” says Anders Perner.

Easier to implement than new treatments

According to Anders Perner, there are more reasons why it is absurd that more money is not being invested in optimizing the simple treatments.

Another reason is that the simple interventions based on solid scientific evidence can be implemented immediately in hospitals throughout the world.

By contrast, potential vaccines or other forms of medicine must be subjected to clinical trials costing billions before they can even be approved for treatment – and then the drugs and vaccines on which we are pinning our hopes may not work at all.

In addition, there is the whole issue of price and production.

“Assume that a vaccine is being developed. A long time will pass before it can be produced on a scale at which everyone can access it. In addition, there is the question of price, because how much should it cost an individual to be protected against COVID-19, and should people be vaccinated every year?” explains Anders Perner.

No funding for established treatments

According to Anders Perner, money is the main reason why research on new drugs can attract so much funding, whereas research on improving already implemented methods cannot.

There is no profit in discovering how much oxygen or how much fluid a person with COVID-19 should receive to optimize survival.

Donors and investors therefore focus in another direction.

Anders Perner thinks that the public sector should be interested in optimizing the established methods, since this can reduce the economic burden of healthcare on society.

“We also know this from other areas, such as smoking and air pollution, in which the public sector also has difficulty in optimizing the health choices,” says Anders Perner.

Improvements have already saved more than 1,000 lives

For the past 10 years, Anders Perner has been carrying out research on optimizing the established methods in intensive care, such as improving fluid treatment, which has saved the lives of more than 1,000 people in Denmark.

Anders Perner thinks this is only the tip of the iceberg.

The vast majority of standard treatments are based on experience and tradition, but most have never been subjected to a rigorous clinical trial showing how to optimally use a specific treatment.

“We are more likely to save more lives of patients with COVID-19 by optimizing standard treatments than by inventing a new treatment. So far, corticosteroids is the only drug that has been shown to reduce mortality among people with COVID-19. This has been around for 50 years, and making money from it is therefore difficult. But because it is already on the shelves in the hospitals, we can easily start treating people with it, and it will quickly save many lives,” explains Anders Perner.

How likely are COVID-19 interventions to benefit the sickest patients?” has been published in Intensive Care Medicine. In 2019, the Novo Nordisk Foundation awarded a Distinguished Investigator grant under its Research Leader Programme to Anders Perner for the project IMPROVE-ICU – Improving Intensive Care through Clinical Trials.
Anders Perner
Professor
Anders Perner is a senior staff specialist in Intensive Care, Rigshospitalet and professor in intensive care at Copenhagen University Hospital. He chairs the Scandinavian Critical Care Trials Group and the strategic research programme ‘New resuscitation strategies in patients with severe sepsis’. This ongoing program will randomize 2000 patients with severe sepsis in three RCTs of resuscitation in 30 ICUs in all the Nordic countries. The first RCT, the 6S trial has been published and the second, the TRISS trial, has been finalized and the third, the CLASSIC trial, is protocolized.