TY - JOUR
T1 - Understanding the Potential Impact of Different Drug Properties on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission and Disease Burden
T2 - A Modelling Analysis
AU - Whittaker, Charles
AU - Watson, Oliver J.
AU - Alvarez-Moreno, Carlos
AU - Angkasekwinai, Nasikarn
AU - Boonyasiri, Adhiratha
AU - Triana, Luis Carlos
AU - Chanda, Duncan
AU - Charoenpong, Lantharita
AU - Chayakulkeeree, Methee
AU - Cooke, Graham S.
AU - Croda, Julio
AU - Cucunubá, Zulma M.
AU - Djaafara, Bimandra A.
AU - Estofolete, Cassia F.
AU - Grillet, Maria Eugenia
AU - Faria, Nuno R.
AU - Costa, Silvia Figueiredo
AU - Forero-Peña, David A.
AU - Gibb, Diana M.
AU - Gordon, Anthony C.
AU - Hamers, Raph L.
AU - Hamlet, Arran
AU - Irawany, Vera
AU - Jitmuang, Anupop
AU - Keurueangkul, Nukool
AU - Kimani, Teresia Njoki
AU - Lampo, Margarita
AU - Levin, Anna S.
AU - Lopardo, Gustavo
AU - Mustafa, Rima
AU - Nayagam, Shevanthi
AU - Ngamprasertchai, Thundon
AU - Njeri, Ng'ang'a Irene Hannah
AU - Nogueira, Mauricio L.
AU - Ortiz-Prado, Esteban
AU - Perroud, Mauricio W.
AU - Phillips, Andrew N.
AU - Promsin, Panuwat
AU - Qavi, Ambar
AU - Rodger, Alison J.
AU - Sabino, Ester C.
AU - Sangkaew, Sorawat
AU - Sari, Djayanti
AU - Sirijatuphat, Rujipas
AU - Sposito, Andrei C.
AU - Srisangthong, Pratthana
AU - Thompson, Hayley A.
AU - Udwadia, Zarir
AU - Valderrama-Beltrán, Sandra
AU - Winskill, Peter
AU - Ghani, Azra C.
AU - Walker, Patrick G.T.
AU - Hallett, Timothy B.
N1 - Publisher Copyright:
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2022
Y1 - 2022
N2 - Background. The public health impact of the coronavirus disease 2019 (COVID-19) pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. Methods. Using a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, COVID-19 disease and clinical care, we explore the public-health impact of different potential therapeutics, under a range of scenarios varying healthcare capacity, epidemic trajectories; and drug efficacy in the absence of supportive care. Results. The impact of drugs like dexamethasone (delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R = 1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalization) could have much greater benefits, particularly in resource-poor settings facing large epidemics. Conclusions. Advances in the treatment of COVID-19 to date have been focused on hospitalized-patients and predicated on an assumption of adequate access to supportive care. Therapeutics delivered earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.
AB - Background. The public health impact of the coronavirus disease 2019 (COVID-19) pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. Methods. Using a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, COVID-19 disease and clinical care, we explore the public-health impact of different potential therapeutics, under a range of scenarios varying healthcare capacity, epidemic trajectories; and drug efficacy in the absence of supportive care. Results. The impact of drugs like dexamethasone (delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R = 1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalization) could have much greater benefits, particularly in resource-poor settings facing large epidemics. Conclusions. Advances in the treatment of COVID-19 to date have been focused on hospitalized-patients and predicated on an assumption of adequate access to supportive care. Therapeutics delivered earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.
KW - COVID-19
KW - SARS-CoV-2
KW - epidemiology
KW - modelling
KW - therapeutics
UR - http://www.scopus.com/inward/record.url?scp=85134490077&partnerID=8YFLogxK
U2 - 10.1093/cid/ciab837
DO - 10.1093/cid/ciab837
M3 - Article
C2 - 34549260
AN - SCOPUS:85134490077
SN - 1058-4838
VL - 75
SP - E224-E233
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -