editorial COVID-19 therapies and vaccine landscape Within a few weeks of the novel coronavirus genome sequence being published, numerous therapies and vaccines have entered clinical trials with a few showing great promise in alleviating symptoms and accelerating recovery.

n late 2019, patients presenting with viral next-generation vaccine development can be pneumonia were reported in Wuhan, expedited by utilizing sequence information IChina, and a novel coronavirus was alone rather than relying on in vitro cultures quickly identified as the causative pathogen of live viruses. Nucleic acid-based vaccines that leads to severe acute respiratory that use this next-generation approach have syndrome (SARS-CoV-2) or COVID- been the frontrunners for COVID-19. One 19. The widely reported unpredictability such example is an mRNA vaccine (mRNA- of the disease means that some infected 1273 — encoding for the virus spike protein individuals are asymptomatic, some have used by viruses to latch onto human host mild flu-like symptoms, whereas other cells) developed by Moderna Therapeutics unfortunate individuals suffer from major and the National Institutes of Health has complications. The lower respiratory tract is already shown promising signs and is the main target for severe symptoms, where Credit: Andrey Deryabin/Alamy Stock Photo currently finalizing preparations for phase high virus shedding has been observed. The III clinical trials7. Another frontrunner body defends itself by an elevated immune in phase IIB/III clinical trials, ChAdOX1 response that fights to destroy virus-infected Favipiravir (Toyama Chemical), previously nCoV19, developed by Oxford University cells. This unfortunately results in blockage developed for the treatment of influenza, and AstraZeneca, is a vaccine platform of the alveoli in the lungs due to inflamed has also been trialled for COVID-19, and based on an adenovirus vector also tissue, leading to shallow respiration, with shows the potential to reduce viral load encoding for the spike protein of some patients presenting with a condition and offer clinical improvement in patients SARS-CoV-28. This platform was previously called acute respiratory distress syndrome with mild to moderate symptoms of developed for MERS and influenza and that can cause death1. As of July 2020, there COVID-19. Other drugs such as Lopinavor, has also shown significant promise thus far have been over 10 million confirmed cases Ritonavir and even hydroxycholoroquine for COVID-19. Scale-up manufacture of of coronavirus infections and over 500,000 have also been tested but have been less these candidates will be a major hurdle in deaths globally. The emergence of the successful. the near future. virus is still contested, although it is now A rather surprising but positive outcome Equally important, diagnosis of patients known that it is phylogenetically related to has been seen with corticosteroids, which is instrumental in the fight against COVID- the SARS-like coronavirus isolated from were previously thought to limit the body’s 19 and so far, real-time polymerase chain horseshoe bats (Rhinolophus sinicus)2. ability to fight the virus but in fact have reaction (RT-PCR) has been the most Unlike SARS and MERS (Middle Eastern been crucial in alleviating symptoms successful at detecting the virus. However, respiratory syndrome), other zoonotic associated with pulmonary failure. In a other diagnostic toolkits are also in coronavirus-based diseases, COVID-19 has recent randomized, controlled clinical trial development. Antigen and antibody tests been declared a pandemic by the World (RECOVERY trial) in the UK involving have been recommended by WHO for the Health Organization (WHO). over 11,500 patients, the use of low-dose detection of the virus at early and late stages Although currently much hope rests dexamethasone, a corticosteroid, was shown of the disease, respectively, and numerous in the development of a vaccine, there has to reduce deaths by approximately 30% pharmaceutical companies are developing a been noteworthy progress in repurposing in COVID-19 patients on ventilators and range of rapid toolkits. existing broad-spectrum antiviral agents3. by 20% in patients on oxygen alone5. It is Overall, it is clear that the landscape of Writing in a Comment in this issue of thought that this low-cost drug suppresses vaccines, therapeutics and diagnostic tools Nature Materials, Nam Joon Cho and Jeffrey the immune system in severely ill patients for COVID-19 is evolving rapidly with Glenn highlight that numerous viruses share whose lungs are compromised promising preliminary results already, which similar physical structures and lifecycle by inflammation. Ultimately, a vaccine in itself is a significant achievement. ❐ patterns. Accordingly, a number of existing would offer more effective protection antiviral drugs are now being used for the from the virus. treatment of the coronavirus. Remdesivir Vaccines typically take 5–10 years to Published online: 23 July 2020 (Gilead Sciences, Inc.) is one such drug that develop and the process involves highly https://doi.org/10.1038/s41563-020-0758-9 was previously developed for treating Ebola controlled preclinical and clinical trials and Marburg viruses. It is currently being before approval for general use. Incredibly, References explored for COVID-19 and has reached within a few weeks of the virus genome 1. Wadman, M., Couzin-Frankel, J., Kaiser, J. & Matacic, C. Science http://doi.org/ggsd2f (2020). phase III clinical trials. Preliminary results sequence being published, vaccines were 2. Zhou, P. et al. Nature 579, 270–273 (2020). have shown that patients with moderate already developed for patient trials. Indeed, 3. Harrison, C. Nat. Biotechnol. 38, 379–381 (2020). COVID-19 pneumonia receiving the there are over 130 COVID-19 vaccines 4. Beigel, J. H. et al. N. Engl. J. Med. http://doi.org/dwkd (2020). drug are 65% more likely to have clinical at various stages of development around 5. University of Oxford https://go.nature.com/2O3HeqY (2020). 6 6. Mullard, A. Lancet 395, 1751–1752 (2020). improvement when compared to those the world . In another Comment, Debby 7. Moderna https://go.nature.com/3faEy6Z (2020). on standard care plans4. Another drug, van Riel and Emmie de Wit highlight that 8. University of Oxford https://go.nature.com/3e7XUYV (2020).

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