Health
Holy Grail treatment for COVID-19 remains out of reach. But options exist – CBC.ca
A COVID-19 treatment showing early signs of promise is at risk of being overshadowed by the vaccine rollout.
Monoclonal antibody treatments have been used by doctors in the United States on people like President Donald Trump, who fought COVID-19 in October, and on others in an effort to try to keep people with the coronavirus out of hospital. Health Canada has authorized one such drug from Eli Lilly, pending the results of trials to verify its benefits to patients.
Our immune system naturally makes antibodies to fight off the coronavirus. But it can take several weeks to gain full protection and some patients go downhill too quickly to wait. The aim of giving a one-time monoclonal antibody treatment is to seize a window of opportunity early in the course of COVID-19.
Dr. Srinivas Murthy, an infectious disease physician and a clinical associate professor in pediatrics at the University of British Columbia in Vancouver, said a treatment that’s simple and works to prevent COVID-19 from becoming severe is “the Holy Grail right now.”
“The challenge with any of those treatments is that you have to give it to a lot of people to prevent hospitalizations or severe disease because a lot of people have mild-COVID,” Murthy said. “Whatever you give has to be safe and convenient otherwise people won’t take it.”
The two monoclonal antibody treatments at the forefront of COVID-19 studies are Eli Lilly’s product, bamlanivimab, and a cocktail from Regeneron Pharmaceuticals that Trump received.
Dr. Saahir Khan, a clinical professor in infectious diseases at the University of Southern California in Los Angeles, is a co-principal investigator of a clinical trial evaluating bamlanivimab.
“The goal of this trial is to find treatment that prevents these patients with what we call mild-to-moderate disease progressing to severe disease that would require hospitalization,” Khan said in an interview.
Elderly people and those with underlying medical conditions such as heart disease or diabetes are at a greater risk of developing severe COVID. About 79 million cases have been reported worldwide. And the need for such drugs is especially pressing as the number of cases continues to climb.
“Unfortunately, as bad as it is now, it’s almost a foregone conclusion that it’s going to get worse for the next month,” Khan said.
Vaccines offer hope, but health officials caution they won’t be widely available to the general public in Canada for a few months.
In the meantime, effective treatments could help reduce the severity of disease and hospitalization rates, lower death rates and flatten the curve so health systems aren’t overwhelmed.
The oldest way to apply antibody treatments is to use the plasma from blood of people who’ve naturally recovered from COVID-19 and give those antibodies to a patient in need. That’s known as convalescent serum or polyclonal antibodies.
WATCH | Promise and doubts on convalescent serum for COVID-19:
An Indian study is casting doubt on the effectiveness of giving patients sick with COVID-19 the blood plasma of others who have battled it, to transfer antibodies. But Canadian researchers say it could still work, if the antibody levels are tested. 3:27
But convalescent serum includes a range of antibodies to various infections, such as influenza, as well as the virus that causes COVID-19, called SARS-CoV-2.
Monoclonal antibodies are synthetic, purer than convalescent serum and recognize a specific target, such as the proteins that SARS-CoV-2 uses to make copies of itself.
Before COVID-19 upended lives worldwide, other monoclonal antibody treatments were used to treat rheumatoid arthritis and Crohn’s disease, including those with injections given at home using an auto-injector-type device.
For a treatment showing early promise, there hasn’t been much pick up of monoclonal antibodies in COVID-19.
UBC’s Murthy, who also co-chairs the World Health Organization’s clinical research committee on COVID-19, said monoclonal antibodies haven’t really been embraced in Canada yet because of access and feasibility questions.
To conduct the trial in southern California for instance, Khan’s hospital set up a special tent outside, similar to COVID assessment centres at some Canadian hospitals. The site is staffed by health-care workers wearing full personal protective equipment to minimize the risk of people coming to participate in the trial spreading COVID-19 to any patients or staff.
What’s more, current monoclonal antibody treatments for COVID-19 need to be given by infusion, similar to some chemotherapy agents. Khan said it takes an hour for patients to receive the monoclonal antibodies and then staff need to closely monitor them for another hour to check for any allergic reactions.
