Understanding the Potential Impact of Different Drug Properties on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission and Disease Burden: A Modelling Analysis
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Abstract
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.
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SciScore for 10.1101/2021.06.17.21259078: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A related caveat to the results presented here is that we assume levels of healthcare seeking within the population such that all individuals with COVID-19 requiring hospitalisation will seek care. However, numerous studies have highlighted the disparities in access to healthcare that exist globally (e.g. (30, 31)), and that cost of care (if borne privately) can be a key deterrent (32). These results are consistent with an emerging …
SciScore for 10.1101/2021.06.17.21259078: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A related caveat to the results presented here is that we assume levels of healthcare seeking within the population such that all individuals with COVID-19 requiring hospitalisation will seek care. However, numerous studies have highlighted the disparities in access to healthcare that exist globally (e.g. (30, 31)), and that cost of care (if borne privately) can be a key deterrent (32). These results are consistent with an emerging body of evidence suggesting that in many low-income settings, a substantial fraction of COVID-19 deaths to date have occurred in the community (33). To the extent that not all of those in need seek care, the limitations we have found for therapeutics for hospitalised patients and the potential benefits of therapeutics for non-hospitalised patients would be even greater than our results show. The framework developed here does not incorporate waning immunity or the possibility of novel SARS-CoV-2 variants able to partially evade protective immunity elicited by prior infection (as in Brazil (8), South Africa (34) and now many other countries). These factors would serve to reduce the effect of population-level immunity and contribute to larger further waves of disease - these are also scenarios under which our findings on the influence on healthcare constraints would be magnified. A limitation to the analyses presented here is that we do not consider differences in admission, triaging and treatment policies across different settings. In practice, there...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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