UPDATED
WHO updates its guidance on treatments for COVID-19
New recommendations reflect the evolving nature of the virus and the changing role of covid-19 therapies
Peer-Reviewed PublicationA panel of international experts representing the World Health Organization’s Guideline Development Group has updated its guidance on treatments for patients with covid-19.
The new recommendations published by The BMJ are part of a living guideline, developed by the World Health Organization with the methodological support of MAGIC Evidence Ecosystem Foundation, to provide up to date, trustworthy guidance on the management of covid-19 and help doctors make better decisions with their patients.
The guidance incorporates the latest clinical trial evidence for existing and new covid-19 therapies and takes account of evidence relating to safety, prognosis, resources, access, and equity issues, as well as patient values and preferences.
The updates include:
- Distinct risk categories to help doctors more accurately assess whether an individual is at high, moderate, or low risk of hospital admission and tailor treatment accordingly.
- A new treatment benefit threshold of 1.5% (down from 6%) reduction in the risk of hospital admission. This reflects the lower baseline risk for most patients with non-severe covid-19 as well as more safety evidence and wider availability of therapies.
- A recommendation to use the antiviral drug nirmatrelvir-ritonavir in patients with non-severe covid-19 at high and moderate risk of hospital admission.
- A recommendation against use of the antiviral drugs remdesivir and molnupiravir for patients with non-severe covid-19 at moderate and low risk of hospital admission (treatment is suggested for patients at high risk of admission).
- A recommendation against use of a new antiviral (VV116) for patients with covid-19 except in clinical trials, regardless of illness severity.
- A strong recommendation against the use of ivermectin for patients with non-severe covid-19 (advice against use of ivermectin in patients with severe or critical covid-19, except in clinical trials, still exists).
The experts say the new recommendations reflect changes in the virulence and transmissibility of circulating SARS-CoV-2 variants and sub-variants, along with changes in immunity related to global vaccinations, which have led to lower baseline risks of severe illness and death for most patients with non-severe covid-19.
They acknowledge that there are still uncertainties around covid-19 therapeutics and emerging evidence and say these recommendations need to be used in light of these uncertainties.
An interactive decision support tool is available to accompany this guidance.
JOURNAL
The BMJ
METHOD OF RESEARCH
Randomized controlled/clinical trial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
A living WHO guideline on drugs for covid-19
ARTICLE PUBLICATION DATE
10-Nov-2023
COI STATEMENT
Competing interests: All GDG members have completed the WHO interest disclosure form. All authors have completed the BMJ Rapid Recommendations interest of disclosure form. The WHO, MAGIC and The BMJ judged that no GDG member or co-chair had any financial conflict of interest. Professional and academic interests are minimised as much as possible, while maintaining necessary expertise on the GDG to make fully informed decisions. MAGIC and The BMJ assessed declared interests from other co-authors of this publication and found no relevant conflicts of interests.
First-ever crowd-sourced small molecule discovery and a potent SARS-CoV-2 antiviral lead compound announced by COVID Moonshot Consortium
Paper shows Open Science is a viable route to early drug discovery
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COVID MOONSHOT CONSORTIUM COLLABORATORS
view moreCREDIT: DIAMOND LIGHT SOURCE
The work of the COVID Moonshot Consortium is being published in the prestigious journal Science on 10 November, revealing their discovery of a potent SARS-CoV-2 antiviral lead compound. It also reflects on the success of its open science approach in launching a patent-free antiviral discovery program to rapidly develop a differentiated lead in response to a pandemic emergency. Open science discovery of potent noncovalent SARS-CoV-2 main protease inhibitors ) DOI 10.1126/science.abo7201.
