The granting of emergency use designation to COVID-19 candidate vaccines: implications for COVID-19 vaccine trials

Expediting approval for medical countermeasures to address high burden disease: an ethical justification to move beyond emergency use authorisation

Addressing global health crises requires a receptive and expedient policy environment to minimise delays in making available potentially life-saving technologies. Over time, the policy environment has adapted to ensure that communities have expedited access to promising technologies, such as vaccines, that can mitigate morbidity and mortality. Emergency authorisations are one such policy mechanism. While these have been employed successfully for several diseases, such as influenza, Ebola and COVID-19, the policy mechanism is tied to contexts where key bodies have designated the disease an 'emergency', whereas no equivalent mechanism exists for those failing to acquire the designation (eg, malaria and tuberculosis). In this paper, we examine ethical issues associated with emergency authorisations. We argue that there is no moral difference between those diseases considered emergencies and many that fail to be designated as such with respect to impact on affected communities. Thus, tying access to an expedient policy mechanism for approval to an emergency designation is ethically unjustified-it should be based on considerations of risks and benefits, the disease burden and the values of the communities that carry those risks and not contingent on if the disease is designated an emergency. We suggest the need to further enhance the policy environment to ensure access to similar expedited approval programmes irrespective of if a disease is an emergency. Levelling the field for access to expedited approval programmes across diseases can help in moving towards achieving global health equity but is not a panacea.

“We are Tired but Do Not Give Up” the Dilemma and Challenges of Primary Nurses Facing the Omicron Variant: Qualitative Research

Background

Everyone becomes aware due to the epidemic, especially primary department nurses. The significance of their experiences teaches nurses how to take care of themselves and be successful in their caregiving.

Objective

The purpose of this study was to investigate the perceptions of nurses working in primary care settings in rural regions during the omicron variant pandemic.

Methods

On the basis of the Nvivo 12 analytic approach, extensive semi-structured interviews were used to perform this qualitative study. 20 interviews later, data saturation had been reached. Data collecting was place from February to March 2022 for a month. The following participant characteristics were discovered through semi-structured interviews with 20 nurse participants. Ages of the participants, who were split between eight men and twelve women, varied from 28 to 43 years (average age 36.4 years). The majority (75% of them) had a vocational education, and their years of experience ranged from five to fifteen (average 11 years).

Results

4 topics and 7 sub-themes' results. The results' fundamental message is: The Nursing Clinical Practice Dilemma, school district, virus type uncertainty Indigenous peoples do not adhere to the concept of the afterlife. Must Be Excited and Alert; School Cluster; Virus Type Confusion; Non-Belief in Covid; and the Dilemma of Nursing in Clinical Practice are the Overarching Themes of This Study.

Conclusion

Making innovations to increase motivation thereby reducing mental and physical fatigue are the implications of the results of this study. Further exploration of the readiness of nurses to treat patients in the main department is believed to be beneficial for the results of this study.

Key ethical issues encountered during COVID-19 research: a thematic analysis of perspectives from South African research ethics committees

BACKGROUND

The COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health Research Ethics Council (NHREC) also left RECs without national guidance for a significant duration of the COVID-19 pandemic. We conducted a qualitative descriptive study that explored the perspectives and experiences of RECs regarding the ethical challenges of COVID-19 research in South Africa.

METHODS

We conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research from January to April 2021. In-depth interviews were conducted remotely via Zoom. Interviews (60-125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. Audio-recordings were transcribed verbatim and field notes were converted into data documents. Line-by-line coding of transcripts was performed, and data were organised into themes and sub-themes. An inductive approach to thematic analysis was used to analyse data.

RESULTS

Five main themes were identified, namely: rapidly evolving research ethics landscape, extreme vulnerability of research participants, unique challenges to informed consent, challenges to community engagement during COVID-19, and overlapping research ethics and public health equity issues. Sub-themes were identified for each main theme.

CONCLUSIONS

Numerous, significant ethical complexities and challenges were identified by South African REC members in the review of COVID-19 related research. While RECs are resilient and adaptable, reviewer and REC member fatigue were major concerns. The numerous ethical issues identified also highlight the need for research ethics teaching and training, especially in informed consent, as well as the urgent requirement for the development of national guidelines for research ethics during public health emergencies. Further, comparative analysis between different countries is needed to develop the discourse around African RECs and COVID-19 research ethics issues.

Fast Methods for Drug Approval: Research Perspectives for Pandemic Preparedness

Public heath emergencies such as the outbreak of novel infectious diseases represent a major challenge for drug regulatory bodies, practitioners, and scientific communities. In such critical situations drug regulators and public health practitioners base their decisions on evidence generated and synthesised by scientists. The urgency and novelty of the situation create high levels of uncertainty concerning the safety and effectiveness of drugs. One key tool to mitigate such emergencies is pandemic preparedness. There seems to be, however, a lack of scholarly work on methodology for assessments of new or existing drugs during a pandemic. Issues related to risk attitudes, evidence production and evidence synthesis for drug approval require closer attention. This manuscript, therefore, engages in a conceptual analysis of relevant issues of drug assessment during a pandemic. To this end, we rely in our analysis on recent discussions in the philosophy of science and the philosophy of medicine. Important unanswered foundational questions are identified and possible ways to answer them are considered. Similar problems often have similar solutions, hence studying similar situations can provide important clues. We consider drug assessments of orphan drugs and drug assessments during endemics as similar to drug assessment during a pandemic. Furthermore, other scientific fields which cannot carry out controlled experiments may guide the methodology to draw defeasible causal inferences from imperfect data. Future contributions on methodologies for addressing the issues raised here will indeed have great potential to improve pandemic preparedness.

Safety, effectiveness and hesitancy of COVID-19 vaccination in children: A cross-sectional study in Pakistan

Background

The elevated risk of serious complications like myocarditis and pericarditis after COVID-19 vaccination, especially in adolescent has been reported in some instances that need to be tested in regional populations and different ethnicity groups. The purpose of the study was to evaluate the side effects, hesitancy, and effectiveness outcomes following COVID-19 vaccination among children in Pakistan.

Methods

The study was planned using a cross-sectional design and data from Children and Adolescents (CA) was collected through a convenient sampling method using a validated questionnaire between February to July 2022. A total of 1,108 CA between the age of 12-18 years who received one or two doses of vaccine were selected and data were collected through direct interviews with respondents.

