COVID Toxicity
COVID Toxicity
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Treatment and Vaccination

COVID-19 Treatments

In Canada, there are currently no approved pharmaceutical interventions for the treatment and/or eradication of COVID-19 in infected individuals. There are several ongoing Canadian clinical trials for drug interventions to address COVID-19, including vaccine candidates, candidates for symptom management in hospitalized patients, and prophylactic agents to prevent infection. Some of these drugs, namely hydroxychloroquine and remdesivir, have been common talking-points by scientifically illiterate political figures as “miracle cures” since North American COVID-19 cases were first identified in early 2020. The use of other unapproved treatments has also been advocated for by other public figures, many of which do not have the knowledge or background sufficient to substantiate their claims.  

The charts below present several purported pharmaceutical interventions to treat or prevent COVID-19, including current research on their efficacy and whether their effects could mitigate SARS-CoV-2 infection.  

A table that says "Hydroxychloroquine (HCQ): Background: HCQ is a perscription drug used as an acute malaria treatment, as well as long-term treatment of autoimmune conditions such as Lupus and rheumatoid arthritis. The use of HCQ as an anti-COVID-19 drug was approved in the US by emergency use authorization (EUA) provided by the FDA. Research: Studies published in the New England Journal of Medicine and the Annals of Internal Medicine found that administration of HCQ does not improve patients outcomes when provided as post-exposure SARS-CoV-2 prophylaxis and/or as COVID-19 treatment. Additionally, long term HCQ use by patients with rheumatologic diseases was not correlated with improved COVID-19 survival. Consensus: While clinical trials are still ongoing, there has been no evidence that HCQ has any significant antiviral effects when administered to otherwise health individuals as a COVID-19 prophylaxis/ treatment. It does, however expose users to potential side effects including liver and kidney dysfunction, heart arrhythmias, low blood sugar, fainting and/or seizure. The FDA has withdrawn its HCQ EUA and the use of HCQ is not recommended as a treatment for COVID-19 as a result of these risks, coupled with its inefficacy. "
A table that says "Remdesivir: Background: Veklury (remdesivir) is antiviral agent produced by Gilead, approved by the FDA as a COVID-19 treatment in hospitalized individuals. Its approval was based on results presented in June 2020, in which 68% of patients with severe COVID-19 showed clinical improvement following a 10-day course of Veklury treatment. Research: While even the qualifying trial is questionable - with a sample size of n = 61 and efficacy of 68% - the results of subsequent trials on administration of remdesivir to COVID-19 patients have been unimpressive. The WHO Solidarity trial found that amongst 2750 COVID-19 patients, remdesivir treatment did not significantly reduce mortality rates. Gilead published another trial in November 2020 to refute the Solidarity trial results, although statistically significant, the strength of its findings was insufficient to overturn their conditional recommendation against the use of remdesivir in COVID-19 patients. Consensus: The efficacy of remdesivir continues to be investigated and is currently not available in Canada as COVID-19 treatment. More factors surrounding its use as a COVID-19 treatment, including its effectiveness against different stages of infection, should be considered before a final decision is made. There is also no information on drug-drug interactions with remdesivir, or how the drug may impact a developing fetus if administered to a pregnant woman. "
A table that says "Oleandrin: Background: Oleandrin, a plant compound (phytochemical) derived from the ornamental flowering bush Nerium oleander, has been touted as a 'cure' for symptoms of COVID-19 by public figures, including Dr. Ben Carson, U.S. Secretary of Housing and Urban Development. Research: There is existing research on the broad antiviral capacities of oleandrin, however these effects have only been demonstrated in cell cultures and animal models. The study 'proving' the anti-SARS-CoV-2 activity of oleandrin has not undergone a peer review process and was conducted in primate kidney cells that were modified to inhibit expression of immune factors. The level of the study, as well as its use of primate-derived cells, is far from representative of the effects oleandrin could have in the human body. Additionally, direct consumption of oleander is highly toxic and cause fatal heart arrhythmias, hepatotoxicity, and nephrotoxicity. Consensus: Oleandrin is not approved for any therapeutic uses, and there is no scientific indication for its use in preventing SARS-CoV-2 transmission and/ or infection in humans. It is possible that oleander extract could have beneficial human health effects, but they can only be determined through human clinical trials; these necessitate a large body of evidence asserting the efficacy of oleandrin in cell, animal, and observational studies before a safe research proposal can be made. "
Intravenous ascorbic acid (vitamin C): Background: Patients with severe COVID-19 have been administered large doses of intravenous (IV) vitamin C as a means of combatting SARS and sepsis induced by SARS-CoV-2. Research: A 2017 study examining the effect vitamin C, thiamine (vitamin B1), and hydrocortisone co-administration in patients with sepsis and SARS showed significantly reduced mortality in treated patients versus the placebo group. Though these results seem promising, a more recent 2020 study on vitamin C administration alone did not significantly impact patient mortality. This indicates that vitamin C alone may not have significant immunoprotective effects, but it may have synergistic effects if administered with other agents. Consensus: Despite lacking clinical evidence for the efficacy of IV vitamin C alone in addressing SARS and sepsis, particularly in COVID-19 patients, there is a low risk of toxicity in healthy individuals. Because excess vitamin C is readily excreted in the urine, its use as an adjunct by healthcare professionals is not expected to be harmful. It is important to note that vitamin C can have adverse drug interactions in some individuals, including those taking blood thinners and/ or those with thrombotic (blood-clotting) disorders. "
An infographic saying "3 drugs that people may think work to treat COVID-19 but don't! No cure is currently available for COVID-19 although... some treatments are being tested to help lessen the physical impact of the virus in the body. These results have yet to be proven. To be clear - these are NOT cures, but rather treatments being researched to help lessen the burden of the virus. 1. Dexamethason steroid: In a preliminary study, it showed potential to decrease mortality in hospitalized COVID-19 patients. Calms the body's immune response and modulates inflammation that can cause lung injury (Horby et al., 2020). 2. Regeneron, Monoclonal antibody therapy. The results have yet to be verified by reputable scientists or doctors. Limited evidence in patients, but suspected to decrease time to recovery. The antibodies are supposed to directly bind the virus and prevent it from entering host cells. (Regeneron, 2020). 3. Remdesivir, antiviral medication. It targets multiple viruses. Originally developed for hepatitis C. It interferes with one of the key enzymes the virus needs to replicate its RNA. Not shown to be clinically effective, and needs further research. (Wang et al, 2020)."
Infographic provided by Dufault, Howes, Issa, Johnson, and Whitten