The COVID Moonshot initiative started as a spontaneous virtual collaboration in March 2020, when a group of scientists and students from academia and biopharma, triggered by a Twitter appeal, joined forces to begin a race against the clock to identify new molecules that could block the SARS-CoV-2 virus. This unprecedented, crowdsourced, and fully open collaboration of more than 200 scientists, rapidly identified and developed novel compounds with excellent antiviral activity against a key enzyme of the SARS-COV-2 virus, namely the main protease (Mpro). The lead candidate is now in pre-clinical evaluation in collaboration with the Drugs for Neglected Disease initiative (DNDi). The COVID Moonshot is dedicated to the discovery of safe, globally affordable antiviral drugs against COVID-19 and future viral pandemics, and is pioneering a straight-to-generic, patent-free approach.
The consortium’s paper reports on the discovery of a non-covalent, non-peptidic inhibitor scaffold with lead-like properties that is differentiated from current main protease inhibitors. Their approach leveraged crowdsourcing, machine learning, exascale molecular simulations, and high-throughput structural biology and chemistry. It built on data from a large experiment, performed in record time at the start of the pandemic, at Diamond Light Source’s XChem facility for crystallographic fragment screening using Diamond’s high-throughput crystallography. In the experiment, 1,495 fragment-soaked crystals were screened within weeks to identify 78 hits that densely populated the enzyme’s active site.
The team were able to generate a detailed map of the structural plasticity of the SARS-CoV-2 main protease, extensive structure-activity relationships for multiple chemotypes, and a wealth of biochemical activity data. All compound designs (>18,000 designs), crystallographic data (>840 ligand-bound X-ray structures), assay data (>10,000 measurements), and synthesized molecules (>2,400 compounds) for this campaign were shared rapidly and openly, creating a rich open and IP-free knowledge base for future anti-coronavirus drug discovery.
By making all data immediately available, with all compounds purchasable from the Ukrainian chemistry supplier Enamine, the consortium aims to accelerate research globally along parallel tracks following up on their initial work. “The data set enclosed in the Science publication provides a unique resource linking comprehensive structural data, fragment hits, multiple chemical scaffolds, as well as biochemical and cellular assay data that can be viewed and exploited by other scientists”, states Dr Lizbe Koekemoer, one of the lead authors and a team leader at the Centre for Medicines Discovery, University of Oxford.
“This is the first time such a large number of protein-ligand structures have been generated for a drug discovery campaign and released in the public domain. It is a testament to Diamond’s high-throughput crystallography infrastructure, but also the astonishing coordination across many research groups world-wide under enormous pressure”, adds Dr Daren Fearon, another lead author and Senior Beamline Scientist at Diamond Light Source, who leads the XChem facility.
As a striking example for the impact of open-science, the Shionogi clinical candidate S-217622, which is available in Japan under emergency approval as Xocova [ensitrelvir], was identified using the data generated at Diamond and openly released. Senior author Prof Frank von Delft, Principal Beamline Scientist at Diamond, Professor for Structural Chemical Biology at University of Oxford, and one of the founders of the consortium, comments, “Open science efforts have transformed many areas of biosciences. The COVID Moonshot provides an exemplar of a viable route to open science early drug discovery leading to advances in infectious diseases drug discovery—a research area of grave public importance but one which is chronically underfunded by the private sector. The Moonshot structure-enabled drug discovery campaign targeting the coronavirus main protease is providing a roadmap for the potential development of future antivirals.”
Dr Annette von Delft, University of Oxford adds; “This publication showcases the enormous value that crowd-sourcing can bring to drug discovery. The COVID Moonshot project has been unique in its collaborative approach and commitment to open science and demonstrates how collaboration can be a driver for innovation.”
“Every day at Diamond, we are proud to be working with leading scientists and academics from all over the world like the COVID Moonshot Consortium, who are conducting innovative and inspired research using our facility. Bringing together experts in physical and life science innovations, cross disciplinary teams, and access to collaborative facilities allows our users to shine their brilliance on new technologies, treatments, sustainable materials and climate solutions for the many 21st century challenges we face,” comments Diamond’s new CEO, Gianluigi Botton.
