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Saturday, January 9, 2021

Cuba to collaborate with Iran on coronavirus vaccine

 Communist-run Cuba said late on Friday it had signed an accord with Iran to transfer the technology for its most advanced coronavirus vaccine candidate and carry out last-stage clinical trials of the shot in the Islamic Republic.

The allies are both under fierce U.S. sanctions that exempt medicine yet often put foreign pharmaceutical companies off trading with them and as such they seek to be self-reliant. Both are also strapped for cash.

Iran launched human trials of its first domestic COVID-19 vaccine candidate late last month, while Cuba has four candidates currently in human trials.

Once its most advanced candidate, Soberana (Sovereign) 2, has completed Phase II trials which started on Dec. 22, it will be tested in Phase III trials in around 150,000 people in Havana, officials have said.

Yet the Caribbean country will need to conduct more late stage trials abroad too given it does not have a high infection rate due to its successful management of its outbreak, they said. Iran, meanwhile, has been the worst-hit country in the Middle East.

Cuba’s Finlay Vaccine Institute said late on Friday it has signed an accord with Iran’s Pasteur Institute to collaborate on testing of Soberana 2.

“This synergy will enable both countries to advance more rapidly in the immunization against the SARS-CoV-2 virus,” it said on its Twitter account.

Cuba says several countries have expressed interest in its coronavirus vaccines but this is the first such accord it has reached.

Health Ministry spokesman Kianush Jahanpur was cited by Iranian media as saying 50,000 volunteers would be recruited to carry out the Phase III clinical trials. Technology transfer and joint production were preconditions for allowing human testing in the country, he said.

Iran Foreign Minister Javad Zarif said he was “impressed” by the biotech achievements of its old ally Cuba in the fight against COVID-19 during a visit to Havana on a Latin American tour last November.

In addition to developing its own vaccine, Iran is participating in the COVAX scheme which aims to secure fair access to COVID-19 vaccines for poorer countries. Yet its Supreme Leader on Friday banned the government from importing COVID-19 vaccines from the United States and Britain, labeling the Western powers “untrustworthy.”

Cuba has not talked of importing vaccines from elsewhere and said it intends to start vaccinating its population against COVID-19 with its own vaccine in the first half of the year.

https://www.reuters.com/article/us-health-coronavirus-cuba-iran/cuba-to-collaborate-with-iran-on-coronavirus-vaccine-idUSKBN29E0JS

Operation Warp Speed’s Slaoui will stay as consultant for Biden

 Moncef Slaoui, the controversial head of Operation Warp Speed, will serve as a consultant in the Biden administration, he confirmed Wednesday. He suggested it would be a less active role than his current position, as the initiative’s chief adviser.

“I will continue to support as needed, I think we are getting close to the point where my value add is more limited and therefore I’ll expect my activity to decrease gradually after January 21,” Slaoui told STAT Wednesday during a briefing with reporters.

Slaoui added that he expected to leave the initiative after two vaccines were authorized, but that he recently decided to extend his tenure in government.

The news of Slaoui’s new role in the Biden administration is surprising. In recent days, President-elect Biden has vociferously criticized Operation Warp Speed for its failure to effectively distribute vaccines quickly. Slaoui, who previously promised that the Trump administration would administer 20 million doses in December, has been at the center of that controversy.

The move may also anger Biden’s liberal base. Liberal groups like Public Citizen and lawmakers like Sen. Elizabeth Warren (D-Mass.) have called for Slaoui’s firing over perceived conflicts of interest. Slaoui’s current contract has allowed him to keep millions of dollars in pharmaceutical stock while still serving as Warp Speed’s chief adviser. It’s not clear if Slaoui’s new role as consultant will come with a requirement that he sells those stocks.

The other head of Operation Warp Speed, Gen. Gus Perna, told STAT he has not been told whether he will remain at the initiative. He added that, “I’m here until my part of the mission is done or I’m told otherwise.” Perna, a four-star military general, currently serves as the operation’s chief operating officer and its top adviser on vaccine distribution.

The incoming Biden administration has not said publicly whether Slaoui or Perna would be asked to stay on. They did not respond to requests for comment on this article.

