In an unparalleled global effort, diagnostics and vaccines to identify and prevent Sars-CoV-2 infections have been made available to public health systems, with various therapeutics for acute cases of COVID-19 being currently tested in clinical trials.
Nevertheless, a significant research gap exists in the understanding and treatment of so-called Long COVID, i.e. the delayed onset of persistent health problems following a SARS-CoV-2 infection with mostly moderate to mild symptoms. While the resulting health economic implications still need to be assessed in the long term, it is already clear that affected patients suffer significantly from reduced quality of life and individual physical and mental performance.
Lessons from the Chikungunya Virus
In a recent letter to The Lancet, a team of researchers, including a scientist from Evotec Infectious Disease Group in Lyon, France, points out that politicians and the public often picture COVID-19 as a mono-phasic infection similar to the flu. This is an understandable cognitive bias as mode of transmission, clinical presentation and the explosive shape of the epidemic curve are all very similar to the flu, in particular the Spanish flu, a pandemic that 100 years ago killed 20-50 million people world-wide. However, the authors – familiar with the biphasic nature of chikungunya virus infections – see striking similarities not between COVID-19 and the flu but between COVID-19 and chikungunya (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00272-3/fulltext).
Chikungunya infections are spread by mosquito bites resulting in acute symptoms like fever and severe joint pain; headaches, muscle pain, swelling and rashes may be further symptoms. The infection is typically overcome within 1-2 weeks, but may cause lasting joint pain. However, it can also have serious long-term consequences and may lead to persistent mental or somatic constraints, causing both individual and economic burdens.
The researchers, therefore, call for a change in perspective when addressing COVID-19 and urge healthcare systems and politics to no longer ignore the biphasic nature of SARS-CoV-2 infections and its potential long-term disease course.
Antibody Treatments for Chikungunya Virus Infections – A Roadmap for COVID-19?
Evotec may contribute new data to allow a better understanding of fighting biphasic infections. However unlike COVID-19, there are currently no vaccines or treatments available to address chikungunya infections. To meet this medical need, the Company is developing EVT894, a first-in-class monoclonal antibody with anti-viral activity to treat and potentially prevent chikungunya virus infections, with the compound entering clinical development in late 2020.
EVT894 was derived from a patient who was infected with the chikungunya virus and shows promising data in pre-clinical testing, achieving potent neutralising activity in vitro and in vivo in both therapeutic and prophylactic disease models. It also demonstrated efficacy against all circulating chikungunya genotypes.
Future findings from the EVT894 studies may provide a blueprint for understanding – and, eventually, treating – biphasic infectious diseases such as chikungunya and COVID-19.
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