Results

The results showed that among 99.8% of respondents who received the Pfizer COVID-19 vaccine, 72.3% of respondents were partially vaccinated (with one dose) while 27.7% were fully vaccinated (with two doses). COVID vaccination regime had a favorable safety profile in children as compared to adults. Vaccine hesitancy in children was reported to be 52.4% and the most common reasons for hesitance were the assumption that the vaccine is not safe (23.7%), the vaccine is not required (19.6%) and the vaccine is not effective (10.4%). The reported side effects were mainly mild (88.5%) followed by moderate (10.6%) and only 0.8% were of severe intensity. Post-vaccination local side effects of mild intensity were common with an onset of an average of 24 h (68%) and a duration of 2-3 days (60.6%). The reported side effects were significantly associated with gender (p = 0.00) while age had no significant effect on the occurrence of side effects. Overall, the vaccine was well tolerated by children and adolescents and was effective in preventing the reoccurrence of COVID-19 infection in 99.9% of participants.

Conclusion

COVID-19 vaccine by Pfizer approved by the FDA for use in CA 12-18 years of age was well tolerated with a good safety profile and no serious adverse drug reactions were reported. The vaccine side effects were mild (88.5%) and lasted for an average of 2-3 days only (60.4%). The vaccine was effective in safeguarding Children against COVID-19 infection.

Effect of vaccination against Covid-19 one year after its introduction in Brazil

BACKGROUND

Worldwide, several efforts have been made to develop, distribute and administer safe and effective vaccines to reduce morbidity and mortality and control the Covid-19 pandemic. This study aimed to analyze the effect of vaccination against Covid-19, one year after its introduction in Brazil.

METHODS

An ecological study that analyzed the general effect of vaccination against Covid-19 on disease morbidity and mortality indicators among the Brazilian population aged 18 years or older per epidemiological week (EW), comparing the pre and postvaccination period. Morbidity and mortality indicators were calculated from secondary databases (hospitalization rate, severity, case fatality rate and mortality) and vaccination coverage by age groups (18 to 59 years and 60 years or older). Morbimortality trends were estimated using the JoinPoint model and their association with vaccine coverage using the Poisson model.

RESULTS

The average weekly percentage change (AWPC) of morbidity and mortality indicators reduced after the introduction of Covid-19 vaccination: hospitalization rate (from 15.3% to -6.0%), severity (from 0.4% to -0.2%), case fatality rate (from 0.3% to -0.2%) and mortality (from 20.5% to -4.3%). The following indicators were inversely associated with the increase in vaccine coverage against Covid-19: hospitalization (IRR: 0.974), mortality (IRR: 0.975) and lethality for people aged 60 years or older (IRR: 0.997).

CONCLUSIONS

In spite of the three epidemic waves and the circulation of variants of concern, the general effect of vaccination against Covid-19 in reducing the trend of morbidity and mortality from the disease in Brazil was demonstrated. These findings contribute to a better understanding of the mass vaccination program against Covid-19 and may inform future public health policies.

COVID-19 vaccine and menstrual conditions in female: data analysis of the Vaccine Adverse Event Reporting System (VAERS)

BACKGROUND

In reports of adverse reactions following vaccination with the coronavirus disease 2019(COVID-19) vaccines, there have been fewer reports of concern for menstrual disorders in female.

OBJECTIVE

Our study employed Vaccine Adverse Event Reporting System (VAERS) to investigate and analyze the relationship between COVID-19 Vaccines and menstrual disorders in female.

METHODS

We collected reports of menstrual disorders in VAERS from July 2, 1990 to November 12, 2021, and performed a stratified analysis. The potential relationship between COVID-19 vaccine and reports of menstrual disorders was evaluated using the Reporting Odds Ratio (ROR) method.

RESULTS

A total of 14,431 reports of menstrual disorders were included in the study, and 13,118 were associated with COVID-19 vaccine. The ROR was 7.83 (95% confidence interval [95%CI]: 7.39-8.28). The most commonly reported event was Menstruation irregular (4998 reports), and a higher percentage of female aged 30-49 years reported menstrual disorders (42.55%) after exposure to COVID-19 Vaccines. Both for all reports of menstrual disorders (ROR = 5.82; 95%CI: 4.93-6.95) and excluding reports of unknown age (ROR = 13.02; 95%CI: 10.89-15.56),suggest that female age may be associated with menstrual disorders after vaccination with the COVID-19 Vaccines.

CONCLUSION

There is a potential safety signal when the COVID-19 vaccine is administered to young adult female (30-49 years old), resulting in menstrual disorders in. However, due to the well-known limitations of spontaneous reporting data, it is challenging to explicity classify menstrual disorders as an adverse event of the COVID-19 Vaccines, and reports of adverse reactions to COVID-19 Vaccines in this age group should continue to be tracked.

Durability of protection and immunogenicity of AZD1222 (ChAdOx1 nCoV-19) COVID-19 vaccine over 6 months

BackgroundWe report updated safety, efficacy, and immunogenicity of AZD1222 (ChAdOx1 nCoV-19) from an ongoing phase 3 trial.MethodsAdults at increased risk of SARS-CoV-2 infection were randomized (2:1), stratified by age, to receive 2 doses of AZD1222 or placebo. The primary efficacy end point was confirmed SARS-CoV-2 reverse-transcriptase PCR-positive (RT-PCR-positive) symptomatic COVID-19 at 15 or more days after a second dose in baseline SARS-CoV-2-seronegative participants. The 21,634 and 10,816 participants were randomized to AZD1222 and placebo, respectively.FindingsData cutoff for this analysis was July 30, 2021; median follow-up from second dose was 78 and 71 days for the double-blind period (censoring at unblinding or nonstudy COVID-19 vaccination) and 201 and 82 days for the period to nonstudy COVID-19 vaccination (regardless of unblinding) in the AZD1222 and placebo groups, respectively. For the primary efficacy end point in the double-blind period (141 and 184 events; incidence rates: 39.2 and 118.8 per 1,000 person years), vaccine efficacy was 67.0% (P < 0.001). In the period to nonstudy COVID-19 vaccination, incidence of events remained consistently low and stable through 6 months in the AZD1222 group; for the primary efficacy end point (328 and 219 events; incidence rates: 36.4, 108.4) and severe/critical disease (5 and 13 events; incidence rates: 0.6, 6.4), respective vaccine efficacy estimates were 65.1% and 92.1%. AZD1222 elicited humoral immune responses over time, with waning at day 180. No emergent safety issues were seen.ConclusionAZD1222 is safe and well tolerated, demonstrating durable protection and immunogenicity with median follow-up (AZD1222 group) of 6 months.Trial registrationClinicalTrials.gov NCT04516746.FundingAstraZeneca; US government.

