Opinion: How to effectively combat COVID-19

By Dr. med. Cordula Sachse-Seeboth

1. Vaccines available so far are not able to guarantee protection against infections (Kasen K et al., Philip P et al.). However, a pandemic can only be interrupted by breaking chains of infection.

2. For the above-mentioned reason, the introduction of compulsory vaccination only makes sense (in a scientific manner) if not only dangerous courses of disease but also infections are effectively prevented. An efficiency of at least 70% should be the minimum requirement before compulsory vaccination is declared.

3. The prioritisation of vaccines should be defined by physicians and scientists and should not be subordinated to economic interests.

As severe courses of disease still occur in at-risk groups and in the elderly population, boosting the population at risk has a higher priority than first and second vaccination of healthy and younger persons.

Large parts of the world’s population are neither first nor second vaccinated. This should also be taken into account for moral reasons before first world countries make third vaccination compulsory.

Since the experience regarding vaccination in the first trimester is low, all COVID19 vaccines should not be applied in the first trimester of pregnancy if possible.

4. The emergence of recent mutations such as Omikron should prompt vaccine optimisation.

a) Routes of application

Already approved and upcoming vaccines may be more effective if additional modes of application are used to induce mucosal immunity within the respiratory tract, as coronavirus uses the respiratory tract as a route of entry. The following routes of application are suggested:

inhaled and/or intranasal and/or oral vaccination, preferably triple combined

If already approved vaccines are used, there is less delay, as only further modes of application would have to be approved.

b) Proactive vaccine development supported by AI/ML

The rate of mutation is faster than vaccine development. However, ML-based tools already exist to make predictions (Arora G et al., Hie B et al.). It is already possible to develop vaccines that cover potential future mutants. How this would affect the regulatory affairs is still completely unclear and requires changes in the current pharmaceutical regulations.

c) How to stop hypermutation – overcoming the mechanisms of hypermutation.

Provided the mechanisms of hypermutation (Simmonds P et al.) are elucidated, it would theoretically be feasible to prevent mutations in an infected person (especially in immunocompromised patients). A drug with antimutagenic potential could significantly reduce the risk of hypermutations and might theoretically be used in many other viral infections.

30 November 2021

References

Arora G, Joshi J, Mandal RS, Shrivastava N, Virmani R, Sethi T. Artificial Intelligence in Surveillance, Diagnosis, Drug Discovery and Vaccine Development against COVID-19. Pathogens. 2021 Aug 18;10(8):1048. doi: 10.3390/pathogens10081048. PMID: 34451513; PMCID: PMC8399076.

Hie B, Zhong ED, Berger B, Bryson B. Learning the language of viral evolution and escape. Science. 2021 Jan 15;371(6526):284-288. doi: 10.1126/science.abd7331. PMID: 33446556.

Kasen K. Riemersma, Brittany E. Grogan, Amanda Kita-Yarbro, Peter J. Halfmann, Hannah E. Segaloff, Anna Kocharian, Kelsey R. Florek, Ryan Westergaard, AllenBateman, Gunnar E. Jeppson, Yoshihiro Kawaoka, David H. O’Connor, Thomas C.Friedrich, Katarina M. Grande
Shedding of Infectious SARS-CoV-2 Despite Vaccination
medRxiv 2021.07.31.21261387; doi:https://doi.org/10.1101/2021.07.31.21261387

Phillip P. Salvatore, Christine C. Lee, Sadia Sleweon, David W. McCormick, LaviniaNicolae, Kristen Knipe, Thomas Dixon, Robert Banta, Isaac Ogle, Cristen Young, Charles Dusseau, Shawn Salmonson, Charles Ogden, Eric Godwin, TeCora Ballom, Tara Ross, Nhien Tran Wynn, Ebenezer David, Theresa K. Bessey, Gimin Kim, SuganthiSuppiah, Azaibi Tamin, Jennifer L. Harcourt, Mili Sheth, Luis Lowe, Hannah Browne, Jacqueline E. Tate, Hannah L. Kirking, Liesl M. Hagan
Transmission potential of vaccinated and unvaccinated persons infected with the SARS-CoV-2 Delta variant in a federal prison, July—August 2021
medRxiv 2021.11.12.21265796; doi:https://doi.org/10.1101/2021.11.12.21265796

Simmonds P. Rampant C→U Hypermutation in the Genomes of SARS-CoV-2 and Other Coronaviruses: Causes and Consequences for Their Short- and Long-Term Evolutionary Trajectories. mSphere. 2020 Jun 24;5(3):e00408-20. doi: 10.1128/mSphere.00408-20. PMID: 32581081; PMCID: PMC7316492.


Biography of the author

Since July 2021 I have been working as a specialist in General Medicine in my own practice in Bad Lauterberg in Germany. In 2004, I finished my dissertation on the topic of »Role of variant Creutzfeldt-Jakob disease for safety of treatment with blood components« in the Department of Transfusion Medicine and Immunology at the University Medical Center in Greifswald under the supervision of Professor Andreas Greinacher. I completed my medical studies at the Universities of Magdeburg and Greifswald, including a period abroad in Castlebar in Ireland.
Before I became a specialist in General Medicine, I gained experience in various medical specialties: Transfusion Medicine and Immunology at the University in Greifswald (Professor Andreas Greinacher), in Microbiology at the University of Rostock, Anatomy at the University of Leipzig, five years in Clinical Pharmacology at the University Medical Center in Göttingen (Professor Jürgen Brockmöller). Here I was involved in planning, conducting and evaluating clinical trials as well as supervising doctoral students and in teaching. I acquired my Internal Medicine training at the University Medical School in Göttingen in the Department of Haematology and Oncology (Professor Lorenz Trümper), in the University Internal Medicine Emergency Department, in the Department of Nephrology and Rheumatology as well as in a General Hospital of Basic and Standard Care in Herzberg. You can find out more about me on my website at https://rapidot.de



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