The discovery platform collaboration that spontaneously formed as the COVID Moonshot now continues its work as the ASAP discovery consortium, which stands for AI-driven Structure-enabled Antiviral Platform, aiming to discover and develop novel broad-spectrum small molecule inhibitors against coronaviruses, flaviviruses and enteroviruses for pandemic preparedness.
The initiative is a collaborative effort of the Nuffield Department of Medicine at the University of Oxford; Diamond Light Source; PostEra; Weizmann Institute of Science; MedChemica Ltd; Icahn School of Medicine at Mount Sinai; Enamine Ltd; Memorial Sloan Kettering Cancer Center; and Thames Pharma Partners LCC. For more information on the project, visit https://dndi.org/research-development/portfolio/covid-moonshot/
COVID Moonshot paper: Open science discovery of potent noncovalent SARS-CoV-2 main protease inhibitors DOI https://doi.org/10.1126/science.abo7201
(Link Not live until 10.11.23) Featured Documents abo7201.pdf
doi: https://doi.org/10.1101/2020.10.29.339317 (BioRix live)
Open Science Discovery of Potent Non-Covalent SARS-CoV-2 Main Protease Inhibitors
View ORCID ProfileMelissa L. Boby, View ORCID ProfileDaren Fearon, View ORCID ProfileMatteo Ferla, View ORCID ProfileMihajlo Filep, View ORCID ProfileLizbé Koekemoer, Matthew C. Robinson, The COVID Moonshot Consortium, View ORCID ProfileJohn D. Chodera, View ORCID ProfileAlpha A Lee, View ORCID ProfileNir London, Annette von Delft, View ORCID ProfileFrank von Delft
First Author: Melissa L. Boby, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine Corresponding Authors: John D. Chodera, Memorial Sloan Kettering Cancer Center; Alpha A. Lee, PostEra Inc. ; Annette von Delft, NIHR Oxford Biomedical Research Centre, University of Oxford; Nir London, nir.london@weizmann.ac.il ; Weizmann Institute of Science ; Frank von Delft, frank.von-delft@diamond.ac.uk ;University of Oxford, Diamond Light Source, University of Johannesburg, UK Research and Innovation; Diamond Light Source
ENDS
For more information: please contact Diamond Communications: Lorna Campbell +44 7836 625999 or Isabelle Boscaro-Clarke +44 1235 778130 Diamond Light Source: www.diamond.ac.uk Twitter: @DiamondLightSou
Diamond Light Source provides industrial and academic user communities with access to state-of-the-art analytical tools to enable world-changing science. Shaped like a huge ring, it works like a giant microscope, accelerating electrons to near light speeds, to produce a light 10 billion times brighter than the Sun, which is then directed off into 33 laboratories known as ‘beamlines’. In addition to these, Diamond offers access to several integrated laboratories including the world-class Electron Bio-imaging Centre (eBIC) and the Electron Physical Science Imaging Centre (ePSIC).
Diamond serves as an agent of change, addressing 21st century challenges such as disease, clean energy, food security and more. Since operations started, more than 16,000 researchers from both academia and industry have used Diamond to conduct experiments, with the support of approximately 760 world-class staff. Almost 12,000 scientific articles have been published by our users and scientists.
Funded by the UK Government through the Science and Technology Facilities Council (STFC), and by the Wellcome Trust, Diamond is one of the most advanced scientific facilities in the world, and its pioneering capabilities are helping to keep the UK at the forefront of scientific research.
Diamond was set-up as an independent not for profit company through a joint venture, between the UKRI’s Science and Technology Facilities Council and one of the world’s largest biomedical charities, the Wellcome Trust - each respectively owning 86% and 14% of the shareholding.