By mid-December in the U.S., less than 20 per cent of the doses of monoclonal antibodies that the federal government allocated had been used. Red tape, staff shortages, testing delays and skepticism are keeping patients and doctors from using the drugs. Evidence on their effectiveness is also thin so far.
Competition from vaccines
Meanwhile, hospitals and health-care systems in Canada and the U.S. are devoting more attention and resources to the vaccine rollout.
Dr. Donald Vinh, an infectious disease specialist and medical microbiologist at the McGill University Health Centre in Montreal, said monoclonal antibodies could help people with COVID-19 who need to keep their blood levels of oxygen up, while staying out of hospital.
Vinh, who advises the federal government’s COVID-19 Therapeutics Task Force, said to his knowledge, monoclonal antibodies aren’t being used in Canada to treat COVID. In contrast, Pfizer-BioNtech’s vaccine is going into arms across the country.
“These vaccines are extremely effective in stimulating people to produce polyantibodies that protect you against COVID,” Vinh said.
Matthew Miller, an associate professor at the Institute for Infectious Disease Research at McMaster University in Hamilton, about 70 kilometres southwest of Toronto, said logistical and economic issues are hindering the use of monoclonal antibodies to treat COVID-19.
Before the treatments can be given, people need to be diagnosed with COVID-19 quickly, Miller said. And he estimated monoclonal antibodies are about 1,000 times more expensive than a vaccine.
The U.S. has paid $1,250 US per dose for 950,000 doses of Lilly’s bamlanivimab. Eli Lilly Canada signed an agreement with the federal government to supply 26,000 initial doses of bamlanivimab, also at $1,250 per dose, between December 2020 and February 2021, pending the results of trials to verify its clinical benefits.
To maximize the potential of monoclonal antibodies and to take advantage of when they work best, Miller suggested using them to prevent infection, rather than treat it.
“The sort of obvious settings where these would be really useful is nursing homes, because obviously those people are at a really high risk of dying and that population is usually a population that’s quite hard to vaccinate,” Miller said.
Other people who could potentially receive the preventive option include employees at meat-packing plants with outbreaks, or households with confirmed COVID-19 cases.
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The United States on Thursday raised the pressure on other Group of Seven leaders to share their vaccine hoards to bring an end to the pandemic by pledging to donate 500 million doses of the Pfizer coronavirus vaccine to the world’s poorest countries.
The largest ever vaccine donation by a single country will cost the United States $3.5 billion but Washington expects no quid pro quo or favours for the gift, a senior Biden administration official told reporters.
U.S. President Joe Biden‘s move, on the eve of a summit of the world’s richest democracies, is likely to prompt other leaders to stump up more vaccines, though even vast numbers of vaccines would still not be enough to inoculate all of the world’s poor.
G7 leaders want to vaccinate the world by the end of 2022 to try to halt the COVID-19 pandemic that has killed more than 3.9 million people and devastated the global economy.
A senior Biden administration official described the gesture as a “major step forward that will supercharge the global effort” with the aim of “bringing hope to every corner of the world.” “We really want to underscore that this is fundamentally about a singular objective of saving lives,” the official said, adding that Washington was not seeking favours in exchange for the doses.
Vaccination efforts so far are heavily correlated with wealth: the United States, Europe, Israel and Bahrain are far ahead of other countries. A total of 2.2 billion people have been vaccinated so far out of a world population of nearly 8 billion, based on Johns Hopkins University data.
U.S. drugmaker Pfizer and its German partner BioNTech have agreed to supply the U.S. with the vaccines, delivering 200 million doses in 2021 and 300 million doses in the first half of 2022.
The shots, which will be produced at Pfizer’s U.S. sites, will be supplied at a not-for-profit price.
“Our partnership with the U.S. government will help bring hundreds of millions of doses of our vaccine to the poorest countries around the world as quickly as possible,” said Pfizer Chief Executive Albert Bourla.
‘DROP IN THE BUCKET’
Anti-poverty campaign group Oxfam called for more to be done to increase global production of vaccines.
“Surely, these 500 million vaccine doses are welcome as they will help more than 250 million people, but that’s still a drop in the bucket compared to the need across the world,” said Niko Lusiani, Oxfam America’s vaccine lead.
