• Broad Anti-coronavirus Activity of Food and Drug Administration-Approved Drugs against SARS-CoV-2 and SARS-CoV

      Weston, Stuart; Coleman, Christopher M; Haupt, Robert; Logue, James; Matthews, Krystal; Li, Yize; Reyes, Hanako M; Weiss, Susan R; Frieman, Matthew B (American Society for Microbiology, 2020-10-14)
      Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China at the end of 2019 and has rapidly caused a pandemic, with over 20 million recorded COVID-19 cases in August 2020 (https://covid19.who.int/). There are no FDA-approved antivirals or vaccines for any coronavirus, including SARS-CoV-2. Current treatments for COVID-19 are limited to supportive therapies and off-label use of FDA-approved drugs. Rapid development and human testing of potential antivirals is urgently needed. Numerous drugs are already approved for human use, and subsequently, there is a good understanding of their safety profiles and potential side effects, making them easier to fast-track to clinical studies in COVID-19 patients. Here, we present data on the antiviral activity of 20 FDA-approved drugs against SARS-CoV-2 that also inhibit SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). We found that 17 of these inhibit SARS-CoV-2 at non-cytotoxic concentrations. We directly followed up seven of these to demonstrate that all are capable of inhibiting infectious SARS-CoV-2 production. Moreover, we evaluated two of these, chloroquine and chlorpromazine, in vivo using a mouse-adapted SARS-CoV model and found that both drugs protect mice from clinical disease.IMPORTANCE There are no FDA-approved antivirals for any coronavirus, including SARS-CoV-2. Numerous drugs are already approved for human use that may have antiviral activity and therefore could potentially be rapidly repurposed as antivirals. Here, we present data assessing the antiviral activity of 20 FDA-approved drugs against SARS-CoV-2 that also inhibit SARS-CoV and MERS-CoV in vitro We found that 17 of these inhibit SARS-CoV-2, suggesting that they may have pan-anti-coronaviral activity. We directly followed up seven of these and found that they all inhibit infectious-SARS-CoV-2 production. Moreover, we evaluated chloroquine and chlorpromazine in vivo using mouse-adapted SARS-CoV. We found that neither drug inhibited viral replication in the lungs, but both protected against clinical disease.
    • Clinical strategies for optimizing infusion center care through a pandemic

      Hanna, Kirollos S; Segal, Eve M; Barlow, Ashley; Barlow, Brooke (SAGE Publications Inc., 2020-09-25)
      The national pandemic resulting from the novel coronavirus, COVID-19, has made the delivery of care for patients with cancer a challenge. There are competing risks of mortality from cancer versus serious complications and higher risk of death from COVID-19 in immunocompromised hosts. Furthermore, compounding these concerns is the inadequate supply of personal protective equipment, decreased hospital capacity, and paucity of effective treatments or vaccines to date for COVID-19. Guidance measures and recommendations have been published by national organizations aiming to facilitate the delivery of care in a safe and effective manner, many of which, are permanently adoptable interventions. Given the critical importance to continue chemotherapy, there remains additional interventions to further enhance patient safety while conserving healthcare resources such as adjustments in medication administration, reduction in laboratory or drug monitoring, and home delivery of specialty infusions. In this manuscript, we outline how to implement these actionable interventions of chemotherapy and supportive care delivery to further enhance the current precautionary measures while maintaining safe and effective patient care. Coupled with current published standards, these strategies can help alleviate the numerous challenges associated with this pandemic. © The Author(s) 2020.
    • Diabetes and Technology in the Covid-19 Pandemic Crisis

      Spanakis, E.K. (SAGE Publications Inc., 2020)
    • Extended use or re-use of single-use surgical masks and filtering facepiece respirators during COVID-19: A rapid systematic review

      Toomey, E; Conway, Y; Burton, C; Smith, S; Smalle, M; Chan, Xhs; Adisesh, A; Tanveer, S; Ross, L; Thomson, I; et al. (Cambridge University Press, 2020-10-08)
      Background: Shortages of personal protective equipment during the COVID-19 pandemic has led to the extended use or re-use of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. Objectives: To synthesise current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering facepiece respirators. Data sources: World Health Organization, European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. Medline, Pubmed, Epistemonikos, Cochrane Database and preprint servers for systematic reviews. Methods: Two reviewers conducted screening and data extraction. Quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesised. Results: Six guidance documents were identified. Levels of detail and consistency across documents varied. Four high-quality systematic reviews were included: three focused on reprocessing (decontamination) of N95 respirators, one on reprocessing of surgical masks. Vaporised hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. Conclusions: There is limited evidence on the impact of extended use and re-use of surgical masks and respirators and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organisations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.
    • Guidelines for Frontline Health Care Staff Safety for COVID-19

