Special Report for BEJournal by UniSA pharmacologist Professor Richard Head and Professor Jennifer Martin, Chair of Clinical Pharmacology at the University of Newcastle.

A new reality has swept into our lives driven by the SARS-CoV2 virus causing COVID-19, a disease that has attacked the very fabric of societies and economies. This aggressor has taken lives with a chilling ruthlessness and in doing so has put humans—the preeminent global problem-solving species—on notice to arrest its onslaught. 

Our immediate response has taken lessons from past plagues and pandemics. As our ancestors did decades ago, we have turned to self-isolation and masks to reduce human-to-human transmission. The sepia images of the 1918 Spanish pandemic are alive again as we walk the streets in 2020 with muffled speech. 

Paralysed interactions and opaque frozen facial expressions are sparking ethical arguments among friends, some of whom believe personal freedoms rate higher than civic duty and public health.

Call for a new approach to treating COVID-19 as hopes fade of finding an effective vaccine or antiviral before the end of the year.

The global hope is for the elimination of SARS-CoV2, or an effective treatment, but how?

Viral elimination requires both long-term lockdowns, an option few governments or citizens appear willing to accept, and the global rollout of an effective vaccine or antiviral which may not occur as planned or be some time off. 

There is an alternative strategy. Effective treatment involves understanding how the virus causes morbidity and mortality in infected humans with serious COVID-19 and using that pathway to our advantage. Focussing on this approach lessens the impact of the virus in the short term while new vaccines and antivirals are being developed.

This alternative view—called treating the host (TTH)—is distinct from our current focus on treatments that seek to incapacitate the virus. TTH accepts that this virus can destroy cells on a grotesque scale, piercing the enzyme ACE2 (the host receptor) to gain entry via the lung and dysregulation of normal cell functions.  ACE2 is critical to regulating and balancing inflammation in many of our organs in the body. When SARS-CoV-2 invades ACE2, it disrupts its normal regulatory function, sending the immune system off balance and driving severe inflammation. 

TTH seeks to restore this inflammatory dysregulation, reduce tissue and organ damage and by doing so, reducing death. The positive news is, that this can potentially be achieved with inexpensive therapies already available in Australia. 

By clinically evaluating existing dose and timing of these drugs that reduce life-threatening inflammatory respiratory processes in serious COVID-19 disease, this affords us time to identify, manufacture and employ drugs and vaccines which target the spread the virus throughout the body to enable long-term elimination.

It would allow us once more to see the wonder of facial expression.

About the Authors

Professor Richard Head is a Pharmacologist and is currently Adjunct Professor in the Division of Health Sciences, University of South Australia, Affiliate Professor in the Discipline of Pharmacology, The University of Adelaide and Honorary CSIRO Fellow. He was previously, interim Director of the Future Industries Institute at the University of South Australia, the Deputy Vice Chancellor & Vice President: Research and Innovation for the University of South Australia with a substantive position as the Director of the Sansom Institute for Health Research, Division of Health Sciences also at the University of South Australia. 

Professor Jennifer Martin is the Chair of the discipline of Clinical Pharmacology in the School of Medicine and Public Health at the University of Newcastle. Working in the Hunter New England Local Health District, Jennifer leads a team of pharmacy and medicine experts together with pharmacoepidemiologists and pharmacoeconomists, who work across a number of areas including cancer.

The authors paper “Buying time: Drug repurposing to treat the host in COVID-19H” was published in Pharmacology Research & Perspectives.