The Anticipated Resolution to the Memorable Pandemic

Jessica Lewis
Jan 19, 2021
6 min read

There have been traces of catastrophic events that strongly resonated with our understanding and willingness to find a cure. As it is written in the proverbs, “time is likely to repeat itself.” Similar to the past, for individuals who have experienced global disease outbreaks such as the H1N1 and the Spanish flu, there is undoubtedly an anticipated resolution. As humans, we must find a way to continue surviving, which requires developing a magic bullet that will hopefully end the COVID-19 pandemic.

Treatment:

At this present time, there are no novel therapies approved for the treatment of COVID-19. The gold standard of treatment is the use of supportive care, including supplemental oxygen.1 The majority of patients hospitalized with COVID-19 requires mechanical ventilation. The Food and Drug Administration (FDA) issued an emergency use authorization for convalescent plasma in patients hospitalized with COVID-19.2 Convalescent plasma is the blood from patients who recovered from the virus, which contains antibodies produced during the immune system’s response. These antibodies neutralize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and prevent the possibility of reinfection. The National Institutes of Health (NIH) established guidelines that are mandated for the treatment of COVID-19 (Figure 1). 1

Figure 1: NIH Treatment Guidelines Based on Disease Severity of COVID-19.

(Abbreviated version of NIH Treatment Guidelines, see reference 1 for full version on the NIH website); ECMO= Extracorporeal membrane oxygenation (uses a pump to circulate blood through an artificial lung back into the bloodstream).

The method of drug repurposing is the current secret weapon to manage the disease. Drug repositioning (repurposing) involves identifying approved or investigational drugs that have promising therapeutic benefits outside the scope of their original indication.3 This strategy is advantageous compared to developing a novel drug because it reduces the risk of failure since the safety profile has already been evaluated. Dexamethasone is administered to patients with severe disease requiring respiratory support.1 It is a corticosteroid that decreases the immune system’s response to SARS-CoV-2. Corticosteroids have anti-inflammatory benefits; therefore, reducing the inflammation mediated by lung injury and reducing progression to respiratory failure. In the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial, patients who required supplemental oxygen and were assigned to dexamethasone at 6 mg/day for ten days were less likely to die within 28 days than those who received standard care.4 Remdesivir (Veklury) is another effective drug prescribed for the treatment of COVID-19. The FDA approved the antiviral drug to treat adults and children (>12 years of age) weighing at least 40 kg who have been hospitalized. Veklury (developed by Gilead) is the first treatment to receive FDA approval for COVID-19.5 The approval of remdesivir was supported by its evaluation in three randomized controlled trials. The drug conferred a more significant survival benefit for patients hospitalized with mild-to-severe cases.5

The drug developed by Regeneron is a cocktail of two monoclonal antibodies (casirivimab and imdevimab). The FDA granted emergency use authorization for the combination therapy to be administered in adults and children (>12 years of age) with a high risk of developing severe illness. Monoclonal antibodies are artificial (laboratory-made) proteins similar to the antibodies naturally produced by the body during an infection to fight invaders, such as SARS-CoV-2. Casirivimab and imdevimab were developed to target the spike protein of the virus, blocking its attachment and entry into human cells. These monoclonal antibodies are not authorized for hospitalized patients or those receiving oxygen therapy due to COVID-19.6

Prevention:

The Centers for Disease Control and Prevention (CDC) issued preventive guidelines to counteract the global outbreak of COVID-19.7 The purchase of face masks skyrocketing during the pandemic. The wearing of face masks became an essential element to coordinate with an outfit. Recently, the showcase of face masks became prominent in the fashion scene. As a crucial element to the prevention of the pandemic, face masks reduce the spread of SARS-CoV-2. N95 respirators and surgical masks are more effective; however, they are reserved for healthcare workers and first responders. The CDC recommends the general public to wear a thick fabric cloth mask (2 layers tightly woven, 100% cotton) that is well-fitted. Additionally, face shields are used for protection and are reserved for health care workers. The mask is not a substitute for social distancing, so it is recommended to continue staying 6 feet apart from others. Another preventive measure is the use of hand sanitizers. The CDC recommends hand sanitizers with at least 60% alcohol (ethyl alcohol, isopropanol, 2-propanol, or ethanol).7 Contact tracing is a crucial intervention that requires identifying and monitoring individuals who may have been exposed to a person who contracted the virus. This intervention was an integral component of controlling the outbreak of the Ebola epidemic. It was proven effective and prevented further increases in viral cases. Other preventive measures require regulatory actions established by the government. The introduction of remote working instilled a great impression onto the general public, as individuals found it more convenient to work in the comfort of their homes while taking care of toddlers in the family or avoiding public transportation. Celebrations such as New Year’s were universally orchestrated in a small cluster as the government limited the size of social gatherings. There was less traveling during the holidays; most people remained at home due to international border closures. To control the virus within the country, the government issued a state of emergency to force people to remain at home. Many preventive measures were established to manage the spread of SARS-CoV-2; however, the ideal preventive method is the development of a vaccine.

