COVID-19: THE LATEST IN VARIANTS AND VACCINES

COVID-19: THE LATEST IN VARIANTS AND VACCINES

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began ravaging the United States after the first case was identified in Washington state in January 2020. Since then, the state of the pandemic has changed drastically and rapidly. It’s been 1 year since the coronavirus hit the United States. Here’s a snapshot of the current state of the pandemic.

According to the WORLD HEALTH ORGANIZATION (WHO), as of March 10, over 117 million cases of COVID-19—the disease caused by the virus—have been reported worldwide, and over 2.6 million people have died as a result of infection. But there may finally be light at the end of the tunnel. More than 268 million vaccine doses have been administered globally, and that number is growing.

We’re 1 year in—and here’s the latest information on the new variants of the virus, how doctors are treating patients with the disease, and a review of the vaccine landscape.

New variants

Viruses constantly mutate and change over time. While not all mutations are successful, some persist, and a number of SARS-CoV-2 variants have emerged and spread over the past year. Three of these have traveled across the world and entered the United States.

The variant known as B.1.1.7 was originally identified in the United Kingdom in the fall of 2020. By January 2021, experts found data to suggest that not only does it spread more quickly compared with other variants, but it’s also associated with an increased risk of death. The variant has since been detected in many other countries. As of March 10, there were 3,283 reported cases of B.1.1.7 in 49 jurisdictions across the United States, according to the Centers for Disease Control and Prevention (CDC).

Another variant, called B.1.351, was identified in South Africa last October. According to the CDC, this variant shares some mutations with B.1.1.7 and appears to spread more quickly than the original virus. B.1.351 was initially detected in the United States in January and, as of March 10, 2021, there were 91 cases reported in 21 jurisdictions, according to the CDC.

A third variant called P.1 is thought to have emerged in Brazil, after it was detected in travelers who arrived from the country at an airport in Japan in January. This variant, which features additional mutations, appeared in the United States around the same time. As of March 10, there were 15 cases of P.1 reported across nine jurisdictions in the United States, according to the CDC.

Drugs for COVID-19 treatment

Most people who contract COVID-19 will be able to recover at home with adequate rest, hydration, and common medications to relieve fever and pain. For those who experience mild to moderate symptoms but are at risk of developing a severe response to the disease (or at risk of being hospitalized for it), the FDA has granted emergency approval to two monoclonal antibody treatments. Bamlanivimab, produced by Eli Lilly, and a combination of casirivimab and imdevimab, produced by Regeneron, were both approved in November. These treatments can reduce the risk of hospitalization, and are given intravenously (in clinic or hospital) soon after symptoms develop.

Of course, many are still being hospitalized as a result of their symptoms. For these patients, the FDA has approved treatments to help curb the COVID-19 mortality rate. These include corticosteroids, like dexamethasone, which are anti-inflammatory drugs given to patients who develop a hyper-immune response (a cytokine storm). In these cases, the immune system’s reaction can cause significant damage to the lungs, which often results in death. An early study indicated, however, that for patients on supplemental oxygen or a ventilator, dexamethasone reduced patients’ chances of dying within 28 days, compared with standard care.

Other treatments include the antiviral drug remdesivir, which was approved by the FDA in October. In November, the FDA approved the use of baricitinib in combination with remdesivir, for patients who require respiratory support. Physicians have also been treating almost all patients with anticoagulation drugs, to prevent blood clots. Typically, patients receive low doses of heparin or enoxaparin.

One treatment that has shown mixed results in studies is convalescent plasma, which has been used for over a century to treat illnesses ranging from polio to SARS, and is widely considered to be safe, according to Harvard Health. The plasma, which is taken from the blood of recovered COVID-19 patients, contains antibodies that were produced to fight the disease. The use of convalescent plasma to treat patients hospitalized with COVID-19 was granted emergency approval by the FDA in August, but subsequent trials indicate that it may not be entirely effective. A review published in February, which analyzed the results of four trials, concluded that convalescent plasma did not significantly improve risk of death, length of hospital stay, or the need for a ventilator.

Vaccines

The race to vaccinate the world is ongoing and the state of affairs changes daily. As of March 10, researchers are testing 75 different vaccines in clinical trials on humans, and at least 78 in preclinical trials on animals. All told, 21 vaccines have reached the final stages of testing. As of March 10, three vaccines have been granted approval for emergency use by the FDA in the United States.

The first was Comirnaty, produced by New York-based Pfizer and the German company BioNTech, which received approval on December 11. This two-dose vaccine, given 3 weeks apart, was found to have an efficacy rate of 95%, according to findings made public by the companies on November 9. In January, the vaccine was found to be less effective against B.1.351, which prompted the firms to begin a study to develop a specific booster for this variant. Recently the vaccine was found to be effective against the Brazilian variant, P.1.

On December 18, the FDA granted emergency approval to a second vaccine: mRNA-1273, produced by Boston-based Moderna. This vaccine works in a similar way to Comirnaty and requires two doses, 4 weeks apart. According to Moderna, trials showed that it has a 94.5% efficacy rate.

On February 27, the FDA issued emergency use authorization for a third vaccine. Johnson & Johnson’s Ad26.COV2.S requires only one dose to be effective, but appears to have a lower efficacy rate of 72% in the United States. In November, the company announced the launch of a phase 3 trial to measure the efficacy of two doses of its vaccine. The results of this trial are expected in late 2021.

Are the vaccines effective against the variants?

This is a very important point that vaccine developers keep in mind. Some vaccines, like measles, don’t require any changes because they are regularly effective. But other vaccines such as those that are used against the influenza virus, need to be changed every year, based on changing variants; WHO coordinates this global network that actually identifies which strain should be combated each year. Regarding SARS-CoV-2, we’re still learning, and our knowledge is evolving. Presently, most scientists believe that the vaccines that are currently in development and those that have been approved should provide protection against these and other variants because they elicit a fairly broad immune response, a host of antibodies and cell-mediated immune responses. And so a couple of changes or mutations in the virus should not make these vaccines ineffective. But right now there are studies going on in labs around the world to actually confirm that. And in the small possibility that current ones are less effective against any of the variants, nowadays the way they are developed, responsive vaccines can be quickly created.

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