ABSTRACT
The race for a search for therapeutics and vaccines began before the COVID-19 outbreak even became a pandemic. Existing medications used in other conditions have been repurposed and tried in patients with varying degrees of disease severity. This is the case, for instance, for the antimalarial hydroxychloroquine, the antiviral remdesivir, the anthelmintic ivermectin, or the interleukin-6 inhibitor tocilizumab. Dexamethasone rose as an essential cornerstone of therapy for the patient with COVID-19 on oxygen supplementation or mechanical ventilation, while remdesivir became the first (and only thus far) FDA-approved medication for patients with severe COVID-19 disease not requiring mechanical ventilation. The first part of this chapter gives an overview of the medical treatment approach for the hospitalized patient and the various neurological complications associated with each of the treatments in use in the United States. The second section of the chapter discusses vaccine development and types. It also goes over vaccines’ neurological side effects and special considerations for patients with different neurological conditions. © 2021 Elsevier Inc. All rights reserved.
ABSTRACT
Developing a vaccine against the global pandemic SARS-CoV-2 is a critical area of active research. Modelling can be used to identify optimal vaccine dosing; maximising vaccine efficacy and safety and minimising cost. We calibrated statistical models to published dose-dependent seroconversion and adverse event data of a recombinant adenovirus type-5 (Ad5) SARS-CoV-2 vaccine given at doses 5.0 × 1010, 1.0 × 1011 and 1.5 × 1011 viral particles. We estimated the optimal dose for three objectives, finding: (A) the minimum dose that may induce herd immunity, (B) the dose that maximises immunogenicity and safety and (C) the dose that maximises immunogenicity and safety whilst minimising cost. Results suggest optimal dose [95% confidence interval] in viral particles per person was (A) 1.3 × 1011 [0.8-7.9 × 1011], (B) 1.5 × 1011 [0.3-5.0 × 1011] and (C) 1.1 × 1011 [0.2-1.5 × 1011]. Optimal dose exceeded 5.0 × 1010 viral particles only if the cost of delivery exceeded £0.65 or cost per 1011 viral particles was less than £6.23. Optimal dose may differ depending on the objectives of developers and policy-makers, but further research is required to improve the accuracy of optimal-dose estimates.