Experimental Covid-19 treatment would reach patients before they're put on ventilators

It’s a moment when there are few therapies available to doctors treating patients with Covid-19: When someone is sick enough to be hospitalized, but not sick enough to require a ventilator or other intervention.

Researchers in Seattle are targeting this moment with a potential new therapy, with the goal of knocking the virus down.

“The treatment that we are trying very quickly to bring to patients is a new type of immunotherapy,” said Dr. Corey Casper. “It provides patients with an infusion of immune cells that we think would be very helpful for combating the virus where it is doing the most harm, specifically in the lungs.”

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Despite anecdotal cases, there is no official treatment or vaccine for Covid-19. Instead, there are statistics -- that roughly 80% of people who get the coronavirus will experience mild symptoms and get over it. Others who are more at risk -- older patients and people with underlying health issues -- are hit much harder.

They require hospitalization and the use of a ventilator which many facilities report being on short supply. Most of the deaths associated with Covid-19 are from these higher-risk groups.

But the Seattle Research Institute where Dr. Casper works just received FDA approval to study a potential new treatment that could help thwart the disease before patients need a ventilator. They are racing to get results as the pandemic continues across the United States and the globe.

“There's a critical moment in the treatment of patients with Covid-19,” Dr. Casper said. “It is where they have already been hospitalized, but not yet sick enough to require the support of an intensive care unit or a ventilator, where we think we can make the most impact.”

A “natural killer” for coronavirus

It’s this “critical moment” when Dr. Casper and other researchers want to give patients an immune cell they call a “natural killer.” These are cells every person has when they are infants. These immune cells search the baby’s body for any type of infection and kill it off before it becomes a problem. It’s part of the innate immune system.

“Patients with Covid-19 have been found to have very low levels of these natural killer cells in their blood when they progress to severe disease,” Dr. Casper said. “That was found in the original SARS epidemic from 2004, and has now been reported in the early patients with severe disease from China.”

“It's one of the reasons we think that because these patients with low numbers of natural killer cells progressed to severe disease,” he said. “We think that if we can provide effective supplements of natural killer cells, these will allow these patients to control this disease more effectively.”

Dr. Casper notes that the FDA’s rather quick approval of the trial indicates we are in a “whole new world” during this pandemic. It usually takes at least six weeks for such approval.

The trial study he is part of will include 80-100 patients with the first patients being treated this month. The study will focus on Covid-19 hot spots, which include Washington state (one site in King County and another in Pierce County). But it will also include patients in other heavily-hit communities on the East Coast.

Preliminary results are expected by summer. But Dr. Casper cautions that effective treatments are still far off. He estimates it will take 12-18 months before a vaccine could become available. That’s partially motivating researchers like him to come up with treatments in the meantime.

An exhausting pandemic

Dr. Casper is just one researcher in one coronavirus hot spot facing the pandemic. But he says “a day in the life of an infectious disease clinician and researcher during this pandemic is a long one.”

He starts his days at 4 a.m., answering emails and texts from colleagues, friends, and family. Then he has meetings with officials on the East Coast ranging from the federal government to regulatory authorities. Then he jumps into the mix locally, with researchers in Seattle, looking for a treatment.

“It's exhausting,” he says. “I know everyone is trying to deal with this ... and all of my friends and my family here in the Seattle area, people really struggling with the impact that this is having on them psychologically, day-to-day. I will say that that's invigorating for me, because I feel even more of a sense of urgency to get something done.”

Still, there are signs of hope.

“I do see evidence that the curve is bending, certainly here in Seattle, more globally as well,” Dr. Casper said. “That, to me, means that with the measures that we've already taken, we'll start to see the numbers of new cases drop.”

“I think what we're going to see is the number of new cases drop and our ability to manage severe complications of this infection improve,” he said. “For those reasons, I'm optimistic. But I'm also really cognizant of the fact that this is going to be a long fight, that we're weary, and this has impacted everyone — from those who know people who are sick, to those who have lost their jobs, to those who are just struggling to figure out, you know, what their normal daily routine now looks like.”

This article is taken from an interview with KUOW’s Kim Malcolm and Dr. Corey Casper, CEO of Seattle’s Infectious Disease Research Institute and clinical professor of global health at the University of Washington.