With restrictions lifted, Southeast Asia is looking for Covid treatments

After nearly two years of rigid travel restrictions, plane tickets to Singapore are selling like hotcakes since the government announced that fully vaccinated tourists from ten countries will finally be able to travel to and from the island without having to quarantine. The island nation’s walk back of their stringent ‘zero-Covid’ border controls in a bid to boost the economy comes off the back of similar announcements in recent weeks by the leaders of its Southeast Asian neighbours, Thailand, Vietnam, Indonesia and the Philippines. Travellers may welcome the news, yet persistent low vaccination rates across Southeast Asia mean their populations remain highly at risk.

Singapore has succeeded in fully vaccinating over 80% of its population, but the more populous country of Thailand has managed just one third so far, Indonesia and the Philippines less than a quarter and Vietnam a mere fifth. These figures bode ill amid the regional relaxation of Covid restrictions—not least because Southeast Asia has yet to emerge from a devastating Delta-fuelled third wave. Indonesia, which became Asia’s Covid epicentre over the summer with over 140,000 deaths, is still announcing thousands of new cases each day. Meanwhile, Thailand has seen 17,000 deaths since April alone, and case numbers are still rising steeply.

In the face of what is realistically speaking an endemic virus, it’s no longer viable to resort to restrictive measures, such as severe economy-crippling lockdowns in order to contain Covid-19. The moves of Singapore and others to ease restrictions is testimony to that, even if Laos decided to extend its lockdown until the end of October. However, this means that public health authorities’ focus will likely slowly evolve from administering vaccinations as a priority to treating severe Covid in those who will eventually get infected.

Rigel is turning the tables on severe Covid with Tavalisse

It is fortunate, therefore, that two categories of Covid therapies are emerging as particularly promising in warding off severe Covid and death. Re-purposed existing drugs have shown promise in reducing the mortality rate among high-risk patients who are already hospitalized, while a bespoke brand-new medication is hoping to slash the number of Covid-19 positive patients who become gravely ill in the first place. These two treatment types are set to change the landscape of Covid treatments in the near future.

Of the first type, Rigel Pharmaceuticals’ fostamatinib– better known as Tavalisse in the US or Tavlesse in Europe – is currently the only oral spleen tyrosine kinase “SYK” inhibitor authorized for use on adult patients with the rare chronic immune thrombocytopenia (ITP) disorder. As such, fostamatinib is already widely available, approved by regulators and clinically proven to be safe for use. Now, during ongoing trials testing the drug’s application as a treatment for Covid-19, the same drug is showing encouraging success in calming the body’s hyperinflammatory response to Covid, thereby reducing death rates and accelerating recovery times of hospitalised Covid patients.

The Phase II trials recently published in the journal Clinical Infectious Diseases demonstrated that, when administered twice a day for two weeks, Tavalisse halved the number of serious adverse events in Covid patients requiring oxygen, with zero deaths in the fostamatinib group by Day 29 compared to three deaths in the placebo group. Of the four intubated trial patients, both patients in the fostamatinib group came off the ventilator within 7 days, while both patients in the placebo group passed away.

Following the promising results, the drug is now being trialled across three studies: a Phase 3 clinical trial for the treatment of hospitalized high-risk Covid patients, a US National Institutes of Health and National Heart, Lung and Blood Institute-sponsored Phase 3 ACTIV-4 Host Tissue Study for hospitalized Covid patients on oxygen, and a Phase 2 clinical trial conducted by London’s Imperial College.

 Stopping Covid in its track with Merck’s Molnupiravir?

The re-purposing of extant drugs as powerful broad-spectrum treatments is an important step in the fight against the virus – as are the new drugs which are also proving a powerful weapon against the virus in its early stages. Case in point is Merck’s Molnupiravir, an antiviral pill for those who have recently tested positive, before they begin to suffer the severe symptoms which lead to hospitalization. During clinical trials, a four-day course of four 200 mg pills, twice daily, was effective at hindering the replication of the virus which often leads to severe illness. Phase 3 results from a study of over 700 unvaccinated patients suggest the drug is capable of reducing the risk of Covid-related hospitalization and death by 50% compared to the placebo group.

Merck’s Covid therapy has already caught the attention of countries across the Asia-Pacific, such as Malaysia, which purchased 150,000 courses of the drug early this month. But in order to avoid treatment hoarding, the company is paving the way for equitable access to Covid treatments by issuing general patents for the pill to manufacturers in India who will sell the medicine at a greatly reduced price to 100 low- to middle-income countries.

With Southeast Asian countries opening up their economies despite lagging vaccination rates, public health systems need to be prepared to administer more Covid infection treatments to fill the current vacuum – especially if debilitating lockdowns are to be avoided. These therapies will be useful in the long-term, too, preventing mortality spikes in the inevitable event of breakthrough cases, aggressive new variants and sickness among those who are unable or unwilling to get vaccinated. As such, therapeutic breakthroughs represent a veritable lifeline to future Covid sufferers in Southeast Asia and beyond.

Image: Jernej Furman/Flickr