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coagulation, which is another feature of severe and deadly Covid-19.
So far, there is no published research on rATG or similar heavy-duty transplant drugs for the treatment of Covid-19. “These are very powerful drugs, and there’s a risk you might endanger someone,” Icenogle says. Some doctors have been willing to test out comparatively mild immunosuppressant drugs, and at least one of those — dexamethasone — has worked. But Icenogle says that many in medicine regard the notion of depleting the immune system of a virus-stricken patient as “at least paradoxical, if not crazy.”
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He thinks that will change. “We’re gradually coming to the realization that Covid-19 is primarily an autoimmune disease that is triggered by a virus,” Icenogle says. “I submit that eventually we’re going to treat these autoimmune processes with some of our big guns.”
Emory University’s Sanz says he also believes that immune-suppressing drugs, including some that have not yet been tried in people with Covid-19, will prove helpful. “Without any doubt,” he says. “But I think that only some patients will benefit.”
He emphasizes, again and again, that Covid-19 is a heterogeneous disease. It affects different people in different ways. Outside of a vaccine, there is unlikely to be a panacea or a single category of treatment that works for everyone. Still, Sanz says that a better understanding of the disease’s autoimmune facets, coupled with a broader deployment of immune-moderating therapies, could help improve patient outcomes — both in the short and long term.
“I think autoimmunity is part of the story,” Sanz adds. “It’s not the whole story.”