The Biden transition did, however, announce a raft of appointees last week who would coordinate the vaccine effort. They include Bechara Choucair, a former executive at Kaiser Permanente, who will serve as Biden’s vaccine coordinator, and Tim Manning, a former FEMA official who will serve as supply coordinator.

https://www.statnews.com/2021/01/06/moncef-slaoui-consultant-biden/

Research strongly suggests COVID-19 virus enters the brain

 More and more evidence is coming out that people with COVID-19 are suffering from cognitive effects, such as brain fog and fatigue.

And researchers are discovering why. The SARS-CoV-2 virus, like many viruses before it, is bad news for the brain. In a study published Dec.16 in Nature Neuroscience, researchers found that the spike protein, often depicted as the red arms of the virus, can cross the blood-brain barrier in mice.

This strongly suggests that SARS-CoV-2, the cause of COVID-19, can enter the brain.

The spike protein, often called the S1 protein, dictates which cells the virus can enter. Usually, the virus does the same thing as its binding protein, said lead author William A. Banks, a professor  of medicine at the University of Washington School of Medicine and a  Puget Sound Veterans Affairs Healthcare System physician and researcher. Banks said binding proteins like S1 usually by themselves cause damage as they detach from the virus and cause inflammation.

“The S1 protein likely causes the brain to release cytokines and inflammatory products,” he said.

In science circles, the intense inflammation caused by the COVID-19 infection is called a cytokine storm. The immune system, upon seeing the virus and its proteins, overreacts in its attempt to kill the invading virus. The infected person is left with brain fog, fatigue and other cognitive issues.

Banks and his team saw this reaction with the HIV virus and wanted to see if the same was happening with SARS CoV-2.

Banks said the S1 protein in SARS-CoV2 and the gp 120 protein in HIV-1 function similarly. They are glycoproteins – proteins that have a lot of sugars on them, hallmarks of proteins that bind to other receptors. Both these proteins function as the arms and hand for their viruses by grabbing onto other receptors.  Both cross the blood-brain barrier and S1, like gp120, is likely toxic to brain tissues.

 “It was like déjà vu,” said Banks, who has done extensive work on HIV-1, gp120, and the blood-brain barrier.

The Banks’ lab studies the blood-brain barrier in Alzheimer’s, obesity, diabetes, and HIV. But they put their work on hold and all 15 people in the lab started their experiments on the S1 protein in April. They enlisted long-time collaborator Jacob Raber, a professor in the departments of Behavioral Neuroscience, Neurology, and Radiation Medicine, and his teams at Oregon Health & Science University.

The study could explain many of the complications from COVID-19.

“We know that when you have the COVID infection you have trouble breathing and that’s because there’s infection in your lung, but an additional explanation is that the virus enters the respiratory centers of the brain and causes problems there as well,” said Banks.

Raber said in their experiments transport of S1 was faster in the olfactory bulb and kidney of males than females. This observation might relate to the increased susceptibility of men to more severe COVID-19 outcomes.

As for people taking the virus lightly, Banks has a message:

“You do not want to mess with this virus,” he said. “Many of the effects that the COVID virus has could be accentuated or perpetuated or even caused by virus getting in the brain and those effects could last for a very long time.”

This study was partially supported by a National Institute on Aging-funded COVID-19 supplement to a shared RF1 grant of Banks and Raber.​

https://newsroom.uw.edu/news/research-strongly-suggests-covid-19-virus-enters-brain

Coronavirus mutation could affect strength of vaccines

 As scientists try to track the spread of a new, more infectious coronavirus variant around the world — finding more cases in the United States and elsewhere this week — they are also keeping an eye on a different mutation with potentially greater implications for how well Covid-19 vaccines work.

The mutation, identified in a variant first seen in South Africa and separately seen in another variant in Brazil, changes a part of the virus that your immune system’s antibodies get trained to recognize after you’ve been infected or vaccinated. Lab studies show that the change could make people’s antibodies less effective at neutralizing the virus. The mutation seems to help the virus disguise part of its signature appearance, so the pathogen might have an easier time slipping past immune protection.

It’s not that the mutation will render existing vaccines useless, scientists stress. The vaccines authorized so far and those in development produce what’s called a polyclonal response, generating numerous antibodies that home in on different parts of the virus. Changes to any of those target sites raise the possibility that the vaccines would be less effective, not that they won’t work at all.

