NMDA Journal Winter 2020-21

nmdental.org 11 will be easier to achieve FDA approval before a vaccine, which typically takes longer. Gilead’s Remdesivir was developed 10 years ago to treat Ebola and failed. However it was used against MERS, a different coronavirus, and it blocked the virus from replicating. Through clinical trials it is administeredwith an anti-inflammatory drug such as Baricitinib. It is also testing children as well as adults. It has been found to shorten recovery time from 15 to 11 days and a 62 percent reduction inmortality. Eli Lilly’s Olumiant, currently for the treatment of rheumatoid arthritis and other overactive immune systemconditions, usedwith Remdisi- vir can shorten hospital stays by one day. Merk’s and Ridgeback Biotherapeutics LP’s EIDD-2801 is in a clinical trial in the UKwhich reduces replication inmultiple coronaviruses including SARS-CoV-2. It is taken orally, which will reachmore people. Favipiravir, made in Japan, is being tested in 43 countries for clinical trials for mild tomoderate COVID-19 patients. Kaletra, a combination of Lopinavir and Triona- vir, works against HIV. Clinical trials are under- going to see if it works against SARS-CoV-2. It has only shown effects to clear the virus using ribavirin and interferon beta-1b. Monoclonal antibodies trigger the immune system to attack a virus just as in our immune system’s antibodies. Sorrento Therapeutics has an antibody drug that is effective in blocking SARS-CoV-2. The company hopes it can be used to treat people with COVID-19 and to prevent the infection. AbCellera isolated 500 unique antibodies from a COVID-19 recovered person and is studying these antibodies. Regeneron Pharmaceuticals Inc. is testing a two-antibody combination in people with symptoms who have not been hospitalized. President Trump was given this drug with apparent success in early October. Doses for 50,000 people are available under a FDA EUA. Fighting COVID-19 Through Operation Warp Speed Vir Biotechonology isolated antibodies from SARS survivors and is working with a Chinese firmWui Biologics for testing in the treatment of COVID-19. Eli Lilly has used two antibodies to reduce the infection to 11 days. ImmuneModulators In some COVID-19 patients, the immune system goes in overdrive releasing large amounts of cytokines causing acute respiratory distress syndrome (ARDS) necessitating the use of a ventilator. The corticosteroid, dexamethasone, has reduced deaths by 33 percent on ventilator uses and by 20 percent for those requiring oxy- gen support. Other drugs used are Bariditinib, for rheumatoid arthritis, CM4620-IE for pancre- atic cancer, and IL-6 inhibitors. The FDA approved a device that filters cytokines out of the blood of COVID-19 patients. StemCells Aathesys, Inc. and Mesoblast are individually in Phase 2 and 3 clinical trials to examine stem cell treatment to benefit ARDS sufferers. Other Therapeutics Hydroxychloroquine and chloroquine were given FDA EUA in March. Studies indicated that the drugs did not significantly help and other studies showed that it helped in early stages of the disease. All trials have been halted. Ibuprofen was initially not recommended because of a study out of France. A Septem- ber study from PLOS Medicine writes that NSAIDs aren’t likely to be linked to adverse side effects in SARS-CoV2 infections. SARS Cov-2 can cause pneumonia and ARDS, so many drug modalities are targeting these diseases. A Phased Approach to Vaccine Allocation for COVID-19 In October, the National Academies of Sci- ences, Engineering, and Medicine released a framework for equitable allocation of a COVID-19 Vaccine for adoption by HHS, State, Tribal, Local and Territorial Authorities (STLT). The report (a 270 page book) recommends a four-phased approach in the allocation of a vaccine built on widely accepted founda- tional principles and guided by evidence to maximize societal benefit by reducing mor- bidity and mortality caused by the transmis- sion of SARS-CoV-2. Phase 1a covers 5 percent of the population who are high risk health workers and first responders including dental office staff. These workers are at a higher risk of trans- mitting the disease to others. Phase 1b covers 10 percent of the people of all ages with comorbid and underlying condi- tions such as cancer, serious heart conditions, sickle cell anemia, metabolic syndrome, and others with at least two or more comorbid conditions and older adults who live in nursing homes, group home, prisons or jails, long- term care facilities, and homeless shelters, where it is hard to maintain physical distance. Phase 2 covers 30 percent to 35 percent of the population including K-12 teachers and staff, childcare workers, workers in the food supply system, and public transit. This also includes workers and residents with a moder- ate risk in congregate living like group homes and institutions for the mentally, develop- mentally and physically disabled, and older adults not included in Phase 2. Phase 3 covers 40 percent to 45 percent of the population who are young and workers in moderate high-risk jobs where some pro- tective measures are used as in advanced education, hotels, banks, exercise facilities, and factories. Phase 4 covers everybody else. References: Websites of: Health and Human Services Healthline Medscape The National Academies of Sciences EngineeringMedicine World HealthOrganization In October, the National Academies of Sciences, Engineering, and Medicine released a framework for equitable allocation of a COVID-19 Vaccine.