COVID-19 Vaccines

Currently, there are no COVID-19 vaccines approved for public use by any regulatory bodies worldwide. Since the identification of COVID-19, several pharmaceutical companies have been focused on developing an effective vaccine. Some of the more notable developments include: 

  • Pfizer and BioNTech: These pharmaceutical companies recently completed a human clinical trial with their vaccine candidate, which tested more than 40, 000 participants. The vaccine candidate had a 95% effectiveness rate in protecting against COVID-19, and no serious side effects were noted.  
  • AstraZeneca: A human clinical trial is currently underway to test their novel COVID-19 vaccine candidate, however no data has been released regarding its effectiveness and/or side effects. 
  • Moderna: The COVID-19 vaccine candidate produced by this company, mRNA 1273, demonstrated a 94.5% efficacy rate in the first interim data analysis of the phase III clinical trial. This human trial involves over 30,000 participants, however the interim analysis concerned only 95 COVID-19-positive participants: 90 exposed to a placebo, and 5 exposed to mRNA 1273. This is a small population size and the efficacy – and lack of serious adverse side effects – may not represent all individuals who could receive the vaccine. 

Despite the optimistic test results reported by pharmaceutical companies, it is unlikely that any COVID-19 vaccine(s) will be approved for use before the end of 2020. One barrier to approval are the stringent regulations surrounding vaccine formulation, testing, dosage, and distribution. There are also several logistical challenges that will to be overcome on the federal, provincial, and municipal levels for Canadians to receive vaccinations, including obtaining enough vaccine, maintaining proper storage facilities, and managing information on who is vaccinated and who is not to ensure that multiple doses of vaccine are received (if required).