Estimating the potential need and impact of SARS-CoV-2 test-and-treat programs with oral antivirals in low-and-middle-income countries (preprint)

Oral antivirals can potentially reduce the burden of COVID-19. However, low SARS-CoV-2 clinical testing rates in many low- and middle-income countries (LMICs) (mean <10 tests/100,000 people/day, July 2022) makes the development of effective test- and-treat programs challenging. Here, we used an agent-based model to investigate how testing rates and strategies could affect development of test- and-treat programs in three representative LMICs. We find that at <10 tests/100,000 people/day, test- and-treat programs are unlikely to have any impact on the public health burden of COVID-19. At low effective transmission rates ( R t ≤ 1.2), increasing to 100 tests/100,000 people/day and allowing uncapped distribution of antivirals to LMICs (estimate = 26,000,000-90,000,000 courses/year for all LMICs), could avert up to 65% of severe cases, particularly in countries with older populations. For higher R t , significant reductions in severe cases are only possible by substantially increasing testing rates or restricting clinical testing to those with higher risk of severe disease.

Impacts of the COVID-19 pandemic on future seasonal influenza epidemics (preprint)

Summary Seasonal influenza viruses typically cause annual epidemics worldwide infecting 5-15% of the human population 1 . However, during the first two years of the COVID-19 pandemic, seasonal influenza virus circulation was unprecedentedly low with very few reported infections 2 . The lack of immune stimulation to influenza viruses during this time, combined with waning antibody titres to previous influenza virus infections, could lead to increased susceptibility to influenza in the coming seasons and to larger and more severe epidemics when infection prevention measures against COVID-19 are relaxed 3,4 . Here, based on serum samples from 165 adults collected longitudinally before and during the pandemic, we show that the waning of antibody titres against seasonal influenza viruses during the first two years of the pandemic is likely to be negligible. Using historical influenza virus epidemiological data from 2003-2019, we also show that low country-level prevalence of each influenza subtype over one or more years has only small impacts on subsequent epidemic size. These results suggest that the risks posed by seasonal influenza viruses remained largely unchanged during the first two years of the COVID-19 pandemic and that the sizes of future seasonal influenza virus epidemics will likely be similar to those observed before the pandemic.

A SARS-CoV-2 mini-genome assay based on negative-sense RNA to study replication inhibitors and emerging mutations (preprint)

Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) is a positive-sense single-stranded RNA virus and the causative agent of the Coronavirus disease 2019 (COVID-19) pandemic. Efforts to identify inhibitors of SARS-CoV-2 replication enzymes and better understand the mechanisms underlying viral RNA synthesis have largely relied on biosafety level 3 (BSL3) laboratories, limiting throughput and accessibility. Recently, replicon systems have been proposed that involve ~ 30 kb RNA-based replicons or large plasmids that express the viral structural and non-structural proteins (nsp) in addition to a positive-sense reporter RNA. Unfortunately, these assays are not user-friendly due to plasmid instability or a poor signal to background ratio. We here present a simple mini-genome assay consisting of a ~ 2.5 kb-long negative-sense, nanoluciferase-encoding sub-genomic reporter RNA that is expressed from a plasmid, and amplified and transcribed by the SARS-CoV-2 RNA polymerase core proteins nsp7, nsp8 and nsp12. We show that expression of nsp7, 8 and 12 is sufficient to obtain robust positive- and negative-sense RNA synthesis in cell culture, that addition of other nsps modulates expression levels, and that replication of the reporter RNA can be inhibited by active site mutations in nsp12 or the SARS-CoV-2 replication inhibitor remdesivir. The mini-genome assay provides a signal that is 170-fold above background on average, providing excellent sensitivity for high-throughput screens, while the use of small plasmids facilitates site-directed mutagenesis for fundamental analyses of SARS-CoV-2 RNA synthesis. Importance statement The impact of the COVID-19 pandemic has made it essential to better understand the basic biology of SARS-CoV-2, and to search for compounds that can block the activity of key SARS-CoV-2 replication enzymes. However, studies with live SARS-CoV-2 require biosafety level 3 facilities, while existing replicon systems depend on long positive-sense subgenomes that are often difficult to manipulate or produce a high background signal, limiting drug-screens and a rapid analysis of emerging SARS-CoV-2 mutations during the COVID-19 pandemic. To make it easier to study emerging SARS-CoV-2 mutants and screen for inhibitors, we developed a simple mini-replicon that produces a minimal background signal, that can be used in any tissue culture lab, and that only requires four small plasmids to work.