LIVE BLOG: R&D response to COVID-19 pandemic

02 Dec 2021 | Live Blog
Covid 19 blog

The coronavirus pandemic is disrupting universities and research institutes across the world. But the same institutions are also working very hard to find out how the disease can be stopped and its effects mitigated.

Follow this live blog for the latest updates on how the crisis is impacting research and innovation, and what governments, funders, companies, universities, associations and scientists are doing to stop or cope with the pandemic.

You can read the full archive of this blog here and here.

The UK Medicines and Healthcare products Agency has become the first to approve Merck and Co’s oral antiviral drug Lagevrio, after concluding it reduces the risk of hospitalisation and death in people with mild to moderate COVID-19 who are at increased risk of developing severe disease.

Lagevrio works by preventing the SARS-CoV-2 virus from replicating, keeping virus levels low in the body and reducing the severity of the disease. It is most effective when taken during the early stages of infection and so the recommendation is to use it as soon as possible following a positive COVID-19 test, and within five days of symptoms onset.

The approval is for treating people who have mild to moderate COVID-19 and at least one risk factor for developing severe illness, such as obesity, older age (>60 years), diabetes or heart disease.

June Raine, MHRA Chief Executive said Lagevrio is the first antiviral for COVID-19 that can be taken by mouth rather than administered intravenously. “This is important, because it means it can be administered outside of a hospital setting, before COVID-19 has progressed to a severe stage,” she said.

Merck’s application to the US Food and Drug Administration for Emergency Use Authorisation of Lagevrio is under review, while the European Medicines Agency has started a rolling review of the marketing authorisation application.

The US government has agreed to purchase 1.7 million courses of treatment, while the UK has placed an initial order for 480,000, which will be used in a real world trial designed to gather further data on the effectiveness of Lagevrio.

The damage caused by COVID-19 to the lungs’ smallest blood vessels has been intricately imaged by scientists from the European Synchrotron Research Facility and University College London (UCL), using high-energy X-rays emitted by a newly updated particle accelerator.

The new imaging technology, Hierarchical Phase Contrast Tomography (HiP-CT), enables 3D mapping across a range of scales, allowing clinicians to view the whole organ as never before by imaging it as a whole and then zooming down to cellular level.

The technique relies on X-rays generated by the European Synchrotron particle accelerator in Grenoble, France, which following a recent upgrade, now provides the brightest source of X-rays in the world, at 100 billion times brighter than a hospital X-ray.

The enables the imaging of blood vessels down to five microns in diameter, a tenth of the diameter of a hair, in an intact human lung. In comparison a clinical grade CT scan only resolves blood vessels that are about 100 times larger, around 1mm in diameter.

Using HiP-CT, the research team in the UK, France and Germany, have seen how severe COVID-19 infection shunts blood between the two separate systems in the lungs, moving it from the capillaries which oxygenate the blood, to those which feed the lung tissue itself. Such cross-linking stops the patient’s blood from being properly oxygenated, a finding which was previously hypothesised but not proven.

Claire Walsh of UCL’s Department of Mechanical Engineering said the ability to see organs across scales like this will “really be revolutionary” for medical imaging. “As we start to link our HiP-CT images to clinical images through artificial intelligence techniques, we will for the first time be able to highly accurately validate ambiguous findings in clinical images,” she said.

Pfizer/BioNTech’s mRNA vaccine for COVID-19 induces a sustained and fully functional memory T cell immune response for up to six months after the second dose, according to a new study of 71 healthcare workers and scientists in Italy who received the vaccine.

The research by Gisella Guerrera and colleagues at the Santa Lucia Foundation in Rome, indicates the vaccine offers long-lived immunity against SARS-CoV-2, creating a persistent reservoir of potent cells specifically targeted to the virus.

The research published in Science this week found that vaccination induced an anti-viral memory T cell response that included both CD4+ and CD8+ stem memory cells that can perform multiple immune functions, from spurring cytokine production to stimulate the immune system, to interacting with B cells to promote antibody production.

