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Stories: Voices from the frontline

Jason Goldman, M.D., M.P.H.

Since the first COVID-19 test result came back positive at one of our hospitals, Jason Goldman, M.D, M.P.H., hasn’t stopped looking for new ways to help patients here and around the world. Donors like you have invested in COVID-19 research, so we caught up with Dr. Goldman, chair of the Swedish COVID-19 Research Steering Committee, to get an update on his work and how leading-edge research is bringing the latest treatments directly to patients.

You led a global trial studying the effectiveness of remdesivir, the emergency approved antiviral treatment for COVID-19. How can distributing scarce medications like remdesivir help us prepare for when a future vaccine becomes available?

Remdesivir is in scarce supply because it's made by a single manufacturer in the U.S. The federal government has purchased the entire commercial stock of remdesivir and is distributing to the states. The Washington Department of Health is charged with distributing remdesivir and has elected for a process to ensure equity. Through the Disaster Management Advisory Committee, part of the Northwest Healthcare Response Network, I’ve been brought in as a subject matter expert on remdesivir to advise the Department of Health on guidelines for distribution. In Washington state we've had a very good process of trying to ensure equity in distribution and making sure that there's no biases in selecting patients for therapy based on race, ethnicity, gender, disability or age.

Now that we’ve treated over 1,000 patients in Washington state with remdesivir, we're going to evaluate how we did and see how successful we were in giving access to the people who could most benefit from the treatment. I think this is very important because it sets the stage for other scarcity issues like the distribution of a future vaccine.

You’re also working on new trials that use a cocktail of antibodies to treat patients with COVID-19. How is this different from convalescent plasma?

When someone gets infected with COVID-19 and recovers, the immune system builds up antibodies against the virus. But some people develop a better immune response than others. With convalescent plasma, we don't measure if the plasma donors have a great immune response or a crummy one. We just take the plasma and give it as a treatment to a patient who’s suffering from COVID.

This new antibody treatment from Regeneron is skimming the cream off the top of all the possible antibodies that someone could make to find the best ones. In the lab, it’s highly effective at neutralizing the virus, so we think it’s going to be a very potent treatment.  

Who is the best candidate for this type of treatment?

The idea is to get the antibody treatment in the very early stages of infection, when the immune system is working, but before the severe lung damage that can happen in the second week of infection.

In addition to patients who are hospitalized, we're going to enroll people who are at home and just have minor symptoms or no symptoms. That's the perfect person to treat to prevent them from needing hospitalization.

Another trial will treat the household contacts of known positive COVID-19 patients in the hopes that they don't acquire the infection. This kind of treatment could be available before a vaccine, so patients who are exposed to COVID-19 could potentially avoid getting sick altogether.

Your collaboration with the Institute for Systems Biology is looking at the disease progression of COVID-19 from every angle by running a variety of tests on samples from patients. Can you give us an update?

We've enrolled 155 patients of the 200 total we plan to include, so we are moving right along on that project. We have a very important manuscript currently under review at the journal Cell which shows immune system trajectories during the early stages infection. You can read the pre-print online.

Another thing we’re working on is looking at patients’ immune systems in relationship to the IL-6 level during a COVID-19 infection. IL-6 is a cytokine made by the body to stimulate the immune system. One of the drugs currently being evaluated as a treatment is tocilizumab, which blocks IL-6.

Although an initial randomized controlled trial did not have positive results, it might still turn out to be a very important drug in treatment of COVID, if used in the right patients at the right time. It’s a fine balancing act. We want to use antiviral or antibody treatments very early on in the infection, when the immune system is fighting the virus. But with drugs like tocilizumab, they may be effective if used later on in the infection, when it’s clear the immune response is going out of whack. It’s all about the timing.

How do donations from our community bolster our research efforts?

The COVID-19 landscape is dynamic, and we, as medical doctors and scientists, are constantly keeping up with the new and emerging literature and adjusting what we do in the clinic and what we do in the lab to try to understand the new insights that are popping up almost every week.

Philanthropy allows us to adjust what we're doing in a much more agile way. And we can amplify the chances of getting other funding by using philanthropic funding to get new projects off the ground. So even small grants can be very useful for kick starting an idea that could then be used to secure more traditional streams of funding like federal or industry funding.