COVID-19 awareness material

2

5

COVID-19…The History

COVID-19 Vaccines

MAY 2020 #[1]

The material is brought to you by NN Medical Team

For healthcare professionals only

Novo Nordisk EgyptThe 47th building, plot 47th, City Center, 5th Settlement, New Cairo, Egypt

001502561050008020W

MO

H a

pp

roval n

um

ber: 0

01

50

25

6/0

50

00

80

20

W In

tern

al n

um

ber:E

G2

0O

B0

00

01

COVID-19…The History “Coronaviruses are large, enveloped, positive-strand RNA (Ribonucleic acid) viruses that can be divided into 4 genera: alpha, beta, delta, and gamma, of which alpha and beta CoVs (Corovaviruses)are known to infect humans.”1

“Four HCoVs (HCoV 229E(Human Coronavirus229E), NL63, OC43, and HKU1) are endemic globally and account for 10% to 30% of upper respiratory tract infections in adults.”1

“Coronaviruses are ecologically diverse with the greatest variety seen in bats, suggesting that they are the reservoirs for many of these viruses.”1

“Human coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs - severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality.”1

“In December 2019, yet another pathogenic HCoV2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China. The ultimate scope and effect of this outbreak is unclear at present as the situation is rapidly evolving.”1

“Until recently, HCoVs received relatively little attention due to their mild phenotypes in humans. This changed in 2002, when cases of severe atypical pneumonia were described in Guangdong Province, China, causingworldwide concern as disease spread via international travel to more than 2 dozen countries. The new disease became known as severe acute respiratory syndrome (SARS), and a beta-HCoV, named SARS-CoV, was identified as the causative agent.”1

“While the trajectory of this outbreak is impossible to predict, effective response requires prompt action from the standpoint of classic public health strategies to the timely development and implementation of effective countermeasures.”1

How does COVID-19 spread?3

“People can contract COVID-19 from others who have the virus. It is spread from an infected person through:

Respiratory droplets generated when you cough or sneeze

Close personal contact, such as touching or shaking hands then touching your mouth, nose or eyes before washing your hands.

Touching something with the virus on it (such as objects and surfaces), then touching your mouth, nose or eyes before washing your hands.

People can also contract COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out, sneezes out or exhales droplets.”3

Adapted from: European Centre for Disease Pre-vention and Control. https://www.ecdc.europa. eu/en/geographical-distribution-2019-ncov-cases2

Adapted from: PAHO. https://www.paho.org/en/covid-19-communication-materials Access date 29th April 2020PAHO:Pan American Health OrganizationWHO:World Health Organization

MAY 2020 / ISSUE#[1] / PAGE 3MAY 2020 / ISSUE#[1] / PAGE 2

4

Main laboratory abnormalities in patients with unfavourable progression COVID-195

• Increased white blood cell count• Increased neutrophil count• Decreased lymphocyte count• Decreased albumin• Increased lactate dehydrogenase (LDH)• Increased alanine aminotransferase (ALT)• Increased aspartate aminotransferase (AST)• Increased total bilirubin• Increased creatinine• Increased cardiac troponin• Increased D-dimer• Increased prothrombin time (PT)• Increased procalcitonin• Increased C-reactive protein (CRP)”

Symptoms and Prevention6

WHO Recommendations7

Adapted from: WHO. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public access date 29th April 2020

COVID-19 VaccinesThe need to rapidly develop a vaccine against SARS-CoV-2 (severe acute respiratory syndrome) comes at a time of explo-sion in basic scientific understanding, including in areas such as genomics and structur-al biology, that is supporting a new era in vaccine development.8

It’s a lengthy process..“Vaccine development is a lengthy, expensive process. Attrition is high, and it typically takes multiple candidates and many years to produce a licensed vaccine. Because of the cost and high failure rates, developers typically follow a linear sequence of steps, with multiple pauses for data analysis or manufacturing process checks. Developing a vaccine quickly requires a new pandemic paradigm (see diagram), with a fast start and many steps executed in parallel before confirming a successful outcome of another step, hence resulting in elevated financial risk.”8Adapted from: European Center for Disease Control and Prevention website . Link: https://

www.ecdc.europa.eu/en/publications-data/info-graphic-covid-19 accessed on 29 April 20206