“With one mutation or even three mutations, it’s expected the antibodies will still recognize this variant, though they might not recognize it as well as other variants,” said Ramón Lorenzo-Redondo, a molecular virologist at Northwestern University’s Feinberg School of Medicine.

Essentially, the mutation is getting attention because it appears more likely to have some effect on vaccines than other mutations that have emerged, though scientists are still trying to test that hypothesis. The more contagious variant raising global alarms, which was first seen in the United Kingdom and is referred to as B.1.1.7, is not thought to have mutations that will greatly affect vaccines, the evidence so far indicates.

“We need to be monitoring for these mutations,” said Jesse Bloom, an evolutionary virologist at Fred Hutchinson Cancer Research Center, who with colleagues published a paper about this specific mutation, known as E484K, this week.

But Bloom added that he believed the virus would have to pick up multiple mutations — and particular mutations in specific spots, not just any alterations — to have a serious effect on vaccine efficacy, which will likely take some time.

“I’m quite optimistic that even with these mutations, immunity is not going to suddenly fail on us,” Bloom said. “It might be gradually eroded, but it’s not going to fail on us, at least in the short term.”

Scientists do think the coronavirus could eventually change so much that the immunity provided by vaccines will be threatened, a process that will pick up as the number of people protected from the virus — either through vaccination or infection — grows and evolutionary pressure in turn increases. But they still anticipate it could take years, and that when it does occur, vaccine makers can tweak their designs to match the newer variant, a process some companies have said would only take weeks.

The SARS-CoV-2 coronavirus, which causes Covid-19, has been mutating as it spreads, just like other viruses. Many of the mutations do nothing, and some might even impede the virus’s quest to replicate and spread. But every so often, a random mutation gives the virus an evolutionary advantage, and that variant can then become dominant. Early on in the pandemic, a mutation known as D614G helped the coronavirus spread more easily, and variants with that mutation quickly overtook others globally.

B.1.1.7, which has since spread to other parts of the world, appears to be even more infectious, with some estimates saying it’s 50% more transmissible. One of its mutations, called N501Y, improves how well the virus’ spike protein can attach to a receptor called ACE2 on human cells, making it more likely for the virus to successfully infect cells and for the virus to pass from person to person.

The same N501Y mutation is also present in the variant identified in South Africa, though the two variants evolved independently. (Public health authorities are trying to steer people away from using terms like the “U.K. variant” or “South African variant,” just as they discourage people from tying SARS-2 by name to China or Wuhan. “We need to use the names appropriately because we don’t want to stigmatize where these variants have been identified,” the World Health Organization’s Maria Van Kerkhove said Tuesday. “That’s true for any virus that’s identified.”)

The inclusion of N501Y appears to help the variant in South Africa spread faster as well, but the variant also has the E484K mutation, unlike the variant that first appeared in the U.K. Though mutations in the same part of the virus have cropped up previously during the pandemic, the specific E484K mutation is attracting more interest now in part because it’s in this variant that’s spreading across South Africa and, through travelers, has started to appear elsewhere, including Japan, Norway, and the U.K.

The E484K change occurs on a part of the spike protein called the receptor binding domain, which plays a crucial role as the virus attaches to ACE2 and is a key target for antibodies. As lab studies have shown, antibodies don’t recognize variants with E484K as well as other forms.

Research from Bloom and colleagues this week further added to that evidence. In their study, which involved mapping how antibodies from people who had recovered from Covid-19 fared against different variants, the scientists found that mutations like E484K had the biggest impact on antibodies’ ability to block the virus, with some people experiencing a more than 10-fold drop in neutralization against the variant. The researchers called the location of the E484K mutation “the site of most concern for viral mutations.” (There was variability among the samples, however; some people were able to neutralize the variant just fine, and mutations in other places had more of an impact than E484K did for certain people.)

Bloom’s study was focused on people who had recovered from an infection, not those who had been vaccinated; researchers around the world are investigating how well current vaccines stand up to different variants.

But despite what he and colleagues found about E484K, Bloom noted that the mutation only reduced neutralizing activity, and didn’t eliminate it. Current vaccines, meanwhile, have shown they can generate strong immune responses. “I’m confident current vaccines will be useful for quite a while,” Bloom wrote in a Twitter thread detailing the research.

