Understanding the Potential Impact of Different Drug Properties On SARS-CoV-2 Transmission and Disease Burden: A Modelling Analysis
Authors: Whittaker Charles , Watson Oliver J. , Alvarez-Moreno Carlos , Angkasekwinai Nasikarn , Boonyasiri Adhiratha , Triana Luis Carlos , Chanda Duncan , Charoenpong Lantharita , Chayakulkeeree Methee , Cooke Graham S. , Croda Julio , Cucunubá Zulma M , Djaafara Bimandra A. , Estofolete Cassia F. , Grillet Maria Eugenia , Faria Nuno R. , Costa Silvia Figueiredo , Forero-Peña David A. , Gibb Diana M. , Gordon Anthony C , Hamers Raph L. , Hamlet Arran , Irawany Vera , Jitmuang Anupop , Keurueangkul Nukool , Kimani Teresia Njoki , Lampo Margarita , Levin Anna S. , Lopardo Gustavo , Mustafa Rima , Nayagam Shevanthi , Ngamprasertchai Thundon , Hannah Njeri Ng’ang’a Irene , Nogueira Mauricio L. , Ortiz-Prado Esteban , Perroud Mauricio W. , Phillips Andrew N. , Promsin Panuwat , Qavi Ambar , Rodger Alison J. , Sabino Ester C. , Sangkaew Sorawat , Sari Djayanti , Sirijatuphat Rujipas , Sposito Andrei C. , Srisangthong Pratthana , Thompson Hayley A. , Udwadia Zarir , Valderrama-Beltrán Sandra , Winskill Peter , Ghani Azra C. , Walker Patrick G.T. , Hallett Timothy B. 
Published: June 2021

AbstractBackgroundThe unprecedented public health impact of the 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 and FindingsWe develop a mathematical model of SARS-CoV-2 transmission, COVID-19 disease and clinical care to explore the potential public-health impact of a range of different potential therapeutics, under a range of different scenarios varying: i) healthcare capacity, ii) epidemic trajectories; and iii) drug efficacy in the absence of supportive care. In each case, the outcome of interest was the number of COVID-19 deaths averted in scenarios with the therapeutic compared to scenarios without. We find the impact of drugs like dexamethasone (which are 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 hospitalisation) could have much greater benefits, particularly in resource-poor settings facing large epidemics.ConclusionsThere is a global asymmetry in who is likely to benefit from advances in the treatment of COVID-19 to date, which have been focussed on hospitalised-patients and predicated on an assumption of adequate access to supportive care. Therapeutics that can feasibly be delivered to those 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.