Natural inhibitors of SARS-CoV-2 main protease: structure based pharmacophore modeling, molecular docking and molecular dynamic simulation studies

Main protease (M^pro) plays a key role in replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study was designed for finding natural inhibitors of SARS-CoV-2 M^pro by in silico methods. To this end, the co-crystal structure of M^pro with telaprevir was explored and receptor-ligand pharmacophore models were developed and validated using pharmit. The database of “ZINC Natural Products” was screened, and 288 compounds were filtered according to pharmacophore features. In the next step, Lipinski’s rule of five was applied and absorption, distribution, metabolism, excretion, and toxicity (ADMET) of the filtered compounds were calculated using in silico methods. The resulted 15 compounds were docked into the active site of M^pro and those with the highest binding scores and better interaction including ZINC61991204, ZINC67910260, ZINC61991203, and ZINC08790293 were selected. Further analysis by molecular dynamic simulation studies showed that ZINC61991203 and ZINC08790293 dissociated from M^pro active site, while ZINC426421106 and ZINC5481346 were stable. Root mean square deviation (RMSD), radius of gyration (Rg), number of hydrogen bonds between ligand and protein during the time of simulation, and root mean square fluctuations (RMSF) of protein and ligands were calculated, and components of binding free energy were calculated using the molecular mechanic/Poisson-Boltzmann surface area (MM/PBSA) method. The result of all the analysis indicated that ZINC61991204 and ZINC67910260 are drug-like and nontoxic and have a high potential for inhibiting M^pro.

A Thorough Synthesis of Phage Therapy Unit Activity in Poland-Its History, Milestones and International Recognition

The year 2020 marked 15 years of the Phage Therapy Unit in Poland, the inception of which took place just one year after Poland's accession to the European Union (2004). At first sight, it is hard to find any connection between these two events, but in fact joining the European Union entailed the need to adapt the regulatory provisions concerning experimental treatment in humans to those that were in force in the European Union. These changes were a solid foundation for the first phage therapy center in the European Union to start its activity. As the number of centers conducting phage therapy in Europe and in the world constantly and rapidly grows, we want to grasp the opportunity to take a closer look at the over 15-year operation of our site by analyzing its origins, legal aspects at the local and international levels and the impressive number and diversity of cases that have been investigated and treated during this time. This article is a continuation of our work published in 2020 summarizing a 100-year history of the development of phage research in Poland.

Cost-utility-safety analysis of alternative intradermal versus classical intramuscular COVID-19 vaccination

COVID-19 immunization has been shown to be effective in the prevention of COVID-19. Traditionally, two vaccination doses given by intramuscular injection are required. Many scientists present ideas for an alternative administration of COVID-19 for reducing the cost and solving the problem of insufficient COVID-19 vaccine supply. Regarding the new alternative vaccine administration, the important consideration is on cost, utility and safety. Herein, we performed cost-utility-safety analysis of alternative intradermal versus classical intramuscular COVID-19 vaccination. From cost analysis, a 80% cost reduction was derived from using intradermal COVID-19 vaccine administration comparing to intramuscular vaccination. Additional, cost-utility and cost-safety analysis also show that the cost per utility and cost per safety values for intradermal vaccination are lower than those of intramuscular vaccination. According to current research, intradermal immunization is a viable alternative to traditional intramuscular COVID-19 vaccine and may even be superior.

COVID-19 Vaccine Challenges in Developing and Developed Countries

The coronavirus disease 2019 (COVID-19) pandemic has led to significant psychological and economical distress. Within a year after COVID-19 was declared a pandemic, several vaccines against COVID-19 were approved for emergency use. The journey from vaccine discovery to global herd immunity against COVID-19 continues to present significant challenges revolving around its development, affordability, accessibility, and acceptability at both a country level and an individual level. The main challenge faced by developed countries is the acceptability of the COVID-19 vaccine and the main challenge faced by developing countries is the affordability and accessibility of the COVID-19 vaccine.

Biotechnological Perspectives to Combat the COVID-19 Pandemic: Precise Diagnostics and Inevitable Vaccine Paradigms

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause for the ongoing global public health emergency. It is more commonly known as coronavirus disease 2019 (COVID-19); the pandemic threat continues to spread aroundthe world with the fluctuating emergence of its new variants. The severity of COVID-19 ranges from asymptomatic to serious acute respiratory distress syndrome (ARDS), which has led to a high human mortality rate and disruption of socioeconomic well-being. For the restoration of pre-pandemic normalcy, the international scientific community has been conducting research on a war footing to limit extremely pathogenic COVID-19 through diagnosis, treatment, and immunization. Since the first report of COVID-19 viral infection, an array of laboratory-based and point-of-care (POC) approaches have emerged for diagnosing and understanding its status of outbreak. The RT-PCR-based viral nucleic acid test (NAT) is one of the rapidly developed and most used COVID-19 detection approaches. Notably, the current forbidding status of COVID-19 requires the development of safe, targeted vaccines/vaccine injections (shots) that can reduce its associated morbidity and mortality. Massive and accelerated vaccination campaigns would be the most effective and ultimate hope to end the COVID-19 pandemic. Since the SARS-CoV-2 virus outbreak, emerging biotechnologies and their multidisciplinary approaches have accelerated the understanding of molecular details as well as the development of a wide range of diagnostics and potential vaccine candidates, which are indispensable to combating the highly contagious COVID-19. Several vaccine candidates have completed phase III clinical studies and are reported to be effective in immunizing against COVID-19 after their rollout via emergency use authorization (EUA). However, optimizing the type of vaccine candidates and its route of delivery that works best to control viral spread is crucial to face the threatening variants expected to emerge over time. In conclusion, the insights of this review would facilitate the development of more likely diagnostics and ideal vaccines for the global control of COVID-19.

Frequency and outcomes of MRI-detected axillary adenopathy following COVID-19 vaccination

Objectives

To assess the frequency of ipsilateral axillary adenopathy on breast MRI after COVID-19 vaccination. To investigate the duration, outcomes, and associated variables of vaccine-related adenopathy.

