Two years ago today Wuhan's Municipal Health Commission in China put weeks of suspicion to rest and officially reported an unusual cluster of pneumonia cases in the city.
Ever since, lockdowns and closed borders, vaccines and ventilators have attempted to eradicate or control the disease we now know all too well as COVID-19.
In the process, Australia’s battle with the SARS-CoV-2 virus has normalised ideas that just two years ago felt like impossible tropes from history: city-wide lockdowns, restriction of movement within and between cities and countries, laws that kept family apart.
Yet with the Omicron variant delivering Australia's most significant outbreak of the pandemic, COVID-19 is arguably more powerful than ever.
The sharp increase in COVID-19 cases has prompted many people to call for an acceleration of the booster vaccination program. However, not everybody agrees that is a logical step.
As we embark on another year overshadowed by this virus, and notwithstanding serious questions about how it may mutate in the future, now is a good time to reflect on how far medical science has brought us in two years.
Vaccines and rapid antigen tests are helping to manage serious disease and COVID spread. And for those who do contract the virus, a growing number of new treatments and therapies are being developed or approved for use in Australia.
Here’s a look at some of the treatment areas that you are likely to hear more about in 2022.
The 'MABs' – monoclonal antibodies
Monoclonal antibodies are proteins made in a lab that mimic the way the immune system fights viruses. They are given to a patient intravenously and set to work within hours.
MABs latch on to the spike protein of an invading coronavirus and boost the body’s immune response, hopefully preventing the virus from invading cells and causing illness.
Research suggests MABs can help people with mild COVID-19 disease if it is administered early in the infection.
Scientists still believe vaccination offers better protection because it generates a stronger immune response and is beneficial from the moment of infection. MABs will only be administered after a patient has tested positive. This means those at risk of severe disease may be too far into their illness before realising they need MAB therapy.
Monoclonal antibodies can be delivered to a patient intravenously.(Unsplash: Marcelo Leal)
Different MABs are useful as support to vaccination depending on what other health issues the patient is juggling and the severity of their COVID illness.
So what monoclonal antibody therapies are authorised for use in Australia?
UPDATES: Read our round-up of the latest news on the COVID-19 pandemicRegdanvimab (Regkirona)
A new therapy, provisionally approved by the Therapeutic Goods Administration in December. Regkirona is used in adult patients with a confirmed SARS-CoV-2 infection.
This is another new one, also approved in December. Actemra is useful for very ill adult patients who are also receiving corticosteroids, supplemental oxygen or ventilation.
Casirivimab and imdevimab (Ronapreve)
Ronapreve received its provisional approval in October and can be used to treat patients from 12 years old, particularly those who do not have antibodies to SARS-CoV-2.
Xevudy, provisionally approved in August, is designed to be administered within five days of symptoms showing in patients over 12 years.
Read more about the Omicron variant:
- What we know about the new variant of COVID-19, Omicron
- Will Omicron spread like Delta?
- Here's what happened over the weekend as the world reacted to the new variant
The 'VIRs' – antiviral medication
Antiviral medication can assist the body fight a virus and comes as an oral pill or as an intravenous infusion. Antivirals work by disrupting the way the virus replicates, slowing or stopping the spread and reducing symptoms. But as with MABs, vaccination is the preferred frontline defence.
A number of antivirals are being used for COVID-19 treatment however they are not yet readily available in Australia. That could change in 2022. This is where things stand:
The TGA provisionally approved Veklury in 2020. It can be used in adults hospitalised with moderate to severe COVID-19.
However the WHO has recommended against its use.
Used to fight the Ebola virus, Remdesivir showed promise as a COVID drug but the WHO is now recommending against it.(Reuters: Ulrich Perrey/Pool )Nirmatrelvir and Ritonavir (Paxlovid)
Pfizer has a brand new antiviral medication that has been approved in the US but is under evaluation for use in Australia. Known also as PF-07321332 it is an anti-viral, Nirmatrelvir, taken in combination with the HIV drug Ritonavir.
This is another antiviral under evaluation in Australia, produced by Merck Sharp and Dohme and Ridgeback Biotherapeutics. This is delivered as a pill and is designed to be the first at-home treatment for COVID-19. It would be prescribed for people with a mild-to-moderate disease, but with comorbidities that place them at high risk for hospitalisation or death from a COVID-19 infection.
Space to play or pause, M to mute, left and right arrows to seek, up and down arrows for volume.WatchDuration: 1 minute 54 seconds1m 54s How accurate are rapid antigen tests?Advances in ICU therapy
Jill Carr, a virologist with Flinders University in Adelaide, is looking at improving treatment for COVID-19 patients who are admitted to an ICU.
"No matter how good a vaccine is, no matter how good our public health strategies are, there are still people who will get sick and end up in hospital," says Carr. "So how can we help them once they're in the ICU?"
Carr says that while ventilators can be life-saving for COVID-19 patients with severe disease the force needed to push oxygen into the body can also damage the lung.
"The COVID lung is quite different to the influenza lung," she says. "Getting oxygen into the lungs and across into the bloodstream is quite a challenge."
A supplied image shows ICU nurse Michelle Spiteri and anaesthetist and intensive care physician Dr Forbes McGain attending to a Covid-19 patient under the Covid Hood developed by McGain and Melbourne University at Footscray Hospital in Melbourne, Friday, July 17, 2020.(AAP: Supplied by Western Health, Penny Stephens)
Carr is using rat models to work out how to use ventilation better and what other treatments can be used in combination to dampen inflammation and improve oxygen transfer.
"Our studies aim to inform practise so that we know what pressure and flow rates are best applied to the ventilator," she says. "So that you can get oxygen into the patient's lung without causing a ventilator induced lung injury."
What you need to know about coronavirus:
Researchers are progressing quickly towards a variant-proof vaccine that could be administered as a booster and provide immunity from any COVID-19 mutation that turns up in the future.
The pathway between the research, and a marketable vaccine, remains long and difficult but Deborah Burnett from the Garvan Institute is hopeful her team can begin human trials in 2022.
With research teams from the Westmead Institute as well as in the US and Norway all studying the promise of a universal booster, 2022 may be the year we receive some hopeful news.
Deborah Burnett. in the Garvan Institute’s Immunogenomics Lab, is researching a universal COVID vaccine.(Supplied: Garvan Institute)Repurposed or off-label drugs
Throughout the pandemic doctors have discovered that some drugs designed for one disease have potential benefits for treating COVID-19.
Of interest were several drugs developed to treat HIV and malaria.
Most famous are those given to former US President Donald Trump during his treatment for a COVID-19 infection in October 2020.
Trump is said to have received the steroid Dexamethasone, the antibody treatment Regeneron and the antiviral drug Remdesivir, which the WHO says shows no evidence of being effective.
And Australia’s Therapeutic Goods Administration warns that a medicine used to treat one condition, does not mean it will be safe to treat another. It follows a rigorous process for checking medications before releasing them for authorised use.
Doctors who prescribe "off-label" medication must outline the risks to the patient and seek informed consent.
Doxycycline, has been used to treat a range of conditions since the 1960s and may also be useful for COVID-19.(Teka77)
Other medicines that have been touted as treatments throughout the pandemic but have been widely discredited for lacking evidence or causing harm. These have include ivermectin (used to treat parasites in animals), doxycycline (a broad spectrum antibiotic used to treat bacterial infections and also to prevent malaria) as well as the mineral zinc which is known to support the immune system but has been found to have no benefits when supplemented to treat COVID-19.
Another malaria medication – hydroxychloroquine – has also been shown to offer no benefit against COVID-19.