It is far harder to measure T cells than antibodies, meaning antibody levels are looked to in assessing waning immune responses. The researchers suggest that with more than 90% of the vaccinated study subjects developing T cells with these lasting protective features, their findings could have implications for discussions about the use of third “booster” doses of the vaccine.

US biotech Novavax announced it completed the rolling submission of data on its COVID-19 vaccine to the European Medicines Agency (EMA) and the Canadian regulator Health Canada, as the vaccine received its first approval from the regulator in Indonesia.

The product, NVX-CoV2373, is the only protein-based vaccine to have gained an approval.

In a Brazil/US clinical trial it was over 100% effective in preventing serious infections, and 90.4% effective overall.

In a phase III trial involving 15,000 participants in the UK, the vaccine demonstrated efficacy of 96.4% against the original virus strain, 86.3% against the Alpha variant and 89.7% efficacy overall. 

Novavax has a manufacturing partnership with the Serum Institute of India, the world's largest supplier of COVID-19 vaccines.

“This is a landmark moment for Novavax and our partner, Serum Institute of India, and it is the first of many authorisations that Novavax expects in the coming weeks and months for our vaccine globally,” said Stanley Erck, Novavax CEO.

The vaccine was engineered from the genetic sequence of the first strain of SARS-CoV-2, using Novavax's recombinant nanoparticle technology to generate antigen derived from the coronavirus spike protein.

It will be packaged as a ready-to-use liquid formulation in a vial containing ten doses, and can be stored in conventional refrigerators, meaning it is possible to distribute it through existing vaccine supply channels, potentially increasing access in hard-to-reach areas of Indonesia and other countries with low COVID-19 vaccination rates.

"Access to supply of a safe and highly effective vaccine, coupled with the ease of its distribution, should be a critical enabler to help Indonesia control the current coronavirus outbreak," said Adar Poonawalla, CEO of the Serum Institute of India.

Vaccine hesitancy is one of the major challenges in containing the COVID-19 pandemic and previous studies have revealed that mass communication, through television and radio adverts, is not a very effective means of persuading the hesitant.

It is known that having the chance to discuss your particular concerns with an expert whom you trust can be more persuasive, but having a face-to-face talk with every vaccine-hesitant individual is impractical.

To overcome this problem, a team of cognitive scientists from the Institut Jean-Nicod and the Laboratoire de Neurosciences Cognitives et Computationnelles created a chatbot that provides users with answers to 51 common questions about COVID-19 vaccines.

Chatbots have the advantage of offering quick, personalised Q and A sessions while reaching a large number of people.

The team tested their chatbot with 338 individuals and compared their reactions to those of a control group of 305 participants who read a brief paragraph that gave information about COVID-19 vaccines.

After a few minutes of interaction with the chatbot, the number of participants with positive views of vaccination increased by 37%. People were also more open to getting vaccinated after using the chatbot: declarations of vaccine refusal fell 20%. Such changes in attitude were negligible in the control group.

It remains to be seen whether the effects of chatbot interaction are lasting, and whether they are the same across age groups, and among those most resistant to vaccination.

Nevertheless, the study demonstrated that a chatbot can indirectly reach a very large audience: half of the experimental group later tried to persuade others to get vaccinated, with three-quarters of them stating they drew on information provided by the chatbot to do so.

The results of a new randomised clinical trial, published in The Lancet Global Health, have demonstrated that using the depression treatment fluvoxamine to treat high-risk outpatients with early-diagnosed COVID-19 reduces the need for prolonged observation in an emergency setting or hospitalisation, compared to a control group who received a placebo.

The results represent an important step in understanding the role of fluvoxamine for outpatients with early diagnosed, symptomatic COVID-19 and reinforce the concept that it is possible to generate rapid and high-quality evidence during the pandemic.

