SA part of worldwide WHO trial to identify effective Covid-19 treatment

SA is one of 10 countries involved in an urgent global trial announced by the World Health Organisation (WHO) to identify the most effective treatment for coronavirus.

The leader of SA's effort is Prof Helen Rees, head of the Wits Reproductive Health & HIV Institute and chair of the WHO's immunisation advisory group for Africa. She played a major role in the fight against ebola.

WHO director-general Tedros Adhanom Ghebreyesus said that "multiple small trials with different methodologies may not give us the clear, strong evidence we need about which treatments help to save lives". But the international solidarity trial, which will compare the efficacy of existing drugs, "is designed to generate the robust data we need".

Speaking to the Sunday Times this week, Rees said the WHO is aiming for "global core protocols so that we get many clinical trials under way with centralised databases and co-ordination so that we can get answers as quickly as possible".

Eight South African health sciences faculties are involved, and the work will involve many of the country's senior clinicians and researchers across specialities such as infectious diseases and intensive care.

"We are in discussion with WHO for a randomised trial - a five-arm study where four different treatment options are evaluated against standard of care. We are looking at antivirals, including one new product," said Rees.

"The second core global protocol SA is talking about is pre-exposure prophylaxis for health-care workers, in other words looking at drugs that might protect health-care workers, or at least give them a less severe disease."

Rees said the Southern African Pharmaceutical Regulatory Affairs Association and "all the ethics committees are urgently reviewing potential therapeutics so that there are no regulatory delays".

Reflecting on lessons from the ebola crisis, Rees said the first thing to note was a key difference.

"Ebola's mode of transmission is local, and poses a threat within a country and perhaps the region of a country.

"But if a virus has respiratory transmission, like the coronavirus, it becomes a global threat."

However, "one of the things we learnt about ebola that is incredibly important is that early identification and chasing of contacts is crucial.

"We were totally dependent on the ability to identify cases early and trace contacts of those infected."

For Ebola, contacts could be immunised. This is not yet possible for Covid-19, but Rees said early diagnosis remained crucial.