Finally Some Good News On Coronavirus Vaccines And Therapeutics!

I have no doubt that for nearly every person reading this email right now the global response to the emergence of the novel coronavirus called Sars-CoV-2 and its resulting spread has intersected with their lives in either a subtle or, in many cases, not-so-subtle fashion.  Finally Some Good News On Coronavirus Vaccines And Therapeutics!

It certainly seems less than subtle even here in California, where we’re currently under statewide shelter-in-place orders.

For most of us, as we see the events unfold, it is very natural to feel a certain amount of anxiety. On a more personal level we might ponder the vulnerability of ourselves, our loved ones, or we might fret about the restrictions on our movement and fluctuating store inventories of basic essentials we sometimes take for granted. We may also worry about the fortitude of our frontline healthcare workers, and possible economic effects as some governments enact restrictive policies to protect public health.

While I maintain no pretense of having all of the answers, I would like to reassure those of you reading this today that my team and I will do our best to continue to responsibly exercise the role FoundMyFitness has in functioning as an asset to members of this community seeking to be informed.

With that in mind, we’ve compiled a brief update just to share with you some of the information and news surrounding COVID-19, the illness caused by the novel coronavirus called SARS-CoV-2.

If you have questions about COVID-19, please submit them here. We’ll be following up on these in an upcoming COVID-19 discussion episode (more information toward the end of this email).

Vaccines

There have been some great developments on the vaccine front.

mRNA

A new NIH phase 1 clinical trial of an investigational RNA vaccine for COVID-19 has begun in Seattle, Washington. It involves a new approach that uses messenger RNA (mRNA) to help the immune system fight off the disease.

Conventional vaccines typically employ antigens – inactivated disease-promoting organisms or proteins produced by an infectious agent, such as a virus or bacterium. These antigens mimic the infectious agent to provoke an immune response and provide immunity from future exposures.

RNA vaccines, on the other hand, utilize an mRNA strand that codes for a disease-specific antigen. The vaccine delivers the mRNA strand to the body’s cells, where the genetic information is used to produce the antigen. Similar to a conventional vaccine-derived antigen, these cell-derived antigens drive an immune response.

The phase 1 clinical trial involves approximately 45 healthy men and women between the ages of 18 and 55 years. The study participants will be enrolled into one of three cohorts to receive either a 25 microgram (mcg), 100 mcg, or 250 mcg dose, via intramuscular injection in their upper arm. A repeat dose will be given four weeks later. The patients will be monitored via follow-up visits after the vaccinations to gauge the vaccine’s safety and effectiveness.

The mRNA vaccine used in this trial, known as mRNA-1273, has shown promise in animal studies, but this is the first trial to test it in humans. Enrollment has already begun for the trial. If you live in the Seattle area and would like to participate, here’s morenformation.

Monoclonal Antibodies

Scientists at DARPA, the Defense Advanced Research Projects Agency, are working to develop a therapeutic strategy against SARS-CoV-2 using monoclonal antibodies.

Antibodies are proteins that identify pathogens for destruction by the immune system. They arise from different cell lineages and bind to multiple epitopes – regions on viral proteins to which immune cells bind to drive a targeted immune response. Monoclonal antibodies, on the other hand, are made by identical immune cells cloned from a single, unique parent cell. They bind to a single, specific epitope.

DARPA’s research is part of the Pandemic Prevention Platform. Their goal is to determine which monoclonal antibodies the body produces when it encounters a particular virus, such as SARS-CoV-2, and then stimulate the body’s production of those antibodies. The process involves sequencing the RNA of B-cells taken from a person who has recovered from a particular pathogen and then producing antibodies against the pathogen. The antibodies can then be injected into a healthy person to promote immunity, or injected into a sick person to facilitate recovery.

This strategy can serve as a sort of stopgap measure until a vaccine is developed. Although identifying and producing these antibodies is a lengthy process, DARPA is working to facilitate discovery and accelerate capacity to produce the antibodies at scale.

Pharmacological Therapeutics

A number of randomized controlled trials are currently underway investigating various antiviral therapies for the treatment of COVID-19. Findings from a very small open-label study recently published in the Journal of Antimicrobial Agents found that hydroxychloroquine decreased viral nasopharyngeal levels of SARS-CoV-2 virus in COVID-19 patients in only three to six days in most patients.

Hydroxychloroquine is a common antimalarial drug that is also used to treat rheumatoid arthritis and lupus. In 2017, it was the 128th most prescribed medication in the United States, with more than five million prescriptions. It is relatively safe and has few side effects. This Wikipedia article provides an overview of hydroxychloroquine.

