1 March 2021 Update on vaccines, new treatment, origin and variants

Mon, 03/01/2021 - 21:20

Dear colleagues,

It is increasingly difficult to stay up-to-date by relying on published (even preprint) papers only. Hopefully, this “new standard” is still reversible as soon as “the heath of the pandemic” will calm down.  Anyhow, I’ll try to deal with the latest in vaccines, some new treatments, contaminated food and variants today.

  1. Update on vaccines
  • Ep 113.1 FDA file of the Janssen Ad26-COV2-S single dose vaccine: It is well balanced
    • Over 25,000 subjects in the 18-65 yrs group, but also > 14,000 over 60. However, the number over 75 was limited to  1541 (Table 7).  
    • Of the latter over 50 % had comorbidities, but those were mainly hypertension, obesity and type 2 diabetes (Table 8).

The vaccine efficacy against moderate to severe/critical COVID

    • Was similar across age groups (Table 12). 
    • A clear difference according to region 2 weeks injection: USA  74 %;  Latin America 64 %, South-Africa 52 % (but 64 % after 28 days   (Table 12).  This may reflect the virus variants present: Wuhan-H1 variant D614G in the U.S. (96.4% of sequenced cases), 20H/501Y.V2 variant (B.1.351) in South Africa (94.5% of sequenced cases), and variant of the P.2 lineage in Brazil (69.4% of sequenced cases, with the remaining 30.6% Wuhan-H1 variant D614G). There were no cases identified as B.1.1.7 or P1 lineages as of February 12, 2021.
    • Some comorbidities are associated with lower vaccine efficacy: HIV, hypertension and type 2 diabetes.  Also age over 60 plays a role here (Table 13).
    • In the  subjects with pre-existing COVID Ab, very few cases were found, but the (additional) protection by the vaccine seemed weak (Table 14).

Efficacy to severe COVID, hospitalization etc  was higher (70-90 %) Table 16-18.  All 7 COVID related deaths were in the placebo group and in South-Africa (Table 19).  There was also a strong reduction of all-cause mortality (Table 21).

The protection against asymptomatic infection was in the 65-75 % range,n but was only evident after 29 days (Table 20).    

The side effects were acceptable.

See also comment in Nature Ep 113-1B

To put these results into perspective, I tried to find some more info on other vaccines with as yet no formally published results, but only releases from the companies or articles in general press:

  • Ep 113-2: Novavax COVID-19 (2 doses of the recombinant S protein in a “matrix” adjuvant):
    • They claim 90 % efficacy in UK at least 7 days after the 2nd dose (while the B.117 variant was taking over the epidemic) .  This is based on a total of 62 symptomatic COVID cases.  The only info on the demographics isd that 27 % was over 65, but no info on co-morbidities.
    • In South-Africa (with the escape variant 90 % circulating) the efficacy was 60 % in the HIV-negative population, based on a total of 44 symptomatic COVID cases. 
    • The efficacy in HIV(+) was lower, but not clear how much.
    • They also claim that the vaccine had a protective effect against the escape variant in people who has been infected previously with the “wild-type, but again no clear numbers.      

 

  • Episode 113-3 CoronaVac  (inactivated by Sinovac) 2 doses.  If I understand well, it was tested in healthcare workers 18-60 yrs) in Brazil and Turkey. 
    • The efficacy (in Brazil?) based on 253 cases was 50.65% for all symptomatic cases, 83.70% for cases requiring medical treatment, and 100.00% for hospitalized, severe, and fatal cases.  Presumable the Brazilian variant plays a role here?
    • In Turkey: Based on an analysis of 29 cases, the efficacy rate for COVID-19 prevention was 91.25%.
  • Ep 113-4 and 5: two papers on the BBIBP-CorV (inactivated by Sinopharm), claiming a 86 % or 79 % efficacy against severe disease.  Apparently tens of million doses have already been administered in at least a dozen of countries.  But nowhere I can find more scientific data. Why not? Frustrating.
  • And some good news: in a elderly home in Ansegem (Flanders), where almost everybody (residents and staff) has been fully vaccinated, nevertheless a dozen of people is infected wit the South-African variant, but nobody is ill.  See https://www.vrt.be/vrtnws/nl/2021/02/28/uitbraak-zuid-afrikaanse-coronavariant-in-woonzorgcentrum-in-anz/  (Sorry only available in Dutch).

 

  1. Novel therapeutics
  • Ep 113-6 and -7: over the weekend we learned that the inhalation  and or IV  granulocyte-monocyte stimulating factor (GM-CSF, sargramostim  or Leukine®) has a positive effect on oxygenation  in patients with acute respiratory failure.  Moreover, there was an increase in COVID-specific CD4 and CD8 T cells and stable or declining levels of inflammatory markers.  (See published protocol and press release).  Curious to read a paper to understand the mechanism…
  • Ep 113-8: the same group of researchers also investigates the effect of a C5 inhibitor in a similar group of patients, but no rekeased results yet…
  • An interesting website on novel therapeutics https://drive.google.com/file/d/1ht7XnCivXVeCd2E8bHd-85M_5mtF-wZ9/view

 

  1. Origin of SARS-CoV-2?
  • Ep 113-9-13 : the WHO team, visiting Wuhan a year after the outbreak, has not been able to track down the origin of course.  Meanwhile, there have been a few (preprint) papers from Singapore and China suggesting that the virus could remain infective on frozen meat.  This hypothesis implies the possibility that the virus actually could have been imported into China.  In view of the very likely bat origin, it seems more likely that raccoons, ferrets or minks could be involved as intermediary host and ultimate infection to human has occurred either in farms or “wet markets”.  Will we ever know?  
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  1. Overview on variants: (Ep 113-14) colleague Patrick Smits provided us with this very nice series of slides that summarize a lot of data in a very concise overview. Thanks!

Best wishes,

Guido