All language subtitles for Breakthrough.Coronavirus.Treating.the.Disease.1080p.HDTV.x264.AAC.MVGroup.org

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(sirens blaring)

In a world on lockdown,

ambulance sirens haunt the streets

as COVID-19 patients quickly fill emergency rooms

and intensive care units.

Despite our technological prowess

and medical know-how, the newness

of this coronavirus limits health professionals' ability

to fight it for the moment.

How do you treat something

for which we don't have pharmaceutical interventions?

Treatment is really supportive.

Here it's about protecting the lungs

and the oxygen capacity until the person gets better.

Scientists feverishly research new treatments

and drug protocols,

all in an international effort to aid the body's defenses

and to turn the tide.

So we're dealing with a serious pathogen

of global significance.

This is not a short battle.

This is a long, long battle that we're going to face.

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While the societal impact of COVID-19

may be clearly evident,

the details of what the disease does

to our bodies can be more difficult to see.

Some coronaviruses, like those that cause the common cold,

attack the upper airways of the respiratory system

and trigger into action almost like organic technology,

says infectious disease specialist, Dr. David Wheeler.

They're kind of like little mini thumb drives

that have information with a protective layer

and they don't do a thing

until you plug 'em into the computer, if you will,

and the cell then pulls in that viral message

and starts being driven by that message,

which mainly is to create more virus.

But just like the MERS

and SARS epidemics earlier this century,

a more penetrating point of attack

makes the COVID-19 virus much more dangerous.

It's in a more vulnerable part of our body,

in the lower airways, deep in the lungs and alveoli.

They go in, take over the cell machinery,

start making new virus.

They prompt the immune response

so when that immune response kicks in,

now we're down into the lungs themselves.

Early symptoms include headache,

body aches, fever and cough.

Those are the big four

and most people that get sick

have several of those.

It's once they start feeling like they're short of breath

and if they go into the emergency room

or the doctor's office

and their oxygen level is low,

then that's where we need to keep a close eye on 'em.

And what we found is that a small number

of the folks just all of a sudden

then get sick very quickly.

So increasingly, these patients need more

than a close eye.

They need supportive respiratory interventions

like those in high-demand ventilators

to help them breathe.

Well, shortness of breath is a sensation of suffocating.

When people are starting

to get a bit more short of breath like that,

sometimes they need to get moved

to the intensive care unit

and put on the breathing machine earlier

than we might in other conditions

'cause we don't want these sort of emergency sessions

where the person's struggling for breath

and where more healthcare workers could get exposed

to lots of aerosols in the air.

In some of the most extreme cases,

an even more scarce resource may be called upon

to perform the work of the lungs,

as a temporary last resort.

It's called ECMO.

Extracorporeal membrane oxygenation.

And that really, it's heart-lung bypass.

They put two cannulas in to veins

and pull blood out, oxygenate it and return it.

This was the treatment given to a man

in his late 50s

after his transfer to George Washington University Hospital,

which released stunning 3D images

of this patient's lung damage,

represented here in green,

laying bare the danger to all.

You do not need an MD after your name

to understand these images.

This is something that the general public

can take a look at and really start

to comprehend how severe the amount of damage

that this is causing to the lung tissue.

The damage that we're seeing is not isolated

to any one part of the lung.

This is severe damage to both lungs diffusely.

This man died about a week

after arriving at the GW Hospital.

A big part of what I think is killing people

is what we call multiorgan failure

as a result of the lungs going first.

And then other organs start to fail.

But what exactly causes this damage?

The answer: another medical acronym.

ARDS, or acute respiratory distress syndrome.

Inflammation in COVID-19 cases brought about

by our own immune systems stuck in overdrive.

A lot of the disease we see

in terms of virus-hosted directions,

is what we refer to as immunopatholgoy.

So it's our own immune system creating some

of the damage in particular target organs

in response to that virus.

And so it's like turning on the heat.

But if it's too much,

then you start hurting the tissues around it.

It starts to create a barrier

between where the alveoli are,

where oxygen's coming in,

and the capillaries right next to it

that are picking up that oxygen

to take it to the body

and there's a little thin membrane,

an interstitions there,

which has very little space in it

but certain kinds of interstitional pneumonia

can start to put fluid in and inflammation in that

and thicken it

so that the oxygen exchange is then compromised.