Aerial view of Diamond Light Source
Professor Frank von Delft, Principal Beamline Scientist, Diamond 104-1
Professor Frank von Delft, Principal Beamline Scientist, Diamond 104-1
CREDIT
Diamond Light Source
Diamond Light Source
JOURNAL
Science
METHOD OF RESEARCH
Imaging analysis
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Open science discovery of potent noncovalent SARS-CoV-2 main protease inhibitors
ARTICLE PUBLICATION DATE
10-Nov-2023
Open-science “COVID Moonshot” discovers new antivirals to treat COVID-19
Although the group’s work has been freely available since its inception in March 2020, the COVID Moonshot Consortium is finally formally reporting their results. The COVID Moonshot – an open-science, crowdsourced, and patent-free drug discovery campaign targeting the SARS-CoV-2 virus – has yielded a wealth of data on the virus’s main protease, including insights that could pave the way for the development of new and better therapeutics. “The lead therapeutics described by [these researchers] may not be ready in time to affect the current pandemic, considering the timelines and challenges of drug approval,” write Brian Shoichet and Charles Craik in a related Perspective. “Nevertheless, the compounds and the techniques used to identify them may well affect human health in the future.”
The novel collaboration included more than 200 volunteer scientists from 47 academic and industrial organizations spanning 25 countries. “The COVID Moonshot provides an example of open science drug discovery leading to advances in infectious diseases drug discovery – a research area of grave public importance, but one that is chronically underfunded by the private sector,” write Melissa and colleagues. Due to its essential role in viral replication, the SARS-CoVB-2 main protease (Mpro) is an attractive target for antiviral development. Current SARS-CoV-2 Mpro inhibitor drugs, such as those drawn from preexisting antiviral pipelines like Paxlovid and Xocova, have shown clinical success. However, the use of these compounds has remained relatively limited and their peptidomimetic and covalent scaffolds create issues for synthesis and administration. Here, Boby et al. describe the discovery of a novel, noncovalent, and nonpeptidic inhibitor scaffold that is chemically distinct from current Mpro inhibitors. Leveraging a crowdsourcing approach and the combined expertise of hundreds of individuals worldwide, Boby et al. describe their open-science drug discovery campaign, which included machine learning, molecular simulations, and high-throughput structural biology and chemistry to assemble a detailed structural map of the SARS-CoV-2 main protease and its biochemical activity. Of the more than 18,000 compound designs produced by the COVID Moonshot Consortium, the authors identified several noncovalent, nonpeptidomimetic inhibitors, including a lead compound with promising bioavailability, safety, and antiviral activity. All compound designs from the project have been shared openly, creating a rich, open, and intellectual property–free knowledge base for future anticoronavirus drug discovery.
JOURNAL
Science
ARTICLE TITLE
Open science discovery of potent noncovalent SARS-CoV-2 main protease inhibitors
ARTICLE PUBLICATION DATE
10-Nov-2023
Texas A&M researchers contribute to international project studying coronavirus transmission in humans, cattle
Researchers will study viral transmission using “commingling events" with cattle, bringing unfamiliar animals together for sustained contact
Grant and Award AnnouncementResearchers from the Texas A&M School of Veterinary Medicine and Biomedical Sciences’ (VMBS) Veterinary Education, Research, and Outreach (VERO) program have joined an international team studying how coronaviruses are spread and whether an individual’s microbiome (the collection of microbes living in or on the body) might impact that transmission.
Coronaviruses are a family of viruses that can cause a variety of diseases in many species, from the common cold and severe acute respiratory syndrome (SARS) in people, to diarrhea in calves and respiratory disease in adult cattle.
The research team — which includes researchers from the United States, the United Kingdom, and Canada — has received $3.5 million from the United States Department of Agriculture National Institute of Food and Agriculture (USDA-NIFA), the National Science Foundation, the National Institutes of Health, and the Biotechnology and Biological Sciences Research Council (BBSRC).
Their work will use cattle as a model for viral transmission during group “commingling events” — when unfamiliar animals or people come together in a defined space and time with intensive and sustained contact.
Commingling is associated with increased disease transmission risk and possible global consequences, as the COVID-19 pandemic has highlighted. Commingling events in humans include large group events, air travel, incarceration, and classroom settings.