The more pressing concern for now, scientists say, remains the spread of B.1.1.7, the variant first seen in the U.K. Though it’s not thought to cause more severe cases of Covid-19, if it causes more cases overall because it spreads more easily, that will lead to more hospitalizations and deaths. It is also likely harder to control than other variants and raises the threshold of the percentage of the population that needs to be protected to reach herd immunity.

“The variant is a really big deal,” said Marc Lipsitch, an epidemiologist at Harvard’s T.H. Chan School of Public Health.

Lipsitch said the U.S. should focus its efforts on curtailing the variant, including by sequencing more samples from patients to identify cases and directing its contact tracing and quarantining campaigns to try to hem it in.

“To the extent that we can find those and preferentially stop the spread, it won’t be perfect, it will be far from perfect, but anything we can do to delay the spread of this new variant virus will make control easier and will help us in the race to get more people vaccinated before this becomes more common,” he said.

https://www.statnews.com/2021/01/07/coronavirus-mutation-vaccine-strength/

Half-Doses as Good as Full?

 NYTimes: A top official of Operation Warp Speed floated a new idea on Sunday for stretching the limited number of Covid-19 vaccine doses in the United States: Halving the dose of each shot of Moderna’s vaccine to potentially double the number of people who could receive it.

Data from Moderna’s clinical trials demonstrated that people between the ages of 18 and 55 who received two 50-microgram doses showed an “identical immune response” to the standard of two 100-microgram doses, said the official, Dr. Moncef Slaoui.

Dr. Slaoui said that Operation Warp Speed was in discussions with the Food and Drug Administration and the pharmaceutical company Moderna over implementing the half-dose regimen. Moderna did not respond immediately to a request for comment.

Each vaccine would still be delivered in two, on-schedule doses four weeks apart, Dr. Slaoui said in an interview with “CBS’s Face the Nation.” He said it would be up to the F.D.A. to decide whether to move forward with the plan.

Half dosing would double Moderna doses permanently rather than temporarily (as with First Doses First). Thus, I would be very happy to see half-dosing and it would obviate the need for FDF.

I and a handful of others started to discuss and advocate First Doses First on Dec. 8 and many times since then. The advocacy was then joined by Tony Blair and by many epidemiologistsimmunologistsvaccine researchersphysicians and public health experts as well, of course, by the British experts on the Joint Committee on Vaccination and Immunisation. It’s clear that the FDA and Operation Warp Speed are now feeling the pressure to take some serious actions to increase supply. If so, my small efforts will have had a very high return.

Keep the pressure on.

https://marginalrevolution.com/marginalrevolution/2021/01/half-doses-as-good-as-full.html

Key COVID-19 Risk Factors in Children

 Children and adolescents who receive positive COVID-19 test results are not only more likely to have been in close contact with someone with a confirmed case of the virus but also are less likely to have reported consistent mask use among students and staff inside the school they attended, reported Charlotte V. Hobbs, MD, and colleagues at the University of Mississippi, Jackson.

In partnership with the Centers for Disease Control and Prevention's COVID-19 Response Team, Hobbs and colleagues conducted a case-control study of 397 children and adolescents under 18 years of age to assess school, community, and close contact exposures associated with pediatric COVID-19. Patients tested for COVID-19 at outpatient health centers or emergency departments affiliated with the University of Mississippi Medical Center between Sept. 1 and Nov. 5, 2020, were included in the study.

Nearly Two-Thirds Reported That Exposure Came From Family Members

Of the total study participants observed, 82 (21%) were under 4 years of age; 214 (54%) were female; 217 (55%) were non-Hispanic black, and 145 (37%) were non-Hispanic white. More than half (53%) sought testing because of COVID-19 symptoms. Of those who tested positive, 66% reported having come into close contact with a COVID-19 case, and 64% reported that those contacts were family members, compared with 15% of contacts who were schoolmates and 27% who were child care classmates.

All participants completed in-person school or child care attendance less than 14 days before testing positive for the virus, including 62% of patients testing positive and 68% of those testing negative. The authors noted that school attendance itself was not found to be associated with any positive test results. In fact, parents in 64% of positive cases and 76% of negative cases reported mask wearing among children and staff inside places of learning.