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In 1918, the Spanish Flu

filled understaffed hospitals beyond capacity.

The personnel shortages, largely a result

of doctors and nurses, serving during World War I.

The effect of war socially

and politically took a huge toll on the health systems

around the world

and the hospitals that will need to provide care.

Likewise, in our battle against COVID-19,

the anticipated surge of cases presents additional hurdles,

necessitating field hospitals

and creating shortages of medical supplies

and equipment, making a bad situation even worse.

With a disease like COVID-19,

what we really have to worry about

is the strain on the health system.

(radio mumbling)

We're waiting to see is this gonna be like Milan,

where you have 50 people waiting to come into the hospital

and you have 20 ventilators

and 40 of those people need the ventilators.

But what about medicinal aids

to fight the novel coronavirus?

Despite limited and anecdotal evidence

for some drugs, public health officials continue

to warn against false hope

and await the results of scientifically sourced

and controlled testing.

There are a number of candidate therapies

that literally, as I speak to you today,

are being tested in randomized control trials.

These pharmaceutical investigations

take two primary approaches.

One targets the virus.

The other explores drugs

to control the immune response to the virus

after ARDS sets in.

What happens then is like a small-scale nuclear war

inside the body.

At late stages when it's this immunological battle,

actually killing the virus probably doesn't do

a lot of good.

It's really trying to control the immune system

that is then the key to successfully treating a patient.

Clinical researcher David Paterson

and his team at Australia's University

of Queensland mobilized to explore a combination

of both approaches.

So the objective of our trial

is really to get in early

and prevent a person needing to go into intensive care,

prevent them needing to be mechanically ventilated

and of course, prevent them from dying.

Reaching back into society's medicine cabinet,

Paterson's team hopes to potentially repurpose drugs,

originally developed to treat malaria

and antiretrovirals used in the fight against HIV/AIDS.

One of them attacks an enzyme that is very necessary

for the virus to replicate.

Another prevents the virus from attaching properly

to human cells.

We think that by inhibiting the virus,

we give the immune system time

to really take control.

The ultimate goal, to save lives,

a difficult task not only medically speaking

but also because of the challenges in gathering data

from the epicenters of this pandemic.

(nurses mumbling)

Where health systems have been overwhelmed,

a lot of practical experience is gained

but it's actually hard to do controlled trials,

for example, to determine whether a drug

is effective or whether certain interventions are effective.

Paterson's answer,

to develop a large study group

of 2,400 patients across 60 hospitals

of measure the outcomes of four different therapies.

Antiretroviral HIV drugs

and antimalarial antiviral and immunomodulator.

A combination of the two

and perhaps, most importantly, a control group.

A person coming to that clinical trial

has to accept though

that there's a one in four chance

that they may not receive any antiviral medication

but it is a trial.

It might be that these antiviral medications

have side effects we didn't anticipate.

It might be that combining two

of the antivirals, all it does is increase side effects.

And once we have this infrastructure of a trial set up,

if there are new antiviral medications

that have been developed in any part of the world,

we can slot them into this trial

and evaluate what is really the best way to go

in terms of treating this infection.

But given the accelerating rise

of confirmed COVID-19 infections,

no treatment can come fast enough.

The biggest challenge is time.

We have to do something now

to stop these epidemic curves rising so steeply.

And yet, even after mitigation efforts

to slow the spread of the virus,

official White House estimates released

at the end of March project between 100

and 240,000 American deaths.

And so physicians like David Wheeler consult

with colleagues to find something that works,

even with no scientifically proven treatment as of yet.

Nowadays, it seems like every new day

is like a new era.

Unwilling to simply wait

for the onslaught of patients,

as seen in China, Italy, Spain and New York,

they scour medical literature

on the hunt for lessons learned.

So in terms of the drugs that we pick,

it's a bit of all right,

what do we kind of think makes sense?

We'd like to do something rather than nothing

but we don't wanna hurt our patients

and so that's where we're trying

to strike that middle ground.

Do no harm but do something.

80% of those infected by the COVID-19 virus

likely won't need any medical care.

But limited medical resources

and the absence of verified effective treatments

means no one should be complacent.

It is gonna probably force a lot of hard decisions.

Some are gonna die, some may be left

with sort of lung complications afterwards and then others,

it's just gonna be a lot of work

to help get them through this.

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