Among animals, commingling routinely occurs during livestock production when the body’s ability to fight disease may be lowered, while, at the same time, the body is being exposed to more pathogens.
“It’s more and more the nature of our society that we have these types of commingling events, through travel, socialization, and the general nature of day-to-day interactions,” said Dr. Paul Morley, VERO’s director of food animal research and one of the project’s co-principal investigators. “Being able to understand how viruses behave would help us apply preventive measures, including vaccination and antiviral treatment, for both humans and cattle.”
The researchers, led by Dr. Noelle Noyes, an associate professor in the University of Minnesota College of Veterinary Medicine, will work to understand why some people and animals get infected and/or develop symptoms during commingling events but others do not.
At VERO, Morley and Dr. Matthew Scott, an assistant professor of microbial ecology and infectious disease, will work alongside three graduate students to collect samples from local beef and dairy cattle to track how bovine coronavirus, which is not able to infect people, spreads between animals.
“The Texas Panhandle is one of the greatest epicenters of cattle production in the United States,” Morley said. “We’re taking advantage of our great contacts in the cattle production industries, both beef and dairy, to look at coronavirus transmission in young calves during natural management circumstances.”
Specifically, they will look at how the virus spreads depending on factors like how many cattle are housed together and if they are moved to new locations via livestock trailers. They will also measure the cattle’s immune systems and microbiomes to understand if differences have an impact on whether cattle get infected.
“We’ll be looking at virus shedding before, during, and after commingling events, as well as immune function, genes that get turned on or off, and changes in the microbiomes of the respiratory and gastrointestinal tracts,” Morley said.
Using cattle from real livestock operations will ensure that data collected accurately represents real-world transmission factors.
“We hope to uncover the complex multi-level mechanisms that underlie viral transmission during intensive mixing of unfamiliar calves,” said Dr. Joseph Neary, principal investigator of the project’s U.K. activities. “These new insights will better inform calf husbandry practices to reduce infectious disease transmission risk, particularly where newly mixed calves have been sourced from multiple farms.”
The study will also expand fundamental scientific understanding of viral behavior.
“A unique aspect of this work is the integration of microbiome dynamics into models of virus transmission at the population level,” Noyes said. “There’s a lot of scientific evidence about the importance of the microbiome in individual health, but we don’t have as much understanding of how population-level microbiome dynamics may influence disease transmission, particularly during situations of heightened disease risk, such as commingling.”
The project is expected to last through 2026. In addition to Texas A&M University and the University of Minnesota, collaborators on the project include scientists from Mississippi State University, the University of Liverpool, and the University of Saskatchewan.
“This project is the idealization of what we’re trying to do at VERO, working with people around the world on a big project with big impact,” Morley said. “The impact on our graduate students is going to be tremendous; they’ll get to interact with this internationally renowned, extremely talented group of people. It’s a great opportunity for them in their graduate programs.”
University of South Florida to lead study analyzing how coronavirus spreads between wildlife and humans
The data will be used to create predictive models that can be used to prepare and protect human health for future variants and diseases
Grant and Award AnnouncementTAMPA, Fla. (Nov. 9, 2023) -- The University of South Florida is one of three members of the Association of American Universities awarded a grant by the U.S. Department of Agriculture to investigate the transmission drivers of infectious diseases. Led by integrative biologist Andrew Kramer, the five-year study on the future of coronavirus in animals is supported by the USDA’s Animal and Plant Health Inspection Service through a multiagency partnership with the National Science Foundation and National Institutes of Health.
“With the increased interactions between humans and wildlife, one of the important things about this work is that it reminds us that it’s not just us here,” Kramer said. “Our health can also make animals sick, and that might make us sicker. And that's an understudied aspect of the dynamics.”
With a $3 million grant from the program, Kramer will examine how the virus spreads between wildlife and humans to create predictive models that can be used to protect human health from future variants and emerging diseases.