Of those study participants testing positive who did come into close contact with someone with COVID-19, the contacts were more likely to be family members than school or child care classmates. Specifically, they were more likely, in the 2-week period preceding testing, to have attended gatherings with individuals outside their immediate households, including social events and activities with other children. Parents of students testing positive were also less likely to report consistent indoor mask use among their children older than 2 years and school staff members.

School Attendance Was Not Found to Increase Likelihood Of Testing Positive

Attending in-person school or child care during the 2 weeks before the SARS-CoV-2 test was not associated with greater likelihood of testing positive, the study authors noted, adding that the majority of study respondents reported universal mask use inside school and child care facilities, consistent with Mississippi State Department of Health recommended guidelines.

Hobbs and colleagues reported at least four limitations of the study. They noted that the study participants may not be representative of youth in other geographic regions of the country. They considered the possibility of unmeasured confounding of participant behaviors that may not have been factored into the study. No attempt was made to verify parent claims of mask use at schools and child care programs. Lastly, they acknowledged that "case or control status might be subject to misclassification because of imperfect sensitivity or specificity of PCR-based testing.

As of Dec. 14, 2020, the CDC reported that 10.2% of all COVID-19 cases in the United States were in children and adolescents under the age of 18.

"Continued efforts to prevent transmission at schools and child care programs are important, as are assessments of various types of activities and exposures to identify risk factors for COVID-19 as children engage in classroom and social interactions." Promoting behaviors to reduce exposures to the virus among youth in the household, the community, schools, and child care programs is important to preventing outbreaks of the virus at schools, the authors cautioned.

In a separate interview with this news organization, Karalyn Kinsella, MD, general pediatrician in a small group private practice in Cheshire, Conn., said, "What this report tells me is that COVID cases are more common when mask use is inconsistent in schools and at home and in schools that don't properly adhere to CDC guidelines. Overall, so long as social distancing guidelines are followed, schools are pretty safe places for kids during this pandemic."

This finding is important, since many families are keeping their children out of school over fears of contracting the virus, she added. Some of the consequences these children are suffering include a lack of social connection and structure, which in some cases is leading to worsening anxiety and depression, and for those with disabilities, such as those who receive physical therapy, occupational therapy, speech or have IEPs, they're not getting the full benefit of the services that they would otherwise receive in person, she observed.

"I don't think families really understand the risks of getting together with family or friends "in their bubble" or the risk of continuing sports participation. This is where the majority of COVID cases are coming from," she said, adding that it is important to discuss this risk with them at appointments. So, when families ask us what we think of in-person learning, I think we should feel fairly confident that the benefit may outweigh the risk."

Hobbs and colleagues, and Kinsella, had no conflicts of interest to report.

SOURCE:MMWR Morb Mortal Wkly Rep. 2020;69:1925-9. doi:10.15585/mmwr.mm6950e3.

https://www.medscape.com/viewarticle/943830

India to continue export of medicines, including vaccines: PM Modi

 

Indian Prime Minister Narendra Modi said on Saturday the nation would continue to export medicines, including vaccines, as companies have ramped up production.

The country, with the highest number of infections in the world after the United States, is developing two indigenous COVID-19 vaccines.

"The world is not only waiting for India's vaccines but is also keenly watching how India handles the world's biggest vaccination program," Modi said in an annual address to the overseas Indians.

"Being the biggest pharmacy of the world, India had supplied medicines to the needy across the globe in the past and it is doing it today as well."

India is the world's biggest vaccine maker. Its pharmaceutical industry has been freeing up capacity and pushing ahead with investments to help support a global vaccination campaign.

Health secretary Rajesh Bhushan earlier this month said there was no ban on vaccine exports, following media reports that the government had imposed restrictions to ensure domestic vaccine requirements were met first.

The country is set to roll out a COVID-19 vaccination programme, aiming to cover 300 million people by July in one of the world's largest inoculation drives against the coronavirus.

Modi said India used to import protective equipment kits, masks, ventilators and testing kits but today the nation is not only self-reliant but also exporting some of these products.

India on Saturday reported 18,222 new coronavirus infections over the past 24 hours, taking its total to 10.43 million, health ministry data showed.

COVID-19 infections are decreasing in India, which saw a daily peak of nearly 98,000 cases in September.

https://www.marketscreener.com/news/latest/India-to-continue-export-of-medicines-including-vaccines-PM-Modi--32152194/