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Comment by hattmall | Hacker News Reader

My question is why don't we have treatment? Yes we know vaccines are good as preventative but we also know that vaccines are vulnerable to mutations and waning efficacy over time. It's also somewhat burdensome to need to vaccinate all people all the time. Where is the research into effective treatments and why do we seem to prefer mass vaccination over acute treatments for the sick. Is it just much more difficult to formulate effective treatments or is the influence of capitalism pushing toward the solution that has the most customers and is the most profitable?

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We have been, it’s just not published as much in the newspapers because it is niche medicine effective in the hospital setting. There are a few proven treatments that can be given early (antibody therapy) and a large host of treatments being studied.

If you google “nih covid treatment guidelines” you can read the official US 355 page pdf of the current treatments with summaries and more in depth.

Overall mortality in the hospital has improved quite a bit, by my estimate from ~10-15% to 5-10%, which may not seem like much but is 50% improvement in about one year! (Edit: I want make sure I point out that this is from a US medium sized city hospital viewpoint, there are biases in my view).

Apart from Hepatitis C, I don't know any viruses that can be cured other than waiting it out for the immune system to take care of it. Maybe that are more cases like that but I don't know of more.

So maybe it's hard to get rid of viruses? As an uneducated person in this subject, it looks that way to me.

No. We don't cure viruses, we cure diseases. A disease like COVID-19 is launched by the virus and some antivirals may be found to be effective in slowing down/stopping replication.

The severe cases of COVID-19 after a week have usually very little virus replication and the disease is about tissue inflammation, organ damage and immune system disorder. There are some treatment protocols for these and they are evolving.

In general, anti-viral treatments don't work very well. Antibiotics have worked great, but it's much harder to effectively target viruses with medicine (probably because they reproduce inside the cells of their hosts)

The short and unsatisfying answer is - Because the funding for infectious disease research has been shrinking for decades. The focus shifted to cancer and lifestyle diseases in the developed world which generate more income.

'move fast and break things' is not applicable when it comes to the human body. :)

Anti viral treatments are really hard to come across, it’s not like the world hasn’t been testing everything we could think of to use as a treatment, it’s just that the vast majority of chemicals that we know of or think might work don’t. Truly effective medicines are rare, finding them quickly is rarer still. Vaccines are also vastly cheaper as an intervention that treatments, currently Phizer is selling one dose for $19.50, for remdesivir it’s more like $500 for one dose and one patient needs about 6 doses for a full course of treatment. So the economic incentives are very much in favor of coming up with new treatments, rather than vaccines. It’s just really hard to do.

There is a _tremendous_ amount of research into effective treatments (and many more non effective ones, including Hydroxychloroquine). For viruses, treatments not very effective and / or _very_ expensive. Comparatively, vaccines are cheap, highly effective, and extremely safe. _Mass_ vaccination is not just preventative, but curative in the sense that if enough people get vaccinated, the virus literally goes away.

We have gotten a lot better at treating COVID patients since the first couple of months, as we figure out which interventions work and which don't. Stuff like putting patients prone made a surprisingly large difference in the mortality rate.

Drugs like antivirals are "vulnerable to mutations and waning efficacy over time" just like vaccines are, and they're a lot harder to make.

Which one is harder to make?

Antivirals. We've very few effective ones on the market.

Does than mean they are more expensive to produce per dose, than vaccines?

That wouldn't be an obstacle. Expensive drugs are profitable drugs; drug manufacturers love those. For example, the antiviral that cures hepatitis C costs $84k-168k for a course of treatment. https://en.wikipedia.org/wiki/Sofosbuvir

It's just harder to make effective ones. https://www.scientificamerican.com/article/why-its-so-hard-t...

> In contrast, viral pathogens live inside our own cells and depend on our proteins for most of their needs, so they offer no such easy targets. And few natural antivirals exist, so scientists need to invent them from scratch, says Kathie Seley-Radtke, a medicinal chemist at the University of Maryland, Baltimore County.

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