A few other studies have demonstrated hydroxychloroquine’s effectiveness against coronaviruses. For example, in vitro studies in 2004 and 2005 showed that hydroxychloroquine is a potent inhibitor of SARS-CoV, the virus that causes severe acute respiratory syndrome, or SARS. A later study found that hydroxychloroquine improved survival rates in newborn mice infected with a related coronavirus. A recent study found hydroxychloroquine three times more effective than chloroquine phosphate at killing the new SARS-CoV-2 virus in vitro, in other words, in cells infected with the virus.

The current clinical study involved 32 confirmed COVID-19 patients who were administered 600 milligrams of hydroxychloroquine daily for six days. Some patients also received azithromycin, an antibiotic that has been shown to have antiviral activity against some viruses, such as Ebola, in animal studies.

Nasopharyngeal samples taken on day six of treatment indicated that 70 percent of the hydroxychloroquine-treated patients had cleared the virus compared with 12.5 percent in the group receiving standard of care. All of the patients who received both the antibiotic azithromycin and the hydroxychloroquine cleared the virus from nasopharyngeal samples.

Randomized-controlled trials need to confirm whether these therapeutics are effective for the treatment of COVID-19. Large randomized-controlled trials are underway in China and the US. In addition, the safety profile of taking hydroxychloroquine and azithromycin together needs to be determined.

Stability of The SARS-CoV-2 Virus

A new study published in the New England Journal of Medicine found the SARS-CoV-2 virus was detectable for up to three hours in aerosols, up to four hours on copper, up to 24 hours on cardboard, and up to two to three days on plastic and stainless steel. This new data provides valuable information about the stability of this virus and suggests that people may become infected through the air and after touching contaminated objects. This really highlights the importance of handwashing and cleaning surfaces that are commonly used in households. Cleaning surfaces with proper disinfectants was shown to decontaminate the virus.

Temperature And Humidity

While the best way to slow the transmission of the SARS-CoV-2 virus is social distancing, the coming of the warm and humid summer months in the Northern Hemisphere may also give some temporary relief to slowing the spread.

Some scientists have suggested in publications that both high heat and high humidity may slow the spread of the SARS-CoV-2 virus . While it is well-known the influenza virus is more stable in cold temperature, and respiratory droplets, which contain viral particles, remain airborne longer in dry air, emerging research on SARS-CoV-2 suggests that it may follow a similar pattern. One study calculated the transmission rate of the SARS-CoV-2 virus could be reduced by almost 50 percent in the summer months in places where it is humid like Japan. Other scientists think that social distancing measures are still important during the summer months to slow virus transmission.

But there are other reasons to be happy about that warm, muggy weather. Humidity has a direct role on immune function. But low humidity hinders the immune response in multiple ways including:

  • Preventing cilia from removing viral particles and mucus.
  • Reducing the ability of airway cells to repair damage caused by the virus in the lungs.
  • Preventing the activity of signaling proteins released by virus-infected cells to alert neighboring cells to the viral threat.

Good News For Healthcare Workers

A study published last September found that surgical masks were as good as N95 respirators for flu and respiratory virus protection in healthcare workers.

The four-year study, which was conducted at 137 outpatient study sites at seven U.S. medical centers during the typical 12-week peak of viral respiratory illness, involved approximately 4,000 healthcare workers. The workers’ average age was 43 years, and most were women (83 percent). Roughly half of the workers were randomly assigned to wear the N95 respirator, and the other half were assigned to wear regular medical masks.

At the end of the study period, the authors of the study noted no statistically significant differences in the number of influenza infections or other respiratory illnesses between the two groups, suggesting that the two masks provided similar levels of protection.

COVID-19 Q&A

We’ve been receiving a lot of questions about COVID-19, and some of you are even generous enough to share amazing and useful resources with me, as well. This really helps us prioritize our literature review and communications during this time. But it’s hard to manage and respond to everything across social channels, so we’ve set up a form to collect your questions in one place.

Please submit your COVID-19 questions or resources here.

We plan to address the topic of COVID-19 in a focused Q&A and/or topic episode in the near future.

Other Resources

There’s a lot of information online, and not all of it is accurate, reliable, or up-to-date. Here are some reliable sources that we would recommend following:

 

  • Medcram has a very analytical and well-referenced overview on updates on COVID-19. I suggest subscribing to their channel for very objective and comprehensive information on COVID-19.
  • National Institutes of Health’s coverage of COVID-19 has up-to-date and relevant information on the latest research. You can subscribe to their newsletter for automatic updates.
  • New England Journal of Medicine’s updates on COVID-19 is a collection of articles and resources relating to the coronavirus outbreak. They have made all the COVID-19 content free to access.
  • A guide with important tips from UCSF experts on maintaining good mental health with COVID-19 anxiety, physical distancing, and “shelter in place.”

 

Stay Healthy Everyone!

Rhonda And Team

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