      Baker, Terrance L.; Greiner, Jack V.; Maxwell-Schmidt, Elizabeth; Lamothe, P. Henri; Vesonder, Modesta (SAGE Publications, 2020-07-13)
      This document establishes safety guidelines for physicians, nurses, and allied health care and facility staff who may be exposed to patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a health care facility. SARS-CoV-2 infection is highly contagious and places health care workers at risk for infection resulting in coronavirus disease (COVID-19). Physicians, nurses, and allied health care and facility staff in all frontline environments must be provided and utilize necessary personal protective equipment (PPE). It is important that health care staff adopt a universal set of guidelines in which to conduct themselves in order to minimize infection with the SARS-CoV-2 contagion. The establishment of these guidelines is necessary in this viral pandemic since such directives can create a standard of safety that is universally accepted. These guidelines establish a framework to provide consistency among health care facilities and staff from the time the staff member arrives at the health care facility until they return home. These guidelines provide a practical description of the minimum necessary protection for physicians, nurses, and allied health care and facility staff against SARS-CoV-2 infection. © The Author(s) 2020.
    • How to Best Protect People With Diabetes From the Impact of SARS-CoV-2: Report of the International COVID-19 and Diabetes Summit

      Zhang, Jennifer Y; Shang, Trisha; Ahn, David; Chen, Kong; Coté, Gerard; Espinoza, Juan; Mendez, Carlos E; Spanakis, Elias K; Thompson, Bithika; Wallia, Amisha; et al. (SAGE Publications Inc., 2021-01-21)
      The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has rapidly involved the entire world and exposed the pressing need for collaboration between public health and other stakeholders from the clinical, scientific, regulatory, pharmaceutical, and medical device and technology communities. To discuss how to best protect people with diabetes from serious outcomes from COVID-19, Diabetes Technology Society, in collaboration with Sansum Diabetes Research Institute, hosted the “International COVID-19 and Diabetes Virtual Summit” on August 26-27, 2020. This unique, unprecedented real-time conference brought together physicians, scientists, government officials, regulatory experts, industry representatives, and people with diabetes from six continents to review and analyze relationships between COVID-19 and diabetes. Over 800 attendees logged in. The summit consisted of five sessions: (I) Keynotes, (II) Preparedness, (III) Response, (IV) Recovery, and (V) Surveillance; eight parts: (A) Background, (B) Resilience, (C) Outpatient Care, (D) Inpatient Care, (E) Resources, (F) High-Risk Groups, (G) Regulation, and (H) The Future; and 24 sections: (1) Historic Pandemics and Impact on Society, (2) Pathophysiology/Risk Factors for COVID-19, (3) Social Determinants of COVID-19, (4) Preparing for the Future, (5) Medications and Vaccines, (6) Psychology of Patients and Caregivers, (7) Outpatient Treatment of Diabetes Mellitus and Non-Pharmacologic Intervention, (8) Technology and Telehealth for Diabetes Outpatients, (9) Technology for Inpatients, (10) Management of Diabetes Inpatients with COVID-19, (11) Ethics, (12) Accuracy of Diagnostic Tests, (13) Children, (14) Pregnancy, (15) Economics of Care for COVID-19, (16) Role of Industry, (17) Protection of Healthcare Workers, (18) People with Diabetes, (19) International Responses to COVID-19, (20) Government Policy, (21) Regulation of Tests and Treatments, (22) Digital Health Technology, (23) Big Data Statistics, and 24) Patient Surveillance and Privacy. The two keynote speeches were entitled (1) COVID-19 and Diabetes—Meeting the Challenge and (2) Knowledge Gaps and Research Opportunities for Diabetes and COVID-19. While there was an emphasis on diabetes and its interactions with COVID-19, the panelists also discussed the COVID-19 pandemic in general. The meeting generated many novel ideas for collaboration between experts in medicine, science, government, and industry to develop new technologies and disease treatment paradigms to fight this global pandemic.
    • The importance of genomic analysis in cracking the coronavirus pandemic

      Zella, Davide; Giovanetti, Marta; Cella, Eleonora; Borsetti, Alessandra; Ciotti, Marco; Ceccarelli, Giancarlo; D'Ettorre, Gabriella; Pezzuto, Aldo; Tambone, Vittoradolfo; Campanozzi, Laura; et al. (Taylor and Francis Inc., 2021-04-28)
      Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has pushed the scientific community to undertake intense research efforts. Understanding SARS-CoV-2 biology is necessary to discover therapeutic or preventive strategies capable of containing the pandemic. Knowledge of the structural characteristics of the virus genome and proteins is essential to find targets for therapies and immunological interventions.Areas covered: This review covers different areas of expertise, genomic analysis of circulating strains, structural biology, viral mutations, molecular diagnostics, disease, and vaccines. In particular, the review is focused on the molecular approaches and modern clinical strategies used in these fields.Expert opinion: Molecular approaches to SARS-CoV-2 pandemic have been critical to shorten time for new diagnostic, therapeutic and prevention strategies. In this perspective, the entire scientific community is moving in the same direction. Vaccines, together with the development of new drugs to treat the disease, represent the most important strategy to protect human from viral disease and prevent further spread. In this regard, new molecular technologies have been successfully implemented. The use of a novel strategy of communication is suggested for a better diffusion to the broader public of new data and results.
    • The Role of a Statewide Critical Care Coordination Center in the Coronavirus Disease 2019 Pandemic-and Beyond

