Coronavirus: UK scientists identify drugs that may help severe cases | Science

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Scientists have identified a collection of drugs with the potential to benefit tens of thousands of patients who are admitted to intensive care with life-threatening coronavirus infections.

The breakthrough emerged from a major study of critically ill patients that revealed a suite of genes involved in antiviral defences and lung inflammation that leave people at greater risk of developing severe Covid disease.

Now that the UK has authorised the first Covid vaccine, who will get it first?

The government’s Joint Committee on Vaccination and Immunisation (JCVI) says its priority is to prevent Covid-related deaths and protect health and social care staff and systems.

Elderly care home residents and their carers are first on the JCVI’s list because their risk of exposure to the virus is higher and because the risk of death closely correlates with older age. They are followed in priority by anyone else over 80 and frontline health and social care workers.

Even so, for pragmatic reasons NHS staff are likely to be the first group to receive the Pfizer/BioNTech jab. This is because the vaccine needs to be stored at ultra-cold temperatures, which can be achieved more easily by using hospital facilities

Are there enough doses to reach all the priority groups?

Together, care home residents, their carers and the over-80s make up nearly 6 million people, and frontline NHS staff a further 736,685. Matt Hancock, the health secretary, has said he expects 10m doses of the Pfizer/BioNTech vaccine to be available this year, so if this is the only vaccine authorised, everyone else would have to wait until further doses become available next year. 

Where will I go for the vaccine?

Covid-19 vaccines are expected to be delivered at three types of venue: NHS trust “vaccine hubs” at hospital sites; mass vaccination centres, which are in the process of being set up at places such as football stadiums, conference buildings and racecourses – these are expected to vaccinate up to 5,000 people a day; and at GP surgeries and pharmacies. GPs can also visit care home residents and housebound patients at home without them needing to travel.

How far apart will the two doses be administered, and will I protected after the first?

While there is some evidence to indicate high levels of short-term protection from a single dose of vaccine, a two-dose schedule is what has been approved by the MHRA.

The second dose will need to be delivered at least 21 days after the first, and both will be injected into the deltoid muscle – the thick triangular muscle we use to raise each arm.

For the Pfizer vaccine, its efficacy rate was calculated seven days after the second shot. It is likely that people will have some protection before this, but this is how long it will take for full protection to kick in. We will learn more about the extent of protection and how long it lasts as data from ongoing clinical trials comes in.

Can I pay to get the vaccine privately?

Unlikely. England’s deputy chief medical officer, Jonathan Van-Tam, has said he believes Covid-19 vaccines should be delivered according to clinical priority rather than allowing people to jump the queue if they can afford it.

Will I be able to choose which vaccine I have?

Also unlikely, at least in the short to medium term. Assuming more than one vaccine is approved, the priority will be distributing any available doses to the people who need it as quickly as possible.

Linda Geddes

The team, led by Edinburgh University researchers, spotted five genes that raised the risk of severe illness, pointing them towards a handful of drugs that are expected to help susceptible patients. The medicines will now be prioritised for clinical trials.

“It’s absolutely startling we’ve seen these results so quickly after the start of the outbreak,” said Kenneth Baillie, a consultant in critical care medicine and senior research fellow at Edinburgh’s Roslin Institute. “What is really exciting about this is we’ve found genes that are directly therapeutically relevant. They lead us directly to treatments.”

The research, by the global Genetics of Mortality in Critical Care (GenOMICC) consortium, compared the DNA of 2,244 critically ill Covid patients from 208 UK intensive care units with the genetic make-up of healthy individuals in a control group.

The analysis revealed key differences in five genes, named IFNAR2, TYK2, OAS1, DPP9 and CCR2, which partially explained why the sick patients became critically ill. Having identified the troublesome genes, the team was able to predict what drug treatments were likely to help.

One drug that holds promise for future Covid treatment is a rheumatoid arthritis medicine called baricitinib. This reduces the activity of TYK2, which the research suggests will help reduce dangerous levels of inflammation in the lungs. Another is an antibody-based medicine that blocks CCR2 and is in clinical trials for psoriasis.

Beyond calming down the immune system, drugs may help invigorate the body’s ability to fight the virus. Some compounds are known to boost the activity of Ifnar2 and are likely to protect people from serious infections by mimicking proteins released by the immune system to fight viruses. However, these would probably need to be given early on to have a substantial impact, the scientists said.

“This is a wonderful breakthrough, really, in understanding what causes the severe disease,” said Peter Openshaw, a professor of experimental medicine at Imperial College London and a co-author on the study.

The findings have been shared with groups around the world who are running clinical trials to assess whether drugs that are already in use for other conditions can help save patients with severe Covid-19 disease. Those include the World Health Organization’s Solidarity trial, Oxford University’s Recovery trial and an international trial named Remap-Cap.

Baillie said that drugs highlighted by the research should now become the top priority for inclusion in clinical trials. “Making those choices really matters,” he said. “If we choose the right intervention to try next in clinical trials then we’ll find out that it works sooner and that could save tens of thousands of lives.” The study is published in Nature.

People with Covid-19 tend to develop symptoms as the virus multiplies in their body, but those who die often succumb to excessive lung inflammation which is driven by the immune system.

Doctors running Oxford University’s Recovery trial discovered in the summer that the cheap steroid dexamethasone slashed deaths among patients needing supplemental oxygen by up to a third, by damping down the immune system.

But more drugs are needed to help patients who do not respond to the steroid, Baillie said. “Two-thirds of them are still dying even treated with dexamethasone, so there’s a long way to go in preventing that inflammation, and we really urgently need new targets,” he said.

Hafta Ichi
Source: The Guardian
Keyword: Coronavirus: UK scientists identify drugs that may help severe cases | Science

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