Covid-19 roundup: CDC director urges states to ready vaccine distribution sites by Nov 1; Researchers say steroids can reduce mortality

Drugmakers aren’t the only ones facing pressure to hurry out a vaccine. Last week, CDC director Robert Redfield penned a letter to state governors, requesting that vaccine distribution sites be fully operational by Nov 1.

Redfield urged governors to fast-track permits and licenses, according to a McClatchy report. “The normal time required to obtain these permits presents a significant barrier to the success of this urgent public health program,” the letter read.

“CDC urgently requests your assistance in expediting applications for these distribution facilities… and, if necessary, asks that you consider waiving requirements that would prevent these facilities from becoming fully operational by November 1, 2020,” it continued.

The August 27 request came on the same day that president Donald Trump gave a national speech promising a “safe and effective” vaccine within the next four months. And rumors have spread that members of the Trump administration told Democratic leader Nancy Pelosi a vaccine candidate could get emergency approval as early as September, and that it would likely be AstraZeneca’s.

Distributors are bracing for significant challenges ahead, including the availability of cold storage facilities to keep vaccines stable. Some mRNA candidates must be stored at temperatures as low as -80 degrees Celsius.

Moderna, which expects to complete Phase III enrollment for its vaccine trial this month, said its candidate would need to be stored long-term at -20 degrees Celsius. BioNTech and Pfizer’s candidate requires long-term storage at -70 degrees Celsius. Last week, the companies announced they’ve enrolled nearly half of 30,000 expected Phase III participants.

FDA commissioner Stephen Hahn has vowed vaccine approval will be strictly data-driven. “We at FDA do not permit politics to enter into our scientific decisions,” he tweeted last week.

But the commissioner is facing heat for misleading comments he made about the efficacy of convalescent plasma as a Covid-19 treatment. Days later, he announced that a vaccine advisory committee meeting will take place on Oct 22.

“If you are making a decision about the vaccine, you’d better be sure you have very good evidence that it is both safe and effective,” Fauci said in an interview with KHN on Tuesday. “I’m not concerned about political pressure.” — Nicole DeFeudis 

Steroids reduce mortality by 20% in severe Covid-19 cases, researchers say

A new analysis of seven international trials is pointing toward steroids as a potentially effective treatment for the sickest of Covid-19 patients.

The study, published in JAMA on Wednesday, pooled data from trials utilizing three types of corticosteroids in more than 1,700 patients in intensive care. Researchers found that the risk of death was reduced by 20% and asserted that the drugs should be the first-line treatment for severely ill patients.

“The meta-analysis indicates that administration of steroids is clearly associated with benefit among critically ill patients with COVID-19, although the exact threshold at which an individual patient should be prescribed corticosteroids remains unclear,” researchers wrote in a related editorial.

Late Wednesday, the WHO updated its treatment guidance to make a “strong recommendation” for the use of low dose hydrocortisone, dexamethasone and methylprednisolone in critical cases. The paper did not find that the drugs had any effect on milder Covid-19 patients.

Only Gilead’s remdesivir has proven to be effective in treating severe Covid-19 cases, though its benefits thus far have been limited.

Wednesday’s paper follows studies from Oxford researchers back in June indicating that dexamethasone could reduce the risk of mortality in such cases. The steroid had shown by itself a one-third reduction among patients on ventilators and a one-fifth reduction in those receiving oxygen.

Steroids can cause some side effects such as opening the body to other infections, however, and the WHO’s new guidance said that those risks reinforce that the drugs should not be used in milder cases. — Max Gelman

China expands emergency vaccine use to aviation industry

First it’s the military. Then came offers for state employees dispatched overseas, as well as medical workers and border control officers. Now, China is handing out experimental coronavirus vaccines to those in the aviation industry.

The move is an expansion of the emergency use program that began in July, whose stated goal is to boost the immunity of high-risk groups to prevent a new wave of infections.

China’s aviation regulator has told airlines, airports, China National Aviation Fuel Group and TravelSky Technology that their frontline workers can access a vaccine candidate on a voluntary basis, Reuters reported citing a notice.

It’s unclear which vaccines the workers will be given. Previous reports of vaccination campaigns at state-owned enterprises also triggered ethical concerns about consent, as experts believe employees may feel pressured to say yes to a vaccine despite lack of safety and efficacy data from large-scale trials.

Four vaccine candidates from Chinese developers have entered Phase III — all overseas — so far. Among them, CanSino’s adenovirus-based shot is authorized for military use while Sinovac and Sinopharm both have vaccines cleared for administration among high-risk groups. — Amber Tong

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