As with so many acute severe infectious diseases it is a delicate balancing act - the immune response is both essential & part of the problem. https://www.theguardian.com/science/2020/oct/04/scientists-study-whether-immune-response-wards-off-or-worsens-covid

Great challenge drug development & assessment is to know where & when in dynamic, rapidly changing viral/immune balance the patient is. At times parts immune response may need 'enhancing' few mins/hours later they may need 'suppressing' or other parts immune response targeted.

Targeting drugs into that highly dynamic situation is fraught with difficulties given rapidly changing clinical & pathogenesis & pharmacokinetic of the drugs. Get the impact or timing wrong & difficult to have a benefit & difficult to show a benefit.

Lessons dengue,YF, Flu,ebola,JE,Chik & others.Personal view in RCTs-target the pathogen thruout clinical course often later than you think is needed (virus replication longer in compartments not sampled),try & understand where in the rapidly changing immune dynamic the patient is

And do large randomised controlled trials with integrated studies viral,immune responses repeatedly assessed thruout clinical course including studies of 'Long COVID". Combinations antiviral,immune modifying therapeutics. But critical to understand that rapidly changing dynamic

Again personal view. Drugs vs pathogen acute infections invariably better when used early in illness. But esp when no prior immunity may well be benefit later in clinical course.Pathogen clearance from easy to access samples (swabs/blood) may miss ongoing replication other organs

Last tweet this sequence. Integrating into all RCTs studies virus,immune response,also critical integrate studies virus & host genetics,imaging studies & longterm FU. Out of horror pandemic will come understanding & treatments severe infections will save many lives now & future.