Methods

In this retrospective cohort study, our database was queried for patients who underwent breast MRI following COVID-19 vaccination from January 22, 2021, to March 21, 2021. The frequency of ipsilateral axillary adenopathy and possible associated variables were evaluated, including age, personal history of ipsilateral breast cancer, clinical indication for breast MRI, type of vaccine, side of vaccination, number of doses, and number of days between the vaccine and the MRI exam. The outcomes of the adenopathy were investigated, including the duration of adenopathy and biopsy results.

Results

A total of 357 patients were included. The frequency of adenopathy on breast MRI was 29% (104/357 patients). Younger patients and shorter time intervals from the second dose of the vaccine were significantly associated with the development of adenopathy (p = 0.002 for both). Most adenopathy resolved or decreased on follow-up, with 11% of patients presenting persistence of adenopathy up to 64 days after the second dose of the vaccine. Metastatic axillary carcinoma was diagnosed in three patients; all three had a current ipsilateral breast cancer diagnosis.

Conclusions

Vaccine-related adenopathy is a frequent event after COVID-19 vaccination; short-term follow-up is an appropriate clinical approach, except in patients with current ipsilateral breast cancer. Adenopathy may often persist 4–8 weeks after the second dose of the vaccine, thus favoring longer follow-up periods.

Key Points

• MRI-detected ipsilateral axillary adenopathy is a frequent benign finding after mRNA COVID-19 vaccination.

• Axillary adenopathy following COVID-19 vaccination often persists > 4 weeks after vaccination, favoring longer follow-up periods.

• In patients with concurrent ipsilateral breast cancer, axillary adenopathy can represent metastatic carcinoma and follow-up is not appropriate.

A Simplified SARS-CoV-2 Mouse Model Demonstrates Protection by an Oral Replicon-Based mRNA Vaccine

A mouse model of SARS-CoV-2 that can be developed in any molecular biology lab with standard facilities will be valuable in evaluating drugs and vaccines. Here we present a simplified SARS-CoV-2 mouse model exploiting the rapid adenoviral purification method. Mice that are sensitive to SARS-CoV-2 infection were generated by transducing human angiotensin-converting enzyme 2 (hACE2) by an adenovirus. The expression kinetics of the hACE2 in transduced mice were assessed by immunohistochemistry, RT-PCR, and qPCR. Further, the ability of the hACE2 to support viral replication was determined in vitro and in vivo. The hACE2 expression in the lungs of mice was observed for at least nine days after transduction. The murine macrophages expressing hACE2 supported viral replication with detection of high viral titers. Next, in vivo studies were carried out to determine viral replication and lung disease following SARS-CoV-2 challenge. The model supported viral replication, and the challenged mouse developed lung disease characteristic of moderate interstitial pneumonia. Further, we illustrated the utility of the system by demonstrating protection using an oral mRNA vaccine. The multicistronic vaccine design enabled by the viral self-cleaving peptides targets receptor binding domain (RBD), heptad repeat domain (HR), membrane glycoprotein (M) and epitopes of nsp13 of parental SARS-CoV-2. Further, Salmonella and Semliki Forest virus replicon were exploited, respectively, for gene delivery and mRNA expression. We recorded potent cross-protective neutralizing antibodies in immunized mice against the SARS-CoV-2 delta variant. The vaccine protected the mice against viral replication and SARS-CoV-2-induced weight loss and lung pathology. The findings support the suitability of the model for preclinical evaluation of anti-SARS-CoV-2 therapies and vaccines. In addition, the findings provide novel insights into mRNA vaccine design against infectious diseases not limiting to SARS-CoV-2.

Immunometabolism at the service of traditional Chinese medicine

To enhance therapeutic efficacy and reduce adverse effects, ancient practitioners of traditional Chinese medicine (TCM) prescribe combinations of plant species/animal species and minerals designated "TCM formulae" developed based on TCM theory and clinical experience. TCM formulae have been shown to exert curative effects on complex diseases via immune regulation but the underlying mechanisms remain unknown at present. Considerable progress in the field of immunometabolism, referring to alterations in the intracellular metabolism of immune cells that regulate their function, has been made over the past decade. The core context of immunometabolism is regulation of the allocation of metabolic resources supporting host defense and survival, which provides a critical additional dimension and emerging insights into how the immune system and metabolism influence each other during disease progression. This review summarizes research findings on the significant association between the immune function and metabolic remodeling in health and disease as well as the therapeutic modulatory effects of TCM formulae on immunometabolism. Progressive elucidation of the immunometabolic mechanisms involved during the course of TCM treatment continues to aid in the identification of novel potential targets against pathogenicity. In this report, we have provided a comprehensive overview of the benefits of TCM based on regulation of immunometabolism that are potentially applicable for the treatment of modern diseases.

Using a health belief model to assess COVID-19 vaccine intention and hesitancy in Jakarta, Indonesia

Since January 2021, Indonesia has administered a nationwide COVID-19 vaccination. This study examined vaccine intention and identified reasons for vaccine hesitancy in the capital city of Jakarta. This is a cross-sectional online survey using the Health Belief Model (HBM) to assess vaccine intent predictors and describe reasons for hesitancy among Jakarta residents. Among 11,611 respondents, 92.99% (10.797) would like to get vaccinated. This study indicated that all HBM constructs predict vaccine intention (P< 0.05). Those with a high score of perceived susceptibility to the COVID-19 vaccine were significantly predicted vaccine hesitancy (OR = 0.18, 95% CI: 0.16-0.21). Perceived higher benefits of COVID-19 vaccine (OR = 2.91, 95% CI: 2.57-3.28), perceived severity of COVID-19 disease (OR: 1.41, 95% CI: 1.24-1.60), and perceived susceptibility of the current pandemic (OR = 1.21, 95% CI: 1.06-1.38) were significantly predicted vaccination intend. Needle fears, halal concerns, vaccine side effects, and the perception that vaccines could not protect against COVID-19 disease emerged as reasons why a small portion of the respondents (n = 814, 7.23%) are hesitant to get vaccinated. This study demonstrated a high COVID-19 vaccine intention and highlighted the reasons for vaccine refusal, including needle fears, susceptibility to vaccine efficacy, halal issues, and concern about vaccine side effects. The current findings on COVID-19 vaccination show that the government and policymakers should take all necessary steps to remove vaccine hesitancy by increasing awareness of vaccine efficacy and benefit interventions.