      Galvagno, Samuel M; Naumann, Andrew; Delbridge, Theodore R; Kelly, Melissa A; Scalea, Thomas M (Wolters Kluwer Health, 2021-10-28)
      Objective: Public health emergencies, like the coronavirus disease 2019 pandemic, can cause unprecedented demand for critical care services. We describe statewide implementation of a critical care coordination center designed to optimize ICU utilization. To describe a centralized critical care coordination center designed to ensure appropriate intensive care resource allocation. Design: A descriptive case series of consecutive critically ill adult patients. Setting: ICUs, emergency departments, freestanding medical facilities in the state of Maryland and adjacent states, serving a population of over 6,045,000 across a land area of 9,776 sq mi (25,314 km2). Patients: Adults requiring intensive care. Interventions: Consultation with a critical care physician and emergency medical services clinician. Measurements and main results: Number of consults, number of patient movements to higher levels of critical care, and number of extracorporeal membrane oxygenation referrals for both patients with and without coronavirus disease 2019. Over a 6-month period, critical care coordination center provided 1,006 critical care consultations and directed 578 patient transfers for 58 hospitals in the state of Maryland and adjoining region. Extracorporeal membrane oxygenation referrals were requested for 58 patients. Four-hundred twenty-eight patients (42.5%) were managed with consultation only and did not require transfer. Conclusions: Critical care coordination center, staffed 24/7 by a critical care physician and emergency medical service clinician, may improve critical care resource use and patient flow. This serves as a model for a tiered regionalized system to ensure that the demand for critical care services may be met during a pandemic and beyond.
    • Transparency too little, too late? Why and how Health Canada should make clinical data and regulatory decision-making open to scrutiny in the face of COVID-19

      Edmonds, Sterling; MacGregor, Andrea; Doll, Agnieszka; Vural, Ipek Eren; Graham, Janice; Fierlbeck, Katherine; Lexchin, Joel; Doshi, Peter; Herder, Matthew (Oxford University Press, 2020-11-19)
    • The variants question: What is the problem?

      Zella, Davide; Giovanetti, Marta; Benedetti, Francesca; Unali, Francesco; Spoto, Silvia; Guarino, Michele; Angeletti, Silvia; Ciccozzi, Massimo (Wiley-Blackwell, 2021-07-13)
      The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in early December 2019 has rapidly widespread worldwide. Over the course of the pandemic, due to the advance of whole-genome sequencing technologies, an unprecedented number of genomes have been generated, providing both invaluable insights into the ongoing evolution and epidemiology of the virus and allowing the identification of hundreds of circulating genetic variants during the pandemic. In recent months variants of SARS-CoV-2 that have an increased number of mutations on the Spike protein have brought concern all over the world. These have been called “variants of concerns” (VOCs), and/or “variants of interests” (VOIs) as it has been suggested that their genome mutations might impact transmission, immune control, and virulence. Tracking the spread of emerging SARS-CoV-2 variants is crucial to inform public health efforts and control the ongoing pandemic. In this review, a concise characterization of the SARS-CoV-2 mutational patterns of the main VOCs and VOIs circulating and cocirculating worldwide has been presented to determine the magnitude of the SARS-CoV-2 threat to better understand the virus genetic diversity and its potential impact on vaccination strategy.
    • Willingness to Get a COVID-19 Vaccine and Its Potential Predictors in Costa Rica: A Cross-Sectional Study

      Faerron Guzmán, Carlos A; Montero-Zamora, Pablo; Bolaños-Palmieri, Carolina; Araya-Amador, Juliana; Benavides-Rawson, Jorge; Ávila-Agüero, María L (Cureus, Inc., 2021-10-15)
      Since 2020, the COVID-19 pandemic has had a significant impact on morbidity and mortality around the world. As one of the most successful and cost-effective health interventions for preventing infectious diseases, immunization against SARS-CoV-2, is at the moment the most effective strategy for controlling the current pandemic. Despite the high vaccine acceptance rates that countries such as Costa Rica have shown in the past, the public acceptance of the COVID-19 vaccine is still uncertain. The purpose of this study was to examine adults' willingness to get a novel COVID-19 vaccine and its potential predictors in Costa Rica. We conducted a cross-sectional study comprising a sample of 4717 adult participants living in Costa Rica who participated in a voluntary electronic survey regarding their intent to get a future COVID-19 vaccine. Results suggest that a high percentage (86.1%) of Costa Ricans aged 18 or more would be willing to be vaccinated once a safe and effective vaccine is approved and distributed in the country. Some relevant significant predictors of willingness to get a COVID-19 vaccine in Costa Rica were higher income, being male, work in the health care sector, and having a relative or a close acquaintance diagnosed with COVID-19. Our findings suggest that it is essential to concentrate efforts on the immediate development of culturally appropriate communication, dissemination, and implementation strategies to maximize immunization against SARS-CoV-2 in Costa Rica.