Future prospects
It is expected that the COVID-19 pandemic will be halted to the maximum
extent under the help of vaccination. China has set an example due to
the practice of “ISISI” strategies for the COVID-19 pandemic. So far,
there are more than 1.2 billions of Chinese residents who received the
whole vaccination, and it’s still continuing coverage among non-adults
from 3 to 17-year-old. We expect that the pandemic will be effectively
halted by not only powerful candidate vaccines but also continuing the
“ISISI” barriers which cover antiviral drugs (Molnupiravir, Paxlovid,
Chinese combination of BRII-196/BRII-198) (4-7), traditional Chinese
medicine, small molecules and plant-derived anti-SARS-CoV-2 agents. It’s
happy to see a living WHO guideline on drugs to prevent COVID-19 (25).
And it’s believed that people will combat the COVID-19 pandemic sooner
or later under the help of these comprehensive strategies.
After rigorous clinical trial design, current vaccination by receiving
developed candidate vaccines is a reliable strategy for
against SARS-CoV-2 infection and transmission, and control of COVID-19
in the globe. Both animal models and clinical trials confirmed the
protective roles elicited by vaccination of multiple safe and effective
vaccines, such as two doses of the mRNA-1273 COVID-19 vaccine (26),
StriFK-FH002C (27), the AS03-adjuvanted preS dTM vaccine (28), ChAdOx1
nCoV-19/AZD1222 (29), Two doses of the SARS-CoV-2 BNT162b2 vaccine (30),
COVID-19 mRNA vaccines (31), Ad26.COV2.S vaccination (32),
AZD1222/ChAdOx1 nCoV-19 vaccination (33). Newly, GRAd-COV2, a candidate
vaccine against COVID-19, is safe and immunogenic in younger and older
adults (34). However, there are still many challenges since current
Omicron variant appear to diminish the protection conferred by
pre-existing immunity.
There was historically high excess mortality during
the COVID-19 pandemic in some European countries since the beginning of
the 20th century (35), but telemedicine service may reduce
infection-related mortality (36). Although there are rare adverse events
(myocarditis, carditis, thrombosis) in some cases (37-39), vaccination
(40) and history of infection (41) have a protection against reinfection
and variants (42). And vaccination in organ transplant recipients may
increase neutralizing antibody response against SARS-CoV-2 variants
(43). In conclusion, on the one hand, we need to rapidly develop novel
efficacious vaccines against SARS-CoV-2 and its major variants (Delta
and Omicron) since human immunity
and early
non-neutralizing antibody responses are associated
with COVID-19 severity (1, 44); On the other hand, we should rigidly
control Omicron variant for restriction of infection and transmission in
the globe by the comprehensive “ISISI” strategies.
Currently, megadose vitamin C (45) can be used as a potential treatment,
unfractionated heparin (UFH) can directly inhibit binding of spike
protein to the human ACE2 protein receptor (46), and protease-activated
receptors (PARs) blockers may fight against cytokine release syndrome
and COVID-19-associated coagulopathy (47), the options to target
complement may halt disease progression and death (48). All in all, a
polypharmacology approach or multi-drug treatment (49, 50) may help
improve clinical outcomes since there are acute kidney injury (AKI) and
fibroproliferative changes in the lung, heart and kidney in COVID-19
cases. Because mass vaccination cannot quickly end the pandemic, it is
suggested to adopt an influenza-like vaccination strategy (51). In
conclusion, the prevention and control of COVID-19 needs the
comprehensive “ISISI” strategies.