"We Are at The Forefront of Rural Areas" Emergency Nurse's Experience During Pandemic: A Qualitative Study

Purpose: The pandemic makes everyone alert, including nurses who are in emergency rooms at community health centers, the importance of their experiences is a lesson for nurses to maintain themselves and be effectivein providing services. This study aimed to explore the experience of nurses who are in emergency rooms at rural area during the coronavirus disease pandemic. Methods: This qualitative research was conducted based on the Nvivo 12 analysis method using in-depth semistructured interviews. Data saturation was reached after 20 interviews were completed. Data collection lasted for 1 month from February to March 2020. Results: Semistructured interviews with 20 nurse participants obtained the following participant characteristics. Eight participants were males and 12 were females with an age ranged from 28 to 43 years (average age 36.4 years). The majority had vocational education (75%), with long experience that ranged from 5 to 15 years (average 11 years). The findings of four themes and seven subthemes. The theme of the findings is Expressions of care, Compliance increases using Personal Protective Equipment (PPE), Focus to refer to, Triage at the forefront. Conclusion: This research reveals that Expressions of care, Compliance increases using PPE, Focus to refer to, Triage at the forefront is the main theme identified in this study. Further investigation of the readiness of nurses in handling patients in the emergency room is considered to be of benefit to the results of this study.

Immunogenicity and Safety of an Intradermal BNT162b2 mRNA Vaccine Booster after Two Doses of Inactivated SARS-CoV-2 Vaccine in Healthy Population

Effective vaccine coverage is urgently needed to tackle the COVID-19 pandemic. Inactivated vaccines have been introduced in many countries for emergency usage, but have only provided limited protection. Heterologous vaccination is a promising strategy to maximise vaccine immunogenicity. Here, we conducted a phase I, randomised control trial to observe the safety and immunogenicity after an intradermal boost, using a fractional dosage (1:5) of BNT162b2 mRNA vaccine in healthy participants in Songkhla, Thailand. In total, 91 volunteers who had been administered with two doses of inactivated SARS-CoV-2 (CoronaVac) were recruited into the study, and then randomised (1:1:1) to received different regimens of the third dose. An intramuscular booster with a full dose of BNT162b2 was included as a conventional control, and a half dose group was included as reciprocal comparator. Both, immediate and delayed adverse events following immunisation (AEFI) were monitored. Humoral and cellular immune responses were examined to observe the booster effects. The intradermal booster provided significantly fewer systemic side effects, from 70% down to 19.4% (p < 0.001); however, they were comparable to local reactions with the conventional intramuscular booster. In the intradermal group after receiving only one fifth of the conventional dosage, serum Anti-RBD IgG was halved compared to the full dose of an intramuscular injection. However, the neutralising function against the Delta strain remained intact. T cell responses were also less effective in the intradermal group compared to the intramuscular booster. Together, the intradermal booster, using a fractional dose of BNT162b2, can reduce systemic reactions and provides a good level and function of antibody responses compared to the conventional booster. This favourable intradermal boosting strategy provides a suitable alternative for vaccines and effective vaccine management to increase the coverage during the vaccine shortage.

Vaccine Development in the Time of COVID-19: The Relevance of the Risklick AI to Assist in Risk Assessment and Optimize Performance

The 2019 coronavirus (COVID-19) pandemic revealed the urgent need for the acceleration of vaccine development worldwide. Rapid vaccine development poses numerous risks for each category of vaccine technology. By using the Risklick artificial intelligence (AI), we estimated the risks associated with all types of COVID-19 vaccine during the early phase of vaccine development. We then performed a postmortem analysis of the probability and the impact matrix calculations by comparing the 2020 prognosis to the contemporary situation. We used the Risklick AI to evaluate the risks and their incidence associated with vaccine development in the early stage of the COVID-19 pandemic. Our analysis revealed the diversity of risks among vaccine technologies currently used by pharmaceutical companies providing vaccines. This analysis highlighted the current and future potential pitfalls connected to vaccine production during the COVID-19 pandemic. Hence, the Risklick AI appears as an essential tool in vaccine development for the treatment of COVID-19 in order to formally anticipate the risks, and increases the overall performance from the production to the distribution of the vaccines. The Risklick AI could, therefore, be extended to other fields of research and development and represent a novel opportunity in the calculation of production-associated risks.

COVID-19 Vaccination Behavior of People Living with HIV: The Mediating Role of Perceived Risk and Vaccination Intention

The COVID-19 vaccination behavior of people living with HIV (PLWH) was examined via a cross-sectional web-based survey of PLWH aged 18 years and older. The survey was conducted from l May to 20 June 2021. The survey included social demographic information; vaccination behavior (B); and questions related to perceived usefulness (PU), perceived risk (PR), subjective norms (SNs), perceived behavior control (PBC), and behavior intention (BI). The associations between the questionnaire variables and COVID-19 vaccination behavior were assessed by calculating the descriptive data, correlation analysis, and structural equation modeling. In total, 43.71% of the 350 eligible respondents had received a COVID-19 vaccine. The differences in COVID-19 vaccination behavior according to age, gender, religious belief, marital status, income, education level, and occupation were not obvious (p > 0.05). PU had a significantly negative effect on PR (p < 0.05). PR had a significantly negative effect on BI (p < 0.05). SNs had a significantly positive effect on BI (p < 0.05). BI had a significantly positive effect on B (p < 0.05). PR fully mediated the effects of PU on BI, BI fully mediated the effects of PR on B, and BI fully mediated the effects of SNs on B (p < 0.05). Health policymakers and medical workers should provide more information about the risks of vaccine application to improve the vaccination behavior of PLWH.