“Recent vaccination developments and campaigns have proved to be effective and important in reducing the number of new symptomatic cases, hospitalisations, and deaths due to COVID-19. However, COVID-19 still poses a risk to individuals in countries with low resources and limited access to vaccinations,” said Edward Mills of McMaster University, Canada, co-principal investigator on the trial.

“Identifying inexpensive, widely available, and effective therapies against COVID-19 is therefore of great importance, and repurposing existing medications that are widely available and have well-understood safety profiles is of particular interest.” Mills said.

Fluvoxamine is a selective serotonin reuptake inhibitor used to treat mental health conditions such as depression and obsessive-compulsive disorders. It was chosen for study as a potential treatment for COVID-19 due to its anti-inflammatory properties.

The trial began in June 2020 with the fluvoxamine arm beginning in January 2021, recruiting a cohort of Brazilian adults who were symptomatic, had tested positive for COVID-19, were unvaccinated, and had at least one additional criterion for high risk.

A total of 741 participants were given 100mg of fluvoxamine twice daily for ten days and 756 participants received a placebo. The trial participants were observed for 28 days post-treatment, with the main outcome of the trial being patients spending more than six hours receiving physician treatment at a specialised COVID-19 emergency setting, or hospitalisation.

Of the 741 participants who received fluvoxamine, 79 (10.6%) required an extended stay for more than six hours in an emergency setting or hospitalisation, compared to 119 (15.7%) of participants who received the placebo. These results demonstrated an absolute reduction in the risk of prolonged hospitalisation/prolonged emergency care of 5% with a relative risk reduction of 32%.

An Anglo-German team of researchers has identified a potential new treatment that suppresses the replication of SARS-CoV-2, after showing that cells infected with virus can only generate more viruses when a particular metabolic pathway is activated.

A synthetic version of vitamin B1, which is a known inhibitor of this pentose phosphate pathway, blocked SARS-CoV-2 replication and the virus could not replicate in infected cells.

The research, by scientists at the University of Kent and Goethe-University Frankfurt, found synthetic vitamin B1 also increased the antiviral activity of another drug. This shows that pentose phosphate pathway inhibitors are a potential new treatment option for COVID-19, both on their own and in combination with other treatments.

In addition, the mechanism differs from that of other antiviral COVID-19 drugs, and viruses resistant to these may be sensitive synthetic vitamin B1.

Martin Michaelis, professor of molecular medicine at Kent University said, “This is a breakthrough in the research of COVID-19 treatments. Since resistance development is a big problem in the treatment of viral diseases, having therapies that use different targets is very important and provides further hope for developing the most effective treatments for COVID-19.”

Co-researcher, Jindrich Cinatl of the Institute for Medical Virology at Goethe-University Frankfurt, said, “Targeting virus-induced changes in the host cell metabolism is an attractive way to interfere specifically with the virus replication process.”

A large-scale government subsidy aimed at encouraging people to eat out in restaurants in the wake of the first 2020 COVID-19 wave in the UK, accelerated a second COVID-19 wave, according to new research.

The COVID-19 pandemic hurt economies around the world, with the hospitality sector particularly vulnerable, due to the decline in tourism and leisure activities.

This rippled across economies, as hospitality workers then reduce their spending and had trouble meeting basic expenses. Some governments used fiscal policy to help the hospitality sector by stimulating demand. One example is the UK Eat-Out-To-Help-Out scheme, which had the inadvertent effect of promoting COVID-19 infections, according to research by Thiemo Fetzer of the Department of Economics at Warwick University.

The scheme, designed to encourage demand for hospitality and restaurants, directly subsidised the cost of meals and non-alcoholic drinks by up to 50% in participating restaurants across the UK for meals served on all Mondays to Wednesdays from 3 August to 31 August 2020.

The discount was capped at a maximum of £10 per person, but there was no limit on how often people could benefit. Aggregate data suggest that the government subsidised 160 million meals, costing the taxpayer £849 million. Restaurant visits increased dramatically on Monday to Wednesday. Official government statistics released at the end of January 2021 suggest that at least 59,981 businesses registered for the scheme.