This combined with research being conducted at the University of Florida and University of Minnesota on the evolution of pathogens and invasive species will provide a big-picture understanding of the transmission dynamics of infectious disease.
As a quantitative ecologist, Kramer will use computational methods to understand the population dynamics and spread of invasive species and emerging diseases in the northeastern forest community, an ecoregion that spans more than 30,000 miles across seven states from Maine to Pennsylvania.
To create the models, Kramer will collaborate with colleagues from the Cary Institute of Ecosystem Studies, IBM Research and Washington State University. Together, the team will analyze how the virus spreads among wildlife mammals, such as white-tailed deer, to advance the currently limited ability to predict zoonotic variants of coronavirus and their risk to humans.
“We want to provide a bigger picture of what’s actually driving the disease and its risk to both humans and animals,” Kramer said. “It appears certain the virus will persist in animals as long as it is prevalent in humans.”
By studying wildlife and how transmission may occur in natural populations, the team can improve assessments of risk to wildlife and humans, enabling better guidance on human and wildlife interactions. Kramer says the hope is that modeling these dynamics will be informative beyond coronavirus and help researchers understand multiple zoonotic pathogens, such as avian influenza and other emerging diseases.
The Ecology and Evolution of Infectious Diseases Program grant was provided by the USDA Animal and Plant Health Inspection Service through the joint National Science Foundation, National Institutes of Health and National Institute of Food and Agriculture with partnership from the Biotechnology and Biological Sciences Research Council.
Cary Institute partners on $3M USDA-funded study on COVID-19 variants that could emerge from wildlife
Project combines AI, virology, and ecology to anticipate future SARS-CoV-2 strains with the potential to pass between animals and people
IMAGE:
NEW PROJECT COMBINES ARTIFICIAL INTELLIGENCE, VIROLOGY, AND ECOLOGY TO ANTICIPATE FUTURE SARS-COV-2 STRAINS WITH THE POTENTIAL TO PASS BETWEEN ANIMALS AND PEOPLE.
view moreCREDIT: CREDITS (CLOCKWISE FROM TOP LEFT): NIH IMAGE GALLERY, USFWS MOUNTAIN-PRAIRIE, LA CITTA VITA, AND CHARLES J. SHARP
Many wild animals can carry COVID-19, including those that live among us, such as deer mice, red foxes, white-tailed deer, and more. These species may act as reservoirs, offering new opportunities for the virus to mutate and spill back into people. The omicron variant, for example, is thought to have emerged from mice.
With $3 million in federal grant funding, a new five-year research project will bring together virology, disease ecology, and artificial intelligence to better understand how SARS-CoV-2 (the virus that causes COVID-19) behaves in natural ecosystems, to anticipate strains with the potential to spread widely between people and animals. The award comes from the U.S. Department of Agriculture Animal and Plant Health Inspection Service through the Ecology and Evolution of Infectious Diseases program, a joint effort of the National Institutes of Health, National Science Foundation, and the National Institute of Food and Agriculture.
“In order to know the risk that new variants pose for people, we really have to figure out how SARS-CoV-2 is moving through mammalian wildlife,” explained Barbara Han of Cary Institute of Ecosystem Studies, who will co-lead the new project with Andrew Kramer from the University of South Florida. The project will also assess risk of spillover from people to wildlife, and how new strains could impact ecological communities.
Whereas most current disease surveillance methods collect existing variants and try to pick out the most concerning ones, the new project will use artificial intelligence to predict future variants that don’t yet exist but could be problematic if they emerge. This will generate a surveillance watch-list for the public health community.
“That way, if we find one of these in the wild, we’ll know that we should sit up and pay attention,” said Han.
Because the strategy is proactive instead of reactive, it has the potential to shift the paradigm for how society monitors and manages SARS-CoV-2 transmission in animals, said Kramer.