COVID-19 related interdisciplinary methods: Preventing errors and detecting research opportunities

More than 130,000 peer-reviewed studies have been published within one year after COVID-19 emerged in many countries. This large and rapidly growing field may overwhelm the synthesizing abilities of both researchers and policy-makers. To provide a sinopsis, prevent errors, and detect cognitive gaps that may require interdisciplinary research methods, the literature on COVID-19 is summarized, twice. The overall purpose of this study is to generate a dialogue meant to explain the genesis of and/or find remedies for omissions and contradictions. The first review starts in Biology and ends in Policy. Policy is chosen as a destination because it is the setting where cognitive integration must occur. The second review follows the opposite path: it begins with stated policies on COVID-19 and then their assumptions and disciplinary relationships are identified. The purpose of this interdisciplinary method on methods is to yield a relational and explanatory view of the field -one strategy likely to be incomplete but usable when large bodies of literature need to be rapidly summarized. These reviews identify nine inter-related problems, research needs, or omissions, namely: (1) nation-wide, geo-referenced, epidemiological data collection systems (open to and monitored by the public); (2) metrics meant to detect non-symptomatic cases -e.g., test positivity-; (3) cost-benefit oriented methods, which should demonstrate they detect silent viral spreaders even with limited testing; (4) new personalized tests that inform on biological functions and disease correlates, such as cell-mediated immunity, co-morbidities, and immuno-suppression; (5) factors that influence vaccine effectiveness; (6) economic predictions that consider the long-term consequences likely to follow epidemics that growth exponentially; (7) the errors induced by self-limiting and/or implausible paradigms, such as binary and reductionist approaches; (8) new governance models that emphasize problem-solving skills, social participation, and the use of scientific knowledge; and (9) new educational programs that utilize visual aids and audience-specific communication strategies. The analysis indicates that, to optimally address these problems, disciplinary and social integration is needed. By asking what is/are the potential cause(s) and consequence(s) of each issue, this methodology generates visualizations that reveal possible relationships as well as omissions and contradictions. While inherently limited in scope and likely to become obsolete, these shortcomings are avoided when this 'method on methods' is frequently practiced. Open-ended, inter-/trans-disciplinary perspectives and broad social participation may help researchers and citizens to construct, de-construct, and re-construct COVID-19 related research.

Using observational epidemiology to evaluate COVID-19 vaccines: integrating traditional methods with new data sources and tools

Although clinical trials are necessary for vaccine approval, observational epidemiology will be required to evaluate the long-term effectiveness, safety, and population impacts of newly approved COVID-19 vaccines under real-world field conditions. In this commentary, I argue that a hybrid approach that combines new data sources and tools, including COVID-19 vaccine registries, with traditional epidemiological methods will be needed to evaluate COVID-19 vaccines using observational epidemiology. Wherever possible, primary data collection, active surveillance, and linkage with existing population-based cohorts should be leveraged to supplement secondary data sources and passive surveillance systems. Evidence-informed public health decision making around provincial COVID-19 immunization programs will need to account for potential biases, incomplete or conflicting information, and heterogeneity across subpopulations.

COVID-19 vaccines and thrombosis with thrombocytopenia syndrome

INTRODUCTION

To combat COVID-19, scientists all over the world have expedited the process of vaccine development. Although interim analyses of clinical trials have demonstrated the efficacy and safety of COVID-19 vaccines, a serious but rare adverse event, thrombosis with thrombocytopenia syndrome (TTS), has been reported following COVID-19 vaccination.

AREAS COVERED

This review, using data from both peer-reviewed and non-peer-reviewed studies, aimed to provide updated information about the critical issue of COVID-19 vaccine-related TTS.

EXPERT OPINION

: The exact epidemiological characteristics and possible pathogenesis of this adverse event remain unclear. Most cases of TTS developed in women within 2 weeks of the first dose of vaccine on the receipt of the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines. In countries with mass vaccination against COVID-19, clinicians should be aware of the relevant clinical features of this rare adverse event and perform related laboratory and imaging studies for early diagnosis. Non-heparin anticoagulants, such as fondaparinux, argatroban, or a direct oral anticoagulant (e.g. apixaban or rivaroxaban) and intravenous immunoglobulins are recommended for the treatment of TTS. However, further studies are required to explore the underlying mechanisms of this rare clinical entity.

PLAIN LANGUAGE SUMMARY

What is the context?Thrombosis with thrombocytopenia syndrome (TTS) usually develops within 2 weeks of the first doses of the ChAdOx1 nCoV-19 and Ad26.COV2.S COVID-19 vaccines.TTS mainly occurs in patients aged < 55 years and is associated with high morbidity and mortality.What is new?TTS mimics autoimmune heparin-induced thrombocytopenia and can be mediated by platelet-activating antibodies against platelet factor 4. Non-heparin anticoagulants, such as fondaparinux, argatroban, or a direct oral anticoagulant (e.g. apixaban or rivaroxaban) should be considered as the treatment of choice if the platelet count is > 50 × 10⁹/L and there is no serious bleeding. Intravenous immunoglobulins and glucocorticoids may help increase the platelet count within days and reduce the risk of hemorrhagic transformation when anticoagulation is initiated.What is the impact?TTS should be a serious concern during the implementation of mass COVID-19 vaccination, and patients should be educated about this complication along with its symptoms such as severe headache, blurred vision, seizure, severe and persistent abdominal pain, painful swelling of the lower leg, and chest pain or dyspnea. The incidence of TTS is low; therefore, maintenance of high vaccination coverage against COVID-19 should be continued.

A reasoned approach towards administering COVID-19 vaccines to pregnant women

There are over 50 SARS-CoV-2 candidate vaccines undergoing Phase II and III clinical trials. Several vaccines have been approved by regulatory authorities and rolled out for use in different countries. Due to concerns of potential teratogenicity or adverse effect on maternal physiology, pregnancy has been a specific exclusion criterion for most vaccine trials with only two trials not excluding pregnant women. Thus, other than limited animal studies, gradually emerging development and reproductive toxicity data, and observational data from vaccine registries, there is a paucity of reliable information to guide recommendations for the safe vaccination of pregnant women. Pregnancy is a risk factor for severe COVID-19, especially in women with comorbidities, resulting in increased rates of preterm birth and maternal morbidity. We discuss the major SARS-CoV-2 vaccines, their mechanisms of action, efficacy, safety profile and possible benefits to the maternal-fetal dyad to create a rational approach towards maternal vaccination while anticipating and mitigating vaccine-related complications. Pregnant women with high exposure risks or co-morbidities predisposing to severe COVID-19 infection should be prioritised for vaccination. Those with risk factors for adverse effects should be counselled accordingly. It is essential to support patient autonomy by shared decision-making involving a risk-benefit discussion with the pregnant woman.

