New Jersey is a powerhouse for the pharmaceutical and biomedical industry. Giants like Johnson & Johnson and Merck have made their home here— and that uniquely positions the state at the forefront of the fight against COVID-19.
Some companies are working with hospitals on clinical trials. Others have rolled out antibody testing across the country that will help states reopen their economies. And there's even a hospital that was the first in the U.S. to try placenta cells as a promising treatment for the illness.
“Every one of us wants to help. I know so many companies using so many resources to try to find a cure,” said Scott Tarriff, CEO of Eagle Pharmaceuticals. “I don't think I've ever seen the industry work together this hard in a common way.”
Listen to Karen Yi discuss what these treatments and trials in New Jersey with Jami Floyd on WNYC's All Things Considered:
Eagle Pharmaceuticals is launching a clinical trial at Hackensack Meridian Health—the largest health care network in the state—to use a drug that normally treats malignant hyperthermia to slow COVID-19 in more mild to moderate cases.
The drug, which is administered through an I.V., should cut off the fuel supply that allows the virus to thrive.
“Certain viruses hijack the cells seeking out calcium, and they use that calcium as fuel, if you will, to provide the growth that they need for the virus to replicate,” Tarriff said.
That, he said, would give the body “enough time for its immune system, its antibodies, to take over and help these patients. And so, in theory, we would have mild and moderate patients who never grow into severe patients.”
New Jersey has the second highest number of cases in the U.S., with more than 92,000 confirmed patients and more than 4,700 deaths. (New York has the most in the country, with 257,000 cases and more than 15,000 deaths.)
Holy Name Health, a Teaneck hospital in hard-hit Bergen County, was ground zero for the outbreak and saw the first surge in patients needing hospitalization and intubation. The hospital has multiple clinical and therapy trials that are starting to show some results.
“It's a new disease, a new virus with no treatments that are proven,” said Dr. Ravit Barkama, assistant vice president for clinical development at Holy Name. “So we start off with an empty tool kit.”
Dr. Barkama said Holy Name had the first COVID-19 patient in the U.S. to be treated with placenta-derived cells. And they just got approval to treat a second.
This biological treatment applies the theory that a woman does not reject her placenta or the baby even though they are genetically different.
“That modification of the immune system to not reject the baby, that could be used to quiet down the immune system,” Dr. Barkama said. “So maybe these cells tell the immune system: Calm down. Be quiet. Don't overreact to this virus because that overreaction is creating a lot of harm.”
Holy Name has another clinical trial—the first in the state—using KEVZARA, an antibody normally used to treat rheumatoid arthritis. The hospital is also using remdesivir, an antiviral originally created to treat Ebola, on a trial basis with Gilead.
Doctors are trying to slow a patient’s deterioration when they reach what’s called the cytokine storm—the point at which the body's immune system goes into overdrive and causes inflammation. That can cause fever, shortness of breath, low oxygen levels, and eventually respiratory failure where a person might need to be intubated.
What these treatments aim to do is cut the inflammation of the body which can cause injury to the tissues.
“The tissues that seem most vulnerable in this infection are the lungs, the kidneys, and the vascular system. But we're recognizing more and more that the brain and other tissues are affected,” said Dr. Thomas Birch, medical director of the Holy Name Institute for Medical Research.
Dr. Birch said the KEVZARA trial is already showing some positive results—fewer patients are being put on ventilators. The hospital is also using ACTEMRA, a drug which is also used to treat rheumatoid arthritis, to achieve similar results.
There are other positive signs across the state. Two patients at Virtua Voorhees Hospital, a 61-year-old man and a 63-year-old woman who were the first to get transfusions from the donated plasma of recovered COVID patients in the state, are recovering.
Hospitals are using a mixture of options to treat patients. In some cases patients are given drugs for off-label purposes—something other than what they were approved for. Or the hospitals launch their own treatment trials, as clinical trials need approval from the Food and Drug Administration and must be randomized studies with a control arm.
Other companies like Ortho Clinical Diagnostics are working to ramp up testing that can help states safely reopen their economies.
Ortho Clinical developed two antibody tests and have shipped 10,000 testing kits to labs and hospitals across the country.
A blood sample is put into an automated machine that uses a viral fragment to see if it binds with the blood to show antibodies. The machine will take a photo of the chemical reaction. More light in the picture means more antibodies, less light means fewer antibodies.
Chief innovation officer Chockalingam Palaniappan said they have one test approved by the FDA to test all antibodies. A second test is pending full approval but will analyze how long the antibodies—these “fighters” battling the virus—stay in the body, which will be key to knowing how often a vaccine will be needed.
“These kinds of tests allow you to discern that very well. So that we know both the rise and fall of the early fighters and then the raised and sustenance of their permanent fighters and how long they stay,” Palaniappan said. “So when you use them in concert, you will get incredible clinical information that's going to help manage the disease for a long time to come.”
He says they'll be able to do upwards of four million tests a day.
But large-scale antibody testing will also need to be paired with mass testing for the coronavirus to ensure whether those with immunity remain contagious and whether those without immunity were ever exposed to the virus.
Two researchers, Dr. Clifton Lacy, a former state health commissioner, and entrepreneur David L. Turock, developed a personal registry that will be able to tell employers or business establishments who can be safely allowed back to work through a simple QR code on people’s phones. (China has implemented, in some cities, a QR code system to determine whether a person can enter certain public spaces.)
They're looking to pilot this in the state and hope it can be a model for the country.
“We need to establish the infectious status or the immune status of the workforce to be able to keep people on the job or get people back into their jobs,” Dr. Lacy said.