Beyond the vaccines: a glance at the small molecule and peptide-based anti-COVID19 arsenal.

Unprecedented efforts of the researchers have been witnessed in the recent past towards the development of vaccine platforms for the control of the COVID-19 pandemic. Albeit, vaccination stands as a practical strategy to prevent SARS-CoV-2 infection, supplementing the anti-COVID19 arsenal with therapeutic options such as small molecules/peptides and antibodies is being conceived as a prudent strategy to tackle the emerging SARS-CoV-2 variants. Noteworthy to mention that collective efforts from numerous teams have led to the generation of a voluminous library composed of chemically and mechanistically diverse small molecules as anti-COVID19 scaffolds. This review article presents an overview of medicinal chemistry campaigns and drug repurposing programs that culminated in the identification of a plethora of small molecule-based anti-COVID19 drugs mediating their antiviral effects through inhibition of proteases, S protein, RdRp, ACE2, TMPRSS2, cathepsin and other targets. In light of the evidence ascertaining the potential of small molecule drugs to approach conserved proteins required for the viral replication of all coronaviruses, accelerated FDA approvals are anticipated for small molecules for the treatment of COVID19 shortly. Though the recent attempts invested in this direction in pursuit of enrichment of the anti-COVID-19 armoury (chemical tools) are praiseworthy, some strategies need to be implemented to extract conclusive benefits of the recently reported small molecule viz. (i) detailed preclinical investigation of the generated anti-COVID19 scaffolds (ii) in-vitro profiling of the inhibitors against the emerging SARS-CoV-2 variants (iii) development of assays enabling rapid screening of the libraries of anti-COVID19 scaffold (iv) leveraging the applications of machine learning based predictive models to expedite the anti-COVID19 drug discovery campaign (v) design of antibody-drug conjugates.

Access to Virtual Care: A New Social Determinant of Health

Introduction The novel COVID-19 illness has changed the world as we know it. The public health measures to contain the highly contagious virus mostly included social distancing, wearing a mask and hand hygiene. Our conventional daily routines adapted to accommodate for the need of the hour including the health care sector, hospital systems transformed their approach to provide timely and easy access to care for patients. However, challenges to provide standard of care were anticipated as neither the hospitals nor the patients were prepared initially for this sudden transition. Virtual care has seen tremendous growth in the United States since the pandemic started in 2020, and unprecedented progress has been made in the last year to provide patients virtual care that is well incorporated with their goals, accessibility and at the same time provide quality of care. We hypothesize that geographical areas which are limited in social resources or have higher income equalities will have higher telephone virtual visit or in person visits as compared to video visits, suggesting either lack of infrastructure or digital literacy in those areas. Lack of video visits can be a barrier to standard of care particularly in behavioral health. Methods We propose a de-identified retrospective study to analyze the visit type at all behavioral health outpatient clinics from January 2020 to most recent data available. Temporal trend of visit types based on demographics, geographical location, diagnoses and sub classification of virtual visit into telephone or video visit will be analyzed. Study has been approved by institutional IRB and currently is in data analysis phase. Aim 1: To study the impact of pandemic on temporal trend of outpatient visit subtypes (in person vs virtual) in behavioral health department. Aim 2: To study the impact of pandemic on temporal trend of outpatient video visits vs telephone visits in behavioral health department. Aim 3: Analyze demographics, location and diagnoses that may be affecting the virtual visits during the pandemic. Results Currently the study is in data analysis phase and results will be availble in January 2022 Conclusions This pandemic has highlighted the vulnerability of our communities and health care systems. Tan et al in their recent study showed that the income inequality within US counties was associated with more cases and deaths due to COVID-19 in the summer months of 2020.3 Relationship between race, income inequality and social resources are complex and implicated in predicting negative outcomes regarding COVID-19. Nearly 20% of U.S. counties are disproportionately black, and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally in 2020.4 With most healthcare system planning to incorporate virtual care as a standard of care, it is imperative that social determinants of health will impact access to virtual care in the imminent future and affect long term health outcomes. Additionally, access to virtual care have a complex relationship model with existing determinants but can also provide an opportunity to improve overall health by identifying limitations, populations and geographical areas which need higher level of awareness such as digital literacy or even perhaps infrastructure support to improve access to care. This research was funded by None

Response and resilience of Asian agrifood systems to COVID-19: An assessment across twenty-five countries and four regional farming and food systems.

Context: The COVID-19 pandemic has been affecting health and economies across the world, although the nature of direct and indirect effects on Asian agrifood systems and food security has not yet been well understood. Objectives: This paper assesses the initial responses of major farming and food systems to COVID-19 in 25 Asian countries, and considers the implications for resilience, food and nutrition security and recovery policies by the governments. Methods: A conceptual systems model was specified including key pathways linking the direct and indirect effects of COVID-19 to the resilience and performance of the four principal Asian farming and food systems, viz, lowland rice based; irrigated wheat based; hill mixed; and dryland mixed systems. Based on this framework, a systematic survey of 2504 key informants (4% policy makers, 6% researchers or University staff, 6% extension workers, 65% farmers, and 19% others) in 20 Asian countries was conducted and the results assessed and analysed. Results and conclusion: The principal Asian farming and food systems were moderately resilient to COVID-19, reinforced by government policies in many countries that prioritized food availability and affordability. Rural livelihoods and food security were affected primarily because of disruptions to local labour markets (especially for off-farm work), farm produce markets (notably for perishable foods) and input supply chains (i.e., seeds and fertilisers). The overall effects on system performance were most severe in the irrigated wheat based system and least severe in the hill mixed system, associated in the latter case with greater resilience and diversification and less dependence on external inputs and long market chains. Farming and food systems' resilience and sustainability are critical considerations for recovery policies and programmes, especially in relation to economic performance that initially recovered more slowly than productivity, natural resources status and social capital. Overall, the resilience of Asian farming and food systems was strong because of inherent systems characteristics reinforced by public policies that prioritized staple food production and distribution as well as complementary welfare programmes. With the substantial risks to plant- and animal-sourced food supplies from future zoonoses and the institutional vulnerabilities revealed by COVID-19, efforts to improve resilience should be central to recovery programmes. Significance: This study was the first Asia-wide systems assessment of the effects of COVID-19 on agriculture and food systems, differentiating the effects of the pandemic across the four principal regional farming and food systems in the region.

Duration of Viral Clearance in Children With SARS-CoV-2 Infection in Rajasthan, India.

OBJECTIVE: To study the clinical and laboratory profile and to assess period for viral clearance in COVID 19 children. METHODS: We reviewed hospital records of children (<18 years) admitted from 1 April to 31 May, 2020 at a tertiary-care public hospital and identified those positive for severe acute respiratory syndrome corona virus (SARS-CoV-2) by RT-PCR of respiratory secretions. RESULTS: 81.2% of the 85 children studied were asymptomatic and 3 (8.5%) died. Severe lymphopenia (43.8%), raised C-reactive protein (93.8%), raised erythrocyte sedimentation rate (75%) and high (>500ng/mL) levels of D-dimer (37.5%) were common. Median (IQR) duration of viral shedding was 7 (5-10) days, with range of 2 to 45 days; 96.3% had viral clearance within 14 days. CONCLUSIONS: Majority of children aged <18 years with SARS-CoV-2 infection had viral clearance within 14 days.