Areas with higher participation in the Eat-Out-To-Help-Out scheme saw both a notable increase in new COVID-19 infection clusters within a week of the scheme starting, and a deceleration in infections within two weeks of the scheme ending.

Areas that had notable rainfall during the prime lunch and dinner hours on days the scheme was active, making customers less likely to visit restaurants to take advantage of the subsidised meals, had a lower infection rate.

The empirical estimates suggest that the scheme may have been responsible for around 11% of all new detected COVID-19 clusters emerging during August and into early September in the UK.

A key question about SARS-CoV-2 is whether it is behaving, or will behave, as a seasonal virus like influenza, or whether it will be equally transmitted during any time of the year.

Now, a new study led by the Barcelona Institute for Global Health (ISGlobal), has provided evidence that COVID-19 is a seasonal infection linked to low temperatures and humidity, much like flu.

The results, published in Nature Computational Science, also highlight the considerable contribution of airborne SARS-CoV-2 transmission to the spread of infection and the need to promote air hygiene measures.

“The question of whether COVID-19 is a genuine seasonal disease becomes increasingly central, with implications for determining effective intervention measures,” said Xavier Rodó, director of the Climate and Health programme at ISGlobal and coordinator of the study.

Rodó and colleagues first analysed the association of temperature and humidity in the initial phase of SARS-CoV-2 spread in 162 countries across five continents, before changes in human behaviour and public health policies were put into place. The results show a negative relationship between the transmission rate (R0) and both temperature and humidity at the global scale: higher transmission rates were associated with lower temperatures and humidity.

The researchers then analysed how this association between climate and disease evolved over time, and whether it was consistent at different geographical scales, using a statistical method that was specifically developed to identify similar patterns of variation at different windows of time.

Again, they found a strong negative association for short time windows between disease, in terms of number of cases and climate, with reference to temperature and humidity. There were consistent patterns during the first, second and third waves of the pandemic at different spatial scales: worldwide, at country level, down to individual regions within highly affected countries, where they looked at Lombardy, Thüringen and Catalonia, and even to the city level in the case of Barcelona.

The first epidemic waves waned as temperature and humidity rose, and the second wave rose as temperatures and humidity fell. However, this pattern was broken during summertime in all continents. “This could be explained by several factors, including mass gatherings of young people, tourism, and air conditioning, among others,” said Alejandro Fontal, first author of the study.

Applying the model in the southern hemisphere, where the virus arrived later, the same negative correlation was observed.

Finally, using an epidemiological model, the researchers showed that incorporating temperature into the transmission rate works better for predicting the rise and fall of the different waves, particularly the first and third ones in Europe. “Altogether, our findings support the view of COVID-19 as a true seasonal low-temperature infection, similar to influenza and to the more benign circulating coronaviruses,” said Rodó.

The research also highlights the need to include meteorological parameters in the evaluation and planning of control measures. 

EMA’s human medicines committee has said a booster dose of Moderna’s COVID-19 vaccine Spikevax may be considered in people aged 18 years and above, after reviewing data showing a third dose given 6 to 8 months after the second dose led to a rise in antibody levels in adults whose antibody levels were waning.

The booster dose consists of half the dose used for the primary vaccination schedule.

Current data indicate the pattern of side effects after the booster is similar to what occurs after the second dose. The risk of inflammatory heart conditions or other very rare side effects after a booster is being carefully monitored, EMA said.

EMA does not dictate vaccines policy at a national level, but its approval means public health bodies may issue official recommendations on the use of booster doses, taking into account the local epidemiological situation, as well as new effectiveness data and the fact there is limited safety data for the booster dose.

Earlier in October EMA concluded that a booster dose of Pfizer/BioNTech’s vaccine may be considered at least six months after the second dose for people aged 18 years and older.

Subscribe to Live Blog Entries