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Abstract Covid-19 has created an emergency of epic proportions While a vaccine may be forthcoming, this is not guaranteed, as discussed herein The potential problems and ominous signs include: a) Lung injury that developed in animals given an experimental vaccine for the severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1);b) A perversion of adaptive immune responses called antibody-dependent-enhancement (ADE) of infection that occurs in SARS-CoV-1 and that may occur in people vaccinated for Covid-19;c) The frequent and recurrent infections that are caused by respiratory coronaviruses;and d) The appearance of mutations in SARS-CoV-2 proteins, which raise the specter of vaccine escape mutants Because success is uncertain, alternatives to vaccines need to be vigorously pursued during this critical moment in the pandemic Alternatives include: a) Engineered monoclonal antibodies that do not cause ADE;b) Cocktails of antiviral drugs and inhibitors of the cellular proteins required for SARS-CoV-2 replication;c) Interferons;and d) Anticoagulants, antioxidants, and immune modulators To organize and coordinate the systematic investigation of existing therapies and new therapies (as they emerge), a Covid-19 clinical trials network is needed to provide: a) Robust funding (on a par with vaccine funding) and administration;b) An adaptive trial design committee to prioritize interventions and review results in real-time;c) A computer interface to facilitate patient enrollment, make data available to investigators, and present findings;d) A practice guidelines study group;and e) A mobile corps of Covid-19 experts available for rapid deployment to assist local healthcare providers and enroll patients in trials as outbreaks occur To combat the Covid-19 pandemic and future mass contagions, the network would be a cornerstone of a comprehensive infectious diseases research program
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