SINGAPORE: A Chinese doctor who was at the epicentre of the COVID-19 outbreak in Wuhan has warned against developing treatments based on anecdotes rather than evidence, adding that there is “no magic bullet” for the disease.
Professor Cao Bin, vice-director of the National Clinical Research Centre for Respiratory Disease in China, had moved from Beijing to Wuhan to help during the initial surge of COVID-19 cases in China.
He developed early trials of using HIV drugs to treat coronavirus patients.
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Speaking at a National University of Singapore (NUS) webinar on Thursday (Aug 20), Prof Cao recalled that during the early days of the pandemic, people were grasping at straws to find a treatment for COVID-19.
“We have heard a lot of stories about the successful treatment of this disease, such as a new drug, or even a kind of drink … for the ill patients,” he said.
“But unfortunately, there is no magic bullet – not only during the early days, but for now.”
He detailed how hydroxychloroquine was initially granted approval by the US Food and Drug Administration (FDA) after US President Donald Trump touted it as way to ward off the coronavirus.
The anti-malaria drug was then used on patients in the US and other parts of the world.
But in June, the FDA revoked the emergency use status for hydroxychloroquine, saying that it is “unlikely to be effective in treating COVID-19”.
“Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorised use,” said the FDA on Jun 15.
Treating some COVID-19 patients is “complicated”, with some developing severe pneumonia, kidney injury and cardiac injury, said Prof Cao.
“Even during a pandemic, even during fear or helplessness, we clinicians should trust evidence, and we should not trust anecdotes,” Prof Cao added.
“I think smart clinicians should make clinical decisions based on evidence, even in the era of COVID-19.”
Instead of a “magic bullet”, he called for “smart strategies” - patients who develop different complications should be treated on a case-by-case basis. Some might have acute kidney injuries, while others might have heart failure or blood clots, he noted.
Prof Cao was one of the first doctors in the world to use antiviral drugs lopinavir and ritonavir – normally given to HIV patients – to treat COVID-19 patients.
In the early days of the clinical trials, he used patients who had severe COVID-19.
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“(If) I start to design the antiviral clinical trial now, maybe I would not (choose) the severe pneumonia patients,” he said.
Most patients he saw in the early days had pneumonia, he explained, saying he wanted to get a treatment to “rescue such patients”.
“You can tell that as doctors, you want to find a magic bullet. To tell you the truth, this is what I thought in the early days of January 2020.
“My colleagues and I wanted to get a kind of magic bullet, but after … we have gathered all the evidence … I have to admit that it’s hard to get a kind of magic bullet.”
Recalling the "fear and helplessness" in Wuhan when the outbreak first started, Prof Cao noted that early patients developed complications such as severe pneumonia, kidney injury and cardiac injury, without doctors understanding why.
In the community, family and friends were getting infected, and young people and healthcare workers were dying from the disease.
“The reason for fear is partly due to … we had no knowledge of this new disease. During the early months of this year, there was only fear and anger," he said.
“Our daily lives were interrupted by this pandemic.”
Prof Cao said concerns only grew as more places were closed and put on lockdowns, followed by the influx of information online.
And few people expected the pandemic to grow like it did.
“During the early days of January, most of the countries had no experience of the disease,” said Prof Cao.
“But soon, we learnt that the disease spread to other parts of the world. First, Iran, Italy, Korea and Spain, France, England, United States – now the most cases in the United States.”
China eventually managed to control the spread of COVID-19 with public awareness, the use of masks in every city and “very strong testing capacity”, Prof Cao said.
Early diagnosis is key, he noted.
“The severe patients are centralised into medical centres where specialists all over the country are working together to take care of the patients," he added.
Thanking healthcare workers for their hard work, Prof Cao said: “I will show respect to all healthcare workers in the diagnosis and treatment of COVID-19 in mainland China."