Distribution plans, data on vaccines; NIH cautious on latest antibody treatment

The latest research and news in COVID-19 focused largely on vaccines. On Dec. 1, the CDC's Advisory Committee on Immunization Practices (ACIP) met and voted on which populations would be top priority for vaccination. They chose health care personnel and residents of long-term care facilities to be in the first phase once a vaccine against SARS-CoV-2 is authorized by the FDA and recommended by ACIP.

On Nov. 24, ACP issued a policy statement offering guidance on ethical distribution of vaccines, including against SARS-CoV-2. It called for prioritizing high-risk health care workers involved in direct patient care and first responders, followed by people with two or more underlying health conditions that put them at risk and older adults and individuals with disabilities of all ages who live in congregate settings. If vaccine supplies permit, all individuals ages 65 years and older should be included in that phase, the policy noted. It then listed additional categories of prioritization, based on people's employment, health status, age, and living situation. The recommendations are based on the National Academies of Sciences, Engineering, and Medicine's October 2019 report, “Framework for Equitable Allocation of COVID-19 Vaccine,” with some modifications by ACP. The College recommended that ACIP adopt this proposal for phased allocation of the vaccines.

Positive news about the durability of immune response after vaccination was provided by a letter to the editor published by the New England Journal of Medicine on Dec. 3. Researchers reported on immunogenicity among 34 healthy adults who received two 100-µg dose injections, 28 days apart, of the mRNA-1273 vaccine developed by Moderna. At 90 days after the second dose, antibodies had declined but remained elevated in all participants. There were also no serious adverse events. “Our findings provide support for the use of a 100-μg dose of mRNA-1273 in an ongoing phase 3 trial, which has recently shown a 94.5% efficacy rate in an interim analysis,” the authors said.

In other COVID-19 news, on Dec. 2, the NIH's COVID-19 Treatment Guidelines Panel declared that there are insufficient data to recommend either for or against the use of casirivimab plus imdevimab for the treatment of outpatients with mild to moderate COVID-19.

The combination of monoclonal antibodies received emergency use authorization (EUA) from the FDA on Nov. 21. The NIH, which issued a similar statement on the other antibody treatment that received an EUA, said that the combination should not be considered the standard of care and that clinicians are encouraged to discuss participation in trials of neutralizing antibodies with patients who have mild to moderate COVID-19. The statement noted that hospitalized patients should not receive the combination outside of a clinical trial. It also reviewed the data that supported the EUA and have not been published in a medical journal.

On Dec. 2, the CDC issued new guidance on quarantining after exposure to SARS-CoV-2. The agency still recommends a quarantine of 14 days but offered some alternatives to shorten that period. Quarantine can end after day 10 if no symptoms have been reported or after day 7 if the person tests negative and had no symptoms. A study published by Health Affairs on Dec. 2 highlighted the importance of testing to reducing viral transmission, comparing rates of testing and COVID-19 spread in 173 countries and territories. “Increased testing and isolation may represent the most effective, least costly alternative in terms of money, economic growth and human life for controlling COVID-19,” the authors said.