Currently, two vaccines were authorized by the FDA for emergency use in the prevention of COVID-19: Pfizer-BioNTech and Moderna.8 Vaccines are reserved for high-risk individuals, including health care workers, essential workers, and the elderly (those in long-term care facilities). The Pfizer-BioNTech vaccine (BNT162b2) is approved for individuals 16 years and older.8 Outcomes from clinical trials showed that the Pfizer-BioNTech vaccine was 95% effective at preventing COVID-19 illness in people without evidence of previous infection.9 The Moderna vaccine (mRNA-1273) is recommended for use in individuals 18 years of age and older.8 This vaccine is 94.1% effective at preventing COVID-19. The Moderna vaccine must be distributed between -25°C and -15°C, then continuously stored in the refrigerator or freezer.10 However, the Pfizer-BioNTech vaccine requires a more stringent temperature condition between -80°C and -60°C in a shipping container with dry ice. Then it must be stored in an ultra-cold freezer or refrigerator.9 These requirements make it very difficult for community clinics and local pharmacies to store and administer the vaccine. Both vaccines are messenger RNA (mRNA) vaccines composed of genetic coding to activate an immune response. This technology can be implemented to design vaccines for human testing faster than traditional methods; however, the drawback lies in the stability of the mRNA. This genetic fragment is very unstable. Even when it is encapsulated in a lipid nanoparticle, it is still crucial to keep it at very cold temperatures to prevent decay.11 If a significant proportion of the population is vaccinated, then the transmission of SARS-CoV-2 can be impeded due to herd immunity (Figure 2).12

Figure 2: The Principles of Herd Immunity & Social Distancing for the Prevention of COVID-19.

A population without immunization and social distancing can lead to an increase in deaths. However, if a significant proportion of the population is social distanced and vaccinated, mortality can decrease. Herd immunity (population immunity) is the indirect protection from a virus when a proportion of the population is immune and cannot transmit the virus to a group of people, therefore protecting other individuals who may not be vaccinated.

Multiple SARS-CoV-2 variants are circulating globally due to the mutations and adaptability of the virus. These variants cause more severe illness and are significantly contagious than the prototype. COVID-19, the unforgettable pandemic, created a phenomenal impact in our lives that may not be remediated any time soon. However, we can start healing individually and perhaps find a way to coexist peacefully with the virus in a commensal relationship. The tragedies of pandemics come and go and instill a greater strength and dignity within us to rise and overcome this global apocalypse.

References:

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed January 17, 2021.
U.S. Food and Drug Administration. (2021, January 15). Recommendations for Investigational COVID-19 Convalescent Plasma. Retrieved January 17, 2021, from https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma.
Pushpakom S, Iorio F, Eyers PA, Escott KJ, Hopper S, Wells A, et al. Drug repurposing: progress, challenges and recommendations. Nat Rev Drug Discov. 2019; 18: 41–58.
Horby P, Lim WS, Emberson J, Mafham M, Bell J, et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. medRxiv. 2020.
U.S. Food and Drug Administration. (2020, October 22). FDA Approves First Treatment for COVID-19. Retrieved January 16, 2021, from https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-covid-19.
U.S. Food and Drug Administration. (2020, November 21). Coronavirus (COVID-19) Update: FDA Authorizes Monoclonal Antibodies for Treatment of COVID-19. Retrieved January 16, 2021, from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibodies-treatment-covid-19.
Centers for Disease Control and Prevention. (2020, December 31). How to Protect Yourself and Others. Your Health. Retrieved January 16, 2021. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.
U.S. Food and Drug Administration. (2021, January 14). COVID-19 Vaccines. Retrieved January 16, 2021. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.
Centers for Disease Control and Prevention. (2021, January 1). Information about the Pfizer-BioNTech Covid-19 Vaccine. Retrieved January 16, 2021 from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html.
Centers for Disease Control and Prevention.(2021, January 1). Information about the Moderna Covid-19 Vaccine. Retrieved January 16, 2021 from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html.
Krammer F. SARS-CoV-2 Vaccine in Development. Nature. 2020; 586: 516-527.
World Health Organization. (2020, December 31). Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. Retrieved January 18, 2021 from https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19.