A MARTÍNEZ, HOST:
The National Institutes of Health has released 72 versions of its influential COVID-19 treatment guidelines in the past four years. Now they're sunsetting those guidelines and fewer treatments are arriving. NPR's Pien Huang takes stock.
PIEN HUANG, BYLINE: If you're sick with COVID and you're at risk of getting worse, you could take pills like Paxlovid or an antiviral infusion. By now, these drugs have a track record of doing a pretty good job of keeping people with COVID out of the hospital.
RAJ GANDHI: How we got here is really, I think, a really important story to tell.
HUANG: Dr. Raj Gandhi is an infectious disease specialist at Massachusetts General Hospital.
GANDHI: I think everyone listening will remember 2020 when we did not know how to treat COVID. We barely knew how the disease progressed, and around the country people were trying different things.
HUANG: People were popping tablets of hydroxychloroquine, there was a run on ivermectin, and there was no proof that either of them worked. It was early in the pandemic when the NIH convened a panel of more than 40 experts and put out the first version of its COVID treatment guidelines, which became a reference for doctors around the world. This panel met several times a week for the next few years and updated the guidelines frequently, sometimes two or three times a month. Raj Gandhi was on that panel.
GANDHI: Our first guideline was basically we don't know what does and doesn't work, but we did learn fairly quickly, mostly in hospitalized patients, what did work.
HUANG: A few months in, data supported a treatment plan for the very ill - use steroids to stop the body's immune system from attacking itself, and combine that with antivirals to stop the virus from replicating. Then, about a year into the pandemic, there was another turning point, says Dr. Phyllis Tien from the University of California, San Francisco. She was also a member of the COVID treatment panel.
PHYLLIS TIEN: And then the monoclonal antibodies, you know, that just provided so much insight into the virus itself.
HUANG: These lab-made antibodies were shown to help COVID patients stay out of the hospital, but the antibodies kept targeting parts of the virus that changed. New COVID strains would knock out each new version within months. This cat-and-mouse strategy didn't last. Carl Dieffenbach, with the National Institutes of Health, says by the end of 2021, there were pills - two kinds of them - that COVID patients could try taking at home to get better.
CARL DIEFFENBACH: Both have, as I like to say, warts - molnupiravir's warts are - it works marginally.
HUANG: Meaning the data showed that it isn't very effective. Paxlovid, on the other hand, works pretty well but cannot be taken with a lot of common drugs.
DIEFFENBACH: People who should take it, but they're on a statin, they're on some other drug, doctors are uncomfortable or unwilling to manage them.
HUANG: Dieffenbach says there's one more drug that looks promising - a pill by the Japanese company Shionogi - that's getting tested against COVID and long COVID. But then that's it. That's the last drug in the COVID pipeline for the near future. Cliff Lane, with the National Institute of Allergy and Infectious Diseases was co-chair of the guideline panel. And after 50 million page views, he says it's time to move on.
CLIFF LANE: I would say it's probably about six months ago we started talking about what will be the end and how do we do the end in a way that we don't create a void?
HUANG: Lane says that specialty doctors groups will take over the guidelines.
LANE: I have to say, and I think if you talk to the members of the panel, they would all say something similar, I think people felt it was probably one of the most important things that they've done in their career.
HUANG: And Lane says researchers have learned new ways to use vaccine and antibody technologies to hopefully shorten the worst of it the next time.
Pien Huang, NPR News.
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