The project is divided into four parts. Step 1 will use AI to create a library of future strains of SARS-CoV-2 with predicted high zoonotic potential, or the ability to infect both people and animals. In order to do this, the AI will be trained on the sequences and protein structures of past strains.
Step 2 will predict which animals may be susceptible to the variants identified in Step 1, and therefore could serve as potential hosts. Scientists know that SARS-CoV-2 enters mammalian cells through the ACE2 receptor. However, ACE2 receptors are slightly different in every species, and haven’t been studied in the vast majority of mammals. To overcome this dearth of data, the team will use artificial intelligence to predict the structure of ACE2 receptors in various species, and whether or not the variants could bind to the receptors and infect the cell.
Payel Das at IBM Research will lead the AI development needed for Steps 1 and 2. “IBM Research is proud to assist in the prediction of coronavirus transmission between wildlife and humans through the latest cutting-edge AI technologies, including generative AI and foundation models,” said Das. “Ultimately, we hope this work can lead to critical insights that will enable us to better prepare for future human health threats.”
Step 3 is where the AI predictions get tested on real cells in a lab. Virologist Michael Letko of Washington State University will engineer parts of the virus strains identified in Step 1, and see if they actually bind with ACE2 receptors in cells from humans and a subset of the animals identified in Step 2. Results will be used to retrain the AI and further improve the predictions of Steps 1 and 2.
“This part of the study is where we will move from concept to concrete,” said Letko. “Making predictions on a computer is one thing, but to actually see how those predictions perform in a physical and biological context will help us truly understand if our models are accurate.”
He added that since the experiment only uses a small piece of each virus sequence — just the part that binds with the ACE2 receptor on the outside of the cell — there is no potential for it to actually cause an infection, replicate, or spread in any way.
In Step 4, the team will draw on 30 years of environmental monitoring at Cary Institute to simulate a Northeastern forest environment to understand how SARS-CoV-2 moves through real ecosystems where many species are differentially susceptible to infection.
Viral outbreaks in most wild populations are under-observed, with estimations of the curves they follow mostly theoretical. By drawing on field data, the team will use models to account for how wildlife interacts in nature, where you can have multiple infected species interfacing via competition, predator-prey relationships, or other forms of contact.
“By connecting potential variants and their performance in lab assays to species interactions in the real world, we can better understand the real implications of SARS-CoV-2 being spread to many different species at the same time,” said Kramer, who will lead this portion of the study.
Understanding these dynamics should help to improve assessments of risk to wildlife and people, and help predict spillover into humans, said Kramer — not only for SARS-CoV-2, but for other types of animal-borne diseases as well, such as avian influenza.
The team hopes that their results will inform surveillance efforts, for example by identifying potential host species that need to be managed or by immediately sounding the alarm when one of the strains predicted to be a threat pops up in the wild.
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Cary Institute of Ecosystem Studies is an independent nonprofit center for environmental research. Since 1983, our scientists have been investigating the complex interactions that govern the natural world and the impacts of climate change on these systems. Our findings lead to more effective resource management, policy actions, and environmental literacy. Staff are global experts in the ecology of: cities, disease, forests, and freshwater.
New study: gargling with salt water may help prevent Covid hospitalization
Hospitalization rates in people with saline regimens significantly lower than in reference population
Peer-Reviewed PublicationIMAGE:
ACAAI ANNUAL SCIENTIFIC MEETING
view moreCREDIT: ACAAI
ANAHEIM, Calif. (Nov. 9, 2023) – As Covid and its health effects move into a fourth year, those who become infected may be searching for remedies to improve their respiratory symptoms and keep them out of the hospital. A new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. determined that both a low- and high-dose saline regimen appeared to be associated with lower hospitalization rates compared to controls in SARS-CoV-2 infections.
