According to the WHO, as of March 10, over 117 million cases of COVID-19—the disease caused by the virus—have been reported worldwide, and over 2.6 million people have died as a result of infection. But there may finally be light at the end of the tunnel. More than 268 million vaccine doses have been administered globally, and that number is growing. We’re 1 year in—and here’s the latest information on the new variants of the virus, how doctors are treating patients with the disease, and a review of the vaccine landscape. 

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New variants

Viruses constantly mutate and change over time. While not all mutations are successful, some persist, and a number of SARS-CoV-2 variants have emerged and spread over the past year. Three of these have traveled across the world.

1. The variant known as B.1.1.7 was originally identified in the United Kingdom in the fall of 2020. By January 2021, experts found data to suggest that not only does it spread more quickly compared with other variants, but it’s also associated with an increased risk of death. The variant has since been detected in many other countries.
2. Another variant, called B.1.351, was identified in South Africa last October. According to the CDC, this variant shares some mutations with B.1.1.7 and appears to spread more quickly than the original virus. B.1.351 was initially detected in the United States in January and, as of March 10, 2021, there were 91 cases reported in 21 jurisdictions, according to the CDC. 
3. A third variant called P.1 is thought to have emerged in Brazil, after it was detected in travellers who arrived from the country at an airport in Japan in January. This variant, which features additional mutations.

Drugs for COVID-19 treatment

Most people who contract COVID-19 will be able to recover at home with adequate rest, hydration, and common medications to relieve fever and pain. For those who experience mild to moderate symptoms but are at risk of developing a severe response to the disease (or at risk of being hospitalised for it), the FDA has granted emergency approval to two monoclonal antibody treatments, notes Harvard Health. Bamlanivimab, produced by Eli Lilly, and a combination of casirivimab and imdevimab, produced by Regeneron, were both approved in November. These treatments can reduce the risk of hospitalisation, and are given intravenously (in clinic or hospital) soon after symptoms develop.

Of course, many are still being hospitalised as a result of their symptoms. For these patients, the FDA has approved treatments to help curb the COVID-19 mortality rate. These include corticosteroids, like dexamethasone, which are anti-inflammatory drugs given to patients who develop a hyper-immune response (a cytokine storm). In these cases, the immune system’s reaction can cause significant damage to the lungs, which often results in death. An early study indicated, however, that for patients on supplemental oxygen or a ventilator, dexamethasone reduced patients’ chances of dying within 28 days, compared with standard care.

Other treatments include the antiviral drug remdesivir, which was approved by the FDA in October. In November, the FDA approved the use of baricitinib in combination with remdesivir, for patients who require respiratory support. Physicians have also been treating almost all patients with anticoagulation drugs, to prevent blood clots. Typically, patients receive low doses of heparin or enoxaparin. 

One treatment that has shown mixed results in studies is convalescent plasma, which has been used for over a century to treat illnesses ranging from polio to SARS and is widely considered to be safe, according to Harvard Health. The plasma, which is taken from the blood of recovered COVID-19 patients, contains antibodies that were produced to fight the disease. The use of convalescent plasma to treat patients hospitalized with COVID-19 was granted emergency approval by the FDA in August, but subsequent trials indicate that it may not be entirely effective. A review published in JAMA Network in February, which analysed the results of four trials, concluded that convalescent plasma did not significantly improve the risk of death, length of hospital stay, or the need for a ventilator.

Vaccines

The race to vaccinate the world is ongoing and the state of affairs changes daily. As of March 10, researchers are testing 75 different vaccines in clinical trials on humans, and at least 78 in preclinical trials on animals, according to an interactive coronavirus vaccine tracker published by the New York Times. All told, 21 vaccines have reached the final stages of testing.

Nine vaccines are currently being used in some capacity across the world. Russia, for example, began offering its population the two-dose vaccine Sputnik V in November. Developed by the Gamaleya Research Institute, which is part of Russia’s Ministry of Health, the vaccine (two doses, 3 weeks apart) purportedly has an efficacy rate of 91.6%. On December 30, Britain authorized the use of AZD1222, a two-dose vaccine given 12 weeks apart, produced by the University of Oxford and the British-Swedish company AstraZeneca. In February, AstraZeneca published a report showing that the vaccine has an efficacy rate of 82.4% and also reduces transmission of the virus. 

There’s no way of knowing whether new emergent variants will quash vaccination attempts, but with case numbers and death rates dropping across the world, there’s good reason to feel optimistic that we’re slowly escaping the clutches of SARS-CoV-2.

This story is contributed by Alistair Gardiner and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.