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Transition in the management of COVID-19


A recent Pharmacological Reports study describes current approaches to managing the coronavirus disease 2019 (COVID-19), including diagnostic, therapeutic, and preventive measures.

Study: Recent review of COVID-19 management: diagnosis, treatment and vaccination. Image Credit: Anatta_Tan / Shutterstock.com

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, is an enveloped positive-sense, single-stranded ribonucleic acid (RNA) virus that primarily transmits between individuals through respiratory droplets and aerosols. Binding between the SARS-CoV-2 spike protein and the host cell membrane angiotensin-converting enzyme 2 (ACE-2) receptor allows the virus to enter cells and replicate.

Although most COVID-19 patients remain asymptomatic or mildly symptomatic, the infection can be severe in susceptible individuals, including the elderly, immunocompromised patients, and individuals with comorbidities. In its severe form, COVID-19 can lead to hypoxemia, acute respiratory distress syndrome (ARDS), cardiovascular problems, hyperinflammation, autoimmune responses, liver and kidney complications, gastrointestinal complications, neuropsychiatric complications, dermatological and musculoskeletal complications, multiorgan failure, and even death.   

Throughout the pandemic, many SARS-CoV-2 variants have emerged worldwide, including those denoted as variants of concern (VOCs). VOCs are associated with improved transmission and infection efficiency.

More recently, the SARS-CoV-2 Omicron VOC has shown a significantly greater ability to evade pre-existing anti-SARS-CoV-2 immunity, which has led to a sharp rise in new COVID-19 cases worldwide.

Diagnosis of COVID-19

The laboratory methods primarily used to diagnose COVID-19 include reverse transcription-polymerase chain reaction (RT-PCR), reverse transcription loop-mediated isothermal amplification (RT-LAMP), antigen testing, point-of-care testing, and fluorescence-based biosensor tests. In addition, chest computed tomography (CT) scans and chest x-rays may also be used for clinical COVID-19 diagnosis.    

RT-PCR, a highly specific and accurate method that detects viral RNA in respiratory samples, is considered the gold standard for COVID-19 diagnosis. Chest CT scans are particularly effective in detecting and assessing the severity of COVID-19-related pneumonia. Fluorescence-based biosensors are cost-effective solutions used to rapidly detect anti-SARS-CoV-2 antibodies in the blood.

Several strategies have been developed to improve the diagnostic efficacy of these methods. A novel approach that combines RT-LAMP and CRISPR-Cas12 has been developed to rapidly and efficiently detect COVID-19. The Automatic Integrated Gene Detection System COVID-19 RNA detection kit has also accurately identified specific viral variants in respiratory samples.

Regarding COVID-19 antibody testing, sensitive and powerful biotools have been developed to detect SARS-CoV-2 nucleocapsid antibodies in the blood. These tools are based on the surface of magnetic microbeads functionalized with nucleocapsid and internally expressed spike proteins.      

Treatment of COVID-19

The United States Food and Drug Administration (FDA) has approved the repurposing of several drugs to treat COVID-19. Most of these drugs are small molecule inhibitors that target viral entry and replication pathways.

Among these, remdesivir has shown potency in reducing the duration of hospital stay and symptom intensity. In addition, clinical studies on lopinavir/ritonavir have highlighted the efficacy of these drugs in reducing adverse disease outcomes, viral load, infection rate, and steroid use.

Arbidol is considered to be more effective than lopinavir in terms of reducing viral load and mortality. However, no clinical benefits of chloroquine and hydroxychloroquine have been observed in COVID-19 patients.   

Molnupiravir, a broad-spectrum antiviral drug, has recently received FDA approval to treat COVID-19 patients. Clinical studies have shown that molnupiravir effectively reduces disease progression, oxygen therapy requirements, and mortality.

In addition to repurposed drugs, biological products, including polyclonal and monoclonal antibodies, convalescent plasma, and hyperimmune γ-globulin, have been used as immunotherapy to treat COVID-19 patients.

Vaccination against COVID-19

Vaccination is a vital prophylactic measure to prevent SARS-CoV-2 infection and transmission, severe COVID-19, hospitalization, and mortality. Several types of vaccines have been developed against COVID-19, including messenger RNA (mRNA)-based, viral vector-based, DNA-based, protein subunit and peptide-based, dendritic cell-based, and virus-like particle-based vaccines.

According to recent data, about 67% of the world population has received at least a single dose of COVID-19 vaccines. Most approved vaccines have been associated with high potency in inducing robust and durable virus-specific humoral and cellular immune responses. However, regarding safety, some rare events of blood clotting and thrombosis with thrombocytopenia syndrome have been documented concerning adenoviral vectors-based vaccines.

In the initial phase of vaccine rollout, a two-dose primary vaccination regimen was approved by federal authorities to control the pandemic trajectory. However, a reduction in vaccine efficacy over time has been observed globally, thus necessitating the approval of a third vaccine booster dose.

This reduction in vaccine efficacy could be due to the emergence of more competent and immunologically fit viral variants like Omicron. However, many studies conducted in real-world settings have shown that the three-dose regimen of COVID-19 vaccines is highly effective in neutralizing several viral variants, including Omicron.

Innovative strategies for COVID-19 management

The use of artificial intelligence (AI) for diagnostic and drug discovery purposes has also shown promise in various aspects of COVID-19 research. To this end, AI can be applied for rapidly analyzing several pre-existing datasets to identify novel drug targets. This approach can also be used for contact tracing and risk-group identification.

Nanotechnology is another essential approach that has been considered to improve COVID-19 management. Some adopted strategies include nanoparticle-incorporated personal protective equipment, nanoparticle-based vaccines and drug delivery systems, nanosensor- and nanofilter-based face masks, ACE2-targeting nanoparticles, and nanoparticle-based biosensors for COVID-19 detection.

Journal reference:

  • Chavda, V. P., Vuppu, S., Mishra, T., et al. (2022). Recent review of COVID-19 management: diagnosis, treatment and vaccination. Pharmacological Reports. doi:10.1007/s43440-022-00425-5.



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