A Novel Vaccine Selection Decision-Making Model (VSDMM) for COVID-19

Selecting a vaccine for fighting a pandemic is one of the serious issues in healthcare. Novel decision models for vaccine selection need to be developed. In this study, a novel vaccine selection decision-making model (VSDMM) was proposed and developed, based on the analytic hierarchy process (AHP) technique, which assesses many alternatives (vaccines) using multi-criteria to support decision making. To feed data to the VSDMM, six coronavirus disease-19 (COVID-19) vaccines were selected in a case study to highlight the applicability of the proposed model. Each vaccine was compared to the others with respect to six criteria and all criteria were compared to calculate the relative weights. The proposed criteria include (1) vaccine availability; (2) vaccine formula; (3) vaccine efficacy; (4) vaccine-related side effects; (5) cost savings, and (6) host-related factors. Using the selected criteria, experts responded to questions and currently available COVID-19 vaccines were ranked according to their weight in the model. A sensitivity analysis was introduced to assess the model robustness and the impacts of changing criteria weights on the results. The VSDMM is flexible in terms of its ability to accept more vaccine alternatives and/or more criteria. It could also be applied to other current or future pandemics/epidemics in the world. In conclusion, this is the first report to propose a VSDMM for selecting the most suitable vaccines in pandemic/epidemic situations or any other situations in which vaccine selection and usage may be deemed necessary.

Integrated vaccination and non-pharmaceutical interventions based strategies in Ontario, Canada, as a case study: a mathematical modelling study

Recently, two coronavirus disease 2019 (COVID-19) vaccine products have been authorized in Canada. It is of crucial importance to model an integrated/combined package of non-pharmaceutical (physical/social distancing) and pharmaceutical (immunization) public health control measures. A modified epidemiological, compartmental SIR model was used and fit to the cumulative COVID-19 case data for the province of Ontario, Canada, from 8 September 2020 to 8 December 2020. Different vaccine roll-out strategies were simulated until 75% of the population was vaccinated, including a no-vaccination scenario. We compete these vaccination strategies with relaxation of non-pharmaceutical interventions. Non-pharmaceutical interventions were supposed to remain enforced and began to be relaxed on 31 January, 31 March or 1 May 2021. Based on projections from the data and long-term extrapolation of scenarios, relaxing the public health measures implemented by re-opening too early would cause any benefits of vaccination to be lost by increasing case numbers, increasing the effective reproduction number above 1 and thus increasing the risk of localized outbreaks. If relaxation is, instead, delayed and 75% of the Ontarian population gets vaccinated by the end of the year, re-opening can occur with very little risk. Relaxing non-pharmaceutical interventions by re-opening and vaccine deployment is a careful balancing act. Our combination of model projections from data and simulation of different strategies and scenarios, can equip local public health decision- and policy-makers with projections concerning the COVID-19 epidemiological trend, helping them in the decision-making process.

Integrated vaccination and non-pharmaceutical interventions based strategies in Ontario, Canada, as a case study: a mathematical modelling study

Recently, two coronavirus disease 2019 (COVID-19) vaccine products have been authorized in Canada. It is of crucial importance to model an integrated/combined package of non-pharmaceutical (physical/social distancing) and pharmaceutical (immunization) public health control measures. A modified epidemiological, compartmental SIR model was used and fit to the cumulative COVID-19 case data for the province of Ontario, Canada, from 8 September 2020 to 8 December 2020. Different vaccine roll-out strategies were simulated until 75% of the population was vaccinated, including a no-vaccination scenario. We compete these vaccination strategies with relaxation of non-pharmaceutical interventions. Non-pharmaceutical interventions were supposed to remain enforced and began to be relaxed on 31 January, 31 March or 1 May 2021. Based on projections from the data and long-term extrapolation of scenarios, relaxing the public health measures implemented by re-opening too early would cause any benefits of vaccination to be lost by increasing case numbers, increasing the effective reproduction number above 1 and thus increasing the risk of localized outbreaks. If relaxation is, instead, delayed and 75% of the Ontarian population gets vaccinated by the end of the year, re-opening can occur with very little risk. Relaxing non-pharmaceutical interventions by re-opening and vaccine deployment is a careful balancing act. Our combination of model projections from data and simulation of different strategies and scenarios, can equip local public health decision- and policy-makers with projections concerning the COVID-19 epidemiological trend, helping them in the decision-making process.

Perspectives in the study of the political economy of COVID-19 vaccine regulation

Vaccines against SARS-CoV-2 continue to be developed at an astonishingly quick speed and the early ones, like Pfizer and Moderna, have been shown to be more effective than many public health scientists had dared to hope. As COVID-19 vaccine research continues to progress, the world's eyes are turning toward medicine regulators. COVID-19 vaccines need to be authorized for use in each country in which the pharmaceutical industry intends to commercialize its product. This results in a patchwork of regulations that can influence the speed at which products are launched and the standards that govern them. In this research forum article, we discuss several key questions about COVID-19 vaccine regulations that should shape research on the next stage of the pandemic response. We call for a research agenda that looks into the political economy of pharmaceutical regulation, particularly from a comparative perspective, including Global South countries.

Ongoing and future COVID-19 vaccine clinical trials: challenges and opportunities

Large-scale deployment of COVID-19 vaccines will seriously affect the ongoing phases 2 and 3 randomised placebo-controlled trials assessing SARS-CoV-2 vaccine candidates. The effect will be particularly acute in high-income countries where the entire adult or older population could be vaccinated by late 2021. Regrettably, only a small proportion of the population in many low-income and middle-income countries will have access to available vaccines. Sponsors of COVID-19 vaccine candidates currently in phase 2 or initiating phase 3 trials in 2021 should consider continuing the research in countries with limited affordability and availability of COVID-19 vaccines. Several ethical principles must be implemented to ensure the equitable, non-exploitative, and respectful conduct of trials in resource-poor settings. Once sufficient knowledge on the immunogenicity response to COVID-19 vaccines is acquired, non-inferiority immunogenicity trials—comparing the immune response of a vaccine candidate to that of an authorised vaccine—would probably be the most common trial design. Until then, placebo-controlled, double-blind, crossover trials will continue to play a role in the development of new vaccine candidates. WHO or the Council for International Organizations of Medical Sciences should define an ethical framework for the requirements and benefits for trial participants and host communities in resource-poor settings that should require commitment from all vaccine candidate sponsors from high-income countries.

In silico Exploration of Interactions Between Potential COVID-19 Antiviral Treatments and the Pore of the hERG Potassium Channel-A Drug Antitarget

Background: In the absence of SARS-CoV-2 specific antiviral treatments, various repurposed pharmaceutical approaches are under investigation for the treatment of COVID-19. Antiviral drugs considered for this condition include atazanavir, remdesivir, lopinavir-ritonavir, and favipiravir. Whilst the combination of lopinavir and ritonavir has been previously linked to prolongation of the QTc interval on the ECG and risk of torsades de pointes arrhythmia, less is known in this regard about atazanavir, remdesivir, and favipiravir. Unwanted abnormalities of drug-induced QTc prolongation by diverse drugs are commonly mediated by a single cardiac anti-target, the hERG potassium channel. This computational modeling study was undertaken in order to explore the ability of these five drugs to interact with known determinants of drug binding to the hERG channel pore. Methods: Atazanavir, remdesivir, ritonavir, lopinavir and favipiravir were docked to in silico models of the pore domain of hERG, derived from cryo-EM structures of hERG and the closely related EAG channel. Results: Atazanavir was readily accommodated in the open hERG channel pore in proximity to the S6 Y652 and F656 residues, consistent with published experimental data implicating these aromatic residues in atazanavir binding to the channel. Lopinavir, ritonavir, and remdesivir were also accommodated in the open channel, making contacts in a model-dependent fashion with S6 aromatic residues and with residues at the base of the selectivity filter/pore helix. The ability of remdesivir (at 30 μM) to inhibit the channel was confirmed using patch-clamp recording. None of these four drugs could be accommodated in the closed channel structure. Favipiravir, a much smaller molecule, was able to fit within the closed channel and could adopt multiple binding poses in the open channel, but with few simultaneous interactions with key binding residues. Only favipiravir and remdesivir showed the potential to interact with lateral pockets below the selectivity filter of the channel. Conclusions: All the antiviral drugs studied here can, in principle, interact with components of the hERG potassium channel canonical binding site, but are likely to differ in their ability to access lateral binding pockets. Favipiravir's small size and relatively paucity of simultaneous interactions may confer reduced hERG liability compared to the other drugs. Experimental structure-function studies are now warranted to validate these observations.

Epidemiological and clinical characteristics of 65 hospitalized patients with COVID-19 in Liaoning, China

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread rapidly to multiple countries through its infectious agent severe acute respiratory syndrome coronavirus 2. The severity, atypical clinical presentation, and lack of specific anti-viral treatments have posed a challenge for the diagnosis and treatment of COVID-19. Understanding the epidemiological and clinical characteristics of COVID-19 cases in different geographical areas is essential to improve the prognosis of COVID-19 patients and slow the spread of the disease.

AIM

To investigate the epidemiological and clinical characteristics and main therapeutic strategy for confirmed COVID-19 patients hospitalized in Liaoning Province, China.

METHODS

Adult patients (n = 65) with confirmed COVID-19 were enrolled in this retrospective study from January 20 to February 29, 2020 in Liaoning Province, China. Pharyngeal swabs and sputum specimens were collected from the patients for the detection of severe acute respiratory syndrome coronavirus 2 nucleic acid. Patient demographic information and clinical data were collected from the medical records. Based on the severity of COVID-19, the patients were divided into nonsevere and severe groups. All patients were followed until March 20, 2020.

RESULTS

The mean age of 65 COVID-19 patients was 45.5 ± 14.4 years, 56.9% were men, and 24.6% were severe cases. During the 14 d before symptom onset, 25 (38.5%) patients lived or stayed in Wuhan, whereas 8 (12.3%) had no clear history of exposure. Twenty-nine (44.6%) patients had at least one comorbidity; hypertension and diabetes were the most common comorbidities. Compared with nonsevere patients, severe patients had significantly lower lymphocyte counts [median value 1.3 × 10⁹/L (interquartile range 0.9-1.95) vs 0.82 × 10⁹/L (0.44-1.08), P < 0.001], elevated levels of lactate dehydrogenase [450 U/L (386-476) vs 707 U/L (592-980), P < 0.001] and C-reactive protein [6.1 mg/L (1.5-7.2) vs 52 mg/L (12.7-100.8), P < 0.001], and a prolonged median duration of viral shedding [19.5 d (16-21) vs 23.5 d (19.6-30.3), P = 0.001]. The overall median viral shedding time was 19.5 d, and the longest was 53 d. Severe patients were more frequently treated with lopinavir/ritonavir, antibiotics, glucocorticoid therapy, immunoglobulin, thymosin, and oxygen support. All patients were discharged following treatment in quarantine.

CONCLUSION

Our findings may facilitate the identification of severe cases and inform clinical treatment and quarantine decisions regarding COVID-19.

Bacille Calmette-Guérin (BCG) vaccine and potential cross-protection against SARS-CoV-2 infection - Assumptions, knowns, unknowns and need for developing an accurate scientific evidence base

After a century of controversies on its usefulness in protection against TB, underlying mechanisms of action, and benefits in various groups and geographical areas, the BCG vaccine is yet again a focus of global attention- this time due to the global COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Recent studies have shown that human CD4+ and CD8+ T-cells primed with a BCG-derived peptide developed high reactivity to its corresponding SARS-CoV-2-derived peptide. Furthermore, BCG vaccine has been shown to substantially increase interferon-gamma (IFN-g) production and its effects on CD4+ T-cells and these non-specific immune responses through adjuvant effect could be harnessed as cross protection against severe forms of COVID-19.The completion of ongoing BGG trials is important as they may shed light on the mechanisms underlying BCG-mediated immunity and could lead to improved efficacy, increased tolerance of treatment, and identification of other ways of combining BCG with other immunotherapies.

Drug Repurposing in the COVID-19 Era: Insights from Case Studies Showing Pharmaceutical Peculiarities

COVID-19 may lead to severe respiratory distress syndrome and high risk of death in some patients. So far (January 2021), only the antiviral remdesivir has been approved, although no significant benefits in terms of mortality and clinical improvement were recently reported. In a setting where effective and safe treatments for COVID-19 are urgently needed, drug repurposing may take advantage of the fact that the safety profile of an agent is already well known and allows rapid investigation of the efficacy of potential treatments, at lower costs and with reduced risk of failure. Furthermore, novel pharmaceutical formulations of older agents (e.g., aerosolized administration of chloroquine/hydroxychloroquine, remdesivir, heparin, pirfenidone) have been tested in order to increase pulmonary delivery and/or antiviral effects of potentially active drugs, thus overcoming pharmacokinetic issues. In our review, we will highlight the importance of the drug repurposing strategy in the context of COVID-19, including regulatory and ethical aspects, with a specific focus on novel pharmaceutical formulations and routes of administration.