“We need a transformation toward more distributed vaccine manufacturing so that qualified producers worldwide can produce billions more low-cost doses on their own terms, without intellectual property constraints,” he said in a statement.
Another issue, especially in some poor countries, is the infrastructure for transporting the vaccines which often have to be stored at very cold temperatures.
Biden has also backed calls for a waiver of some vaccine intellectual property rights but there is no international consensus yet on how to proceed.
The new vaccine donations come on top of 80 million doses Washington has already pledged to donate by the end of June. There is also $2 billion in funding earmarked for the COVAX programme led by the World Health Organization (WHO) and the Global Alliance for Vaccines and Immunization (GAVI), the White House said.
GAVI and the WHO welcomed the initiative.
Washington is also taking steps to support local production of COVID-19 vaccines in other countries, including through its Quad initiative with Japan, India and Australia.
(Reporting by Steve Holland in St. Ives, England, Andrea Shalal in Washington and Caroline Copley in Berlin; Writing by Guy Faulconbridge and Keith Weir;Editing by Leslie Adler, David Evans, Emelia Sithole-Matarise, Giles Elgood and Jane Merriman)
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Both the United States and China have pledged large donations of COVID-19 vaccines to countries around the world. Washington has promised 80 million doses, three-quarters of which will be delivered via the international vaccine initiative COVAX, in what has been seen as an effort to counter China’s widening vaccine diplomacy. It began deliveries last week.
China had shipped vaccines to 66 countries in the form of aid, according to state news agency Xinhua. Beijing has not disclosed an overall figure for its donations but Reuters calculations based on publicly available data show at least 16.57 million doses have been delivered. China has also pledged to supply 10 million doses to COVAX.
VACCINES DONATED BY U.S. (plan for the first 25 mln):
Regional partners and priority recipients
COUNTRY/TERRITORY PLEDGED DELIVERED
Including Canada, Mexico, 1 mln to S.Korea in June
South Korea, West Bank and
Gaza, Ukraine, Kosovo,
Haiti, Georgia, Egypt,
Jordan, India, Iraq, Yemen,
United Nations
TOTAL 6 mln 1 mln
Allocations through COVAX
South and Central America
COUNTRY/TERRITORY PLEDGED DELIVERED
Brazil, Argentina, Colombia,
Costa Rica, Peru, Ecuador,
Paraguay, Bolivia,
Guatemala, El Salvador,
Honduras, Panama, Haiti,
Dominican Republic and other
Caribbean Community
(CARICOM) countries
TOTAL 6 mln
Asia
COUNTRY/TERRITORY PLEDGED DELIVERED
India, Nepal, Bangladesh,
Pakistan, Sri Lanka,
Afghanistan, Maldives,
Malaysia, Philippines,
Vietnam, Indonesia,
Thailand, Laos, Papua New
Guinea, Taiwan, and the
Pacific Islands
TOTAL 7 mln
Africa
COUNTRY/TERRITORY PLEDGED DELIVERED
To be selected in
coordination with the
African Union
TOTAL 5 mln
VACCINES DONATED BY CHINA (source – Reuters calculations and official data):
Asia Pacific
COUNTRY/TERRITORY PLEDGED DELIVERED
Afghanistan 400,000
Bangladesh Second batch of First batch of 500,000 delivered
600,000 on May 12
Brunei 52,000 in Feb
Cambodia 1.7 mln as of April 28
Kyrgyzstan 150,000 in March
Laos 300,000 in Feb
800,000 in late March
300,000 in late April
Maldives 200,000 in early March
Mongolia 300,000 in late February
Myanmar 500,000 in early May
Nepal 800,000 in late March
1 mln in early June
Pakistan 500,000 in early Feb
250,000 in Feb
500,000 in March
Philippines 600,000 in late Feb
400,000 in late March
Sri Lanka 600,000 at end March
500,000 in late May
Thailand 500,000 in May
500,000 in June
Timor-Leste 100,000 100,000 in early June
TOTAL 11.052 million
Africa
COUNTRY/TERRITORY PLEDGED DELIVERED
Angola 200,000 in late March
Algeria 200,000 200,000 in Feb
Botswana 200,000 in April
Cameroon 200,000 in April
Congo 100,000 100,000 in March
Egypt 600,000 in March
Ethiopia 300,000 in late March
Equatorial Guinea 100,000 in Feb
Guinea 200,000 in early March
Mozambique 200,000 in late Feb
Namibia 100,000 by early April
Niger 400,000 in late March
Sierra Leone 240,000 by late May
Togo 200,000 in April