“Between 2020 and 2022, individuals aged 18-65 years with positive PCR test for SARS-CoV-2 infection were randomly selected to undergo low- or high-dose saline regimens for 14 days,” says Sebastian Espinoza, lead author of the study. “The low- and high-saline solutions consisted of 2.13 grams and 6 grams of salt dissolved in 8 ounces of warm water, respectively. Gargling and nasal rinsing was done four times a day for 14 days. Primary outcomes included frequency and duration of symptoms associated with SARS-CoV-2 infection; secondary outcomes included hospital or ICU admission, mechanical ventilatory support, or death. Exclusion criteria were chronic hypertension or participation in another interventional study. Those on the low- and high-dose saline solutions, as well as those in the reference population, had similar rates of vaccination.”
58 individuals were allocated to either the low (27) or high (28) saline regimens; 3 were lost to follow-up. There were no significant differences in the primary or secondary outcomes of the study between these two groups. During the study period, 9,398 individuals with positive SARS-CoV-2 infection were evaluated and were the reference population. The hospitalization rates in the low- (18.5%) and high- (21.4%) saline regimens were significantly lower than in the reference population (58.8%.) No significant differences were noted in other outcomes among these groups.
“Our goal was to examine saline nasal irrigation and gargling for possible association to improved respiratory symptoms associated with coronavirus infection,” says Jimmy Espinoza, MD, co-author of the study. “We found that both saline regimens appear to be associated with lower hospitalization rates compared to controls in SARS-CoV-2 infections. We hope more studies can be done to further investigate the association.”
Abstract Title: Double blind randomized controlled trial of saline solution gargling and nasal rinsing in SARS-CoV-2 infection
Presenter: Sebastian Espinoza
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P244
Double blind randomized controlled trial of saline solution gargling and nasal rinsing in SARS-CoV-2 infection
S. Espinoza*1, L. Trauffler2, A. Shamshirsaz2, A. Shamshirsaz3, A. Espinoza2, J. Espinoza2, A. O'Brien2, 1. Sugar Land, TX; 2. Houston, TX; 3. Boston, MA.
Introduction: Saline nasal irrigation and gargling improve respiratory symptoms associated with coronavirus infection. This study determines the role of two saline regimens on symptoms associated with SARS-CoV-2.
Methods: Between 2020 and 2022, individuals aged 18-65 years with positive PCR test for SARS-CoV-2 infection were randomly allocated to low- or high-saline regimens for 14 days. Low- and high-saline solutions consisted of 2.13 grams and 6 grams of salt dissolved in 8 ounces of warm water, respectively. Gargling and nasal rinsing was done four times a day for 14 days. Primary outcomes included frequency and duration of symptoms associated with SARS-CoV-2 infection; secondary outcomes included hospital or ICU admission, mechanical ventilatory support, or death. Exclusion criteria were: chronic hypertension or participation in other interventional study.
Results: 58 individuals were allocated to the low-(n=27) or high-(n=28) saline regimens; 3 were lost to follow-up. There were no significant differences in the primary or secondary outcomes of the study between these two arms (Table 1). During the study period, 9,398 individuals with positive SARS-CoV-2 infection were evaluated (reference population). The hospitalization rates in the low-(18.5%) and high-(21.4%) saline regimens were significantly lower than in the reference population (58.8%; p<0.001). No significant differences were noted in other outcomes among these groups (Table 1).
Conclusion: 1) Low- and high- saline regimens for gargling and nasal rinsing are associated with similar frequency and duration of symptoms related with SARS-CoV-2 infection. 2) Both saline regimens appear to be associated with lower hospitalization rates compared to controls in SARS-CoV-2 infections.
Table 1: Demographic and clinical characteristics of the study population
Data expressed as percentage (proportions) or median (range). p1: comparison between low and high-salt regimen. P2: comparison between low-salt regimen and reference population; p3: comparison between high-salt regimen and reference population. *Symptoms: fever or chills, cough, sore throat, shortness of breath, difficulty breathing, headache, new loss of taste or smell, muscle or body aches, fatigue, nausea, vomiting, diarrhea.
JOURNAL
Annals of Allergy Asthma & Immunology
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