MAY 2020 / ISSUE#[1] / PAGE 5MAY 2020 / ISSUE#[1] / PAGE 4

SARS-COV-2

“Like SARS-CoV (severe acute respiratory syndrome- CoronaVirus) and MERS-CoV,(Middle East Respiratory Syndrome CoronaVirus) the recent SARS-CoV-2 belongs to the Betacoronavirus genus. It has a genome size of ~30 kilobases which, like other coronaviruses, encodes for multiple structural and non-structural proteins. The structural proteins include the spike (S) protein, the envelope (E)protein, the membrane (M)protein, and the nucleocapsid (N)protein. With SARS-CoV-2 beingdiscovered very recently, there iscurrently a lack of immunologicalinformation available about thevirus (e.g., information aboutimmunogenic epitopes elicitingantibody or T cell responses).Preliminary studies

suggest that SARS-CoV-2 is quite similar to SARS-CoV based on the full-length genome phylogenetic analysis, and the putatively similar cell entry mechanism and human cell receptor usage.

Due to this apparent similarity between the two viruses, previous research that has provided an understanding of protective immune responses against SARS-CoV may potentially be leveraged to aid vaccine development for SARS-CoV-2.”9

“Despite the apparent similarity between SARS-CoV and SARS-CoV-2, there is still considerable genetic variation between the two, and it is not obvious a-prior if epitopes that elicit an immune response against SARS-CoV are likely to be effective against SARS-CoV-2. We found that only 23% and 16% of known SARS-CoV T cell and B cell epitopes map identically to SARS-CoV-2, respectively, and with no mutation having been observed in these epitopes among the available SARS-CoV-2 sequences (as of 21 February 2020). This provides a strong indication of their potential for eliciting a robust T cell or antibody response in SARS-CoV-2.”9

MAY 2020 / ISSUE#[1] / PAGE 7MAY 2020 / ISSUE#[1] / PAGE 6

The table lists major platform types and examples of SARS-CoV-2 vaccine types being developed on each. Accessed on 28th April 2020 ,A more complete and continually updated list is available from the WHO8 through this link: https://www.who.int/who-documents-detail/draft-landscape-of-covid-19-candidate-vaccines.

References

1. Paules CI et al. JAMA. 2020 ;323(8):707-708. doi: 10.1001/jama.2020.0757, Coronavirus Infections—More Than Just the Common Cold.

2. European Centre for Disease Prevention and Control, Situation update worldwide, as of 29thApril 2020 accessed from: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases

3. Diabetes Canada ,FAQ about COVID-19 as of 29th April 2020, accessed from: https://www. diabetes.ca/en-CA/resources/tools---resources/faq-about-covid-19-and-diabetes

4. Infographic:COVID-19, Cover your cough adapted from PAHO/WHO accessed from: https://www.paho.org/en/covid-19-communication-materials

5. Lippi G et al. 2020. Clinical Chemistry and Laboratory Medicine. doi: 10.1515/cclm-2020-0198,Laboratory abnormalities in patients with COVID-2019 infection

6. European Center for Disease Control and Prevention, Infographic COVID-19 accessed from:https://www.ecdc.europa.eu/en/publications-data/infographic-covid-19

7. Novel Coronavirus 2019 (COVID-19) advice for public, WHO, Accessed from : https://www. who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

8. Lurie N et al. New England Journal of Medicine. 2020. doi:10.1056/nejmp2005630, DevelopingCovid-19 Vaccines at Pandemic Speed

9. Ahmed S Viruses. 2020;12(3):254. doi:10.3390/v12030254, Preliminary Identification of Potential Vaccine Targets for the COVID-19 Coronavirus (SARS-CoV-2) Based on SARS-CoVImmunological Studies

MAY 2020 / ISSUE#[1] / PAGE 8