Uganda 300,000
Zimbabwe 200,000 in Feb
200,000 in March
100,000 in May
TOTAL 3.74 million
South America
COUNTRY/TERRITORY PLEDGED DELIVERED
Bolivia 100,000 in late Feb
100,000 in late March
Venezuela 500,000 in early March
TOTAL 700,000
Europe & Middle East
COUNTRY/TERRITORY PLEDGED DELIVERED
Belarus 100,000 in Feb
300,000 in May
Georgia 100,000 at end April
Iran 250,000 at end February
Iraq 50,000 in early March
Montenegro 30,000 in early March
North Macedonia 100,000 in May
Syria 150,000 in late April
TOTAL 1.08 million
(Reporting by Roxanne Liu and Ryan Woo in Beijing and Cooper Inveen in Dakar; Additional reporting by MacDonald Dzirutwe in Harare, Asif Shahzad in Islamabad, Gopal Sharma in Kathmandu; Editing by Edwina Gibbs)
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Here’s what you need to know about the coronavirus now:
Australia’s Melbourne to exit lockdown
Australia’s second largest city Melbourne will exit a hard lockdown as planned on Thursday night, Victoria state authorities said, although some restrictions on travel and gatherings would likely remain for another week.
After two weeks in a strict lockdown that forced people to remain at home except for essential business, Melbourne’s five million residents will get more freedom to step outside from 11:59 p.m. local time (1359 GMT) on Thursday.
However, people must stay within 25 km (15 miles) of their homes, officials said, in an effort to stop transmission during an upcoming long weekend. There will also be a total ban on house gatherings and masks will be mandatory indoors.
Deliveries of Thai-made AstraZeneca vaccines delayed
Malaysia and Taiwan are expecting deliveries of AstraZeneca vaccines manufactured in Thailand to be delayed, officials said, the latest countries to report a holdup with orders from the Thai plant.
The delay comes amid concerns over AstraZeneca’s distribution plans in Southeast Asia, which depends on 200 million doses made by Siam Bioscience, a company owned by Thailand’s king that is making vaccines for the first time.
Any questions about Siam Bioscience meeting production targets are sensitive because King Maha Vajiralongkorn is its sole owner. Insulting Thailand’s monarchy is a crime punishable by up to 15 years in prison.
Indonesia aims to speed up vaccinations
President Joko Widodo said on Wednesday he hoped Indonesia’s vaccination rollout will hit one million shots a day by July, as authorities opened up inoculations to anyone aged over 18 in Jakarta to contain increased transmission in the capital.
Health officials in the world’s fourth most populous country, which aims to vaccinate 181.5 million people by next year, are trying to speed up the rollout after facing some supply issues.
The president said he wanted vaccinations to hit a targeted 700,000 doses a day this month and then rise again.
Singapore finds Delta most prevalent among variants
Singapore has found the Delta variant of the coronavirus to be the most prevalent among local cases of variants of concern (VOCs), according to health ministry data, highlighting its level of infectiousness.
There were 449 local cases with VOCs as of May 31, of which 428 were the Delta variant first detected in India and nine of the Beta variant first identified in South Africa.
Singapore reported its 34th death due to COVID-19, taking its toll from the pandemic beyond the 33 casualties recorded during the 2003 Severe Acute Respiratory Syndrome outbreak.
U.S. forming expert groups on lifting travel restrictions
The Biden administration is forming expert working groups with Canada, Mexico, the European Union and the United Kingdom to determine how best to safely restart travel after 15 months of pandemic restrictions, a White House official said on Tuesday.
Another U.S. official said the administration will not move quickly to lift orders that bar people from much of the world from entering the United States because of the time it will take for the groups to do their work.
The groups will be led by the White House COVID Response Team and the National Security Council and include the Centers for Disease Control and other U.S. agencies.
(Compiled by Linda Noakes; Editing by Giles Elgood)
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