Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA.
Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.
BMC Infect Dis. 2022 Aug 9;22(1):683. doi: 10.1186/s12879-022-07639-1.
Despite the development of safe and effective vaccines, effective treatments for COVID-19 disease are still urgently needed. Several antiviral drugs have shown to be effective in reducing progression of COVID-19 disease.
In the present work, we use an agent-based mathematical model to assess the potential population impact of the use of antiviral treatments in four countries with different demographic structure and current levels of vaccination coverage: Kenya, Mexico, United States (US) and Belgium. We analyzed antiviral effects on reducing hospitalization and death, and potential antiviral effects on reducing transmission. For each country, we varied daily treatment initiation rate (DTIR) and antiviral effect in reducing transmission (AVT).
Irrespective of location and AVT, widespread antiviral treatment of symptomatic adult infections (20% DTIR) prevented the majority of COVID-19 deaths, and recruiting 6% of all adult symptomatic infections daily reduced mortality by over 20% in all countries. Furthermore, our model projected that targeting antiviral treatment to the oldest age group (65 years old and older, DTIR of 20%) can prevent over 30% of deaths. Our results suggest that early antiviral treatment (as soon as possible after inception of infection) is needed to mitigate transmission, preventing 50% more infections compared to late treatment (started 3 to 5 days after symptoms onset). Our results highlight the synergistic effect of vaccination and antiviral treatment: as the vaccination rate increases, antivirals have a larger relative impact on population transmission. Finally, our model projects that even in highly vaccinated populations, adding antiviral treatment can be extremely helpful to mitigate COVID-19 deaths.
These results suggest that antiviral treatments can become a strategic tool that, in combination with vaccination, can significantly reduce COVID-19 hospitalizations and deaths and can help control SARS-CoV-2 transmission.
尽管已经开发出安全有效的疫苗，但仍迫切需要针对 COVID-19 疾病的有效治疗方法。一些抗病毒药物已被证明可以有效减缓 COVID-19 疾病的进展。
在本工作中，我们使用基于主体的数学模型来评估在四个具有不同人口结构和当前疫苗接种覆盖率的国家（肯尼亚、墨西哥、美国和比利时）中使用抗病毒治疗的潜在人群影响。我们分析了抗病毒治疗在减少住院和死亡方面的效果，以及在减少传播方面的潜在抗病毒效果。对于每个国家，我们改变了每日治疗开始率（DTIR）和抗病毒治疗在减少传播方面的效果（AVT）。
无论地点和 AVT 如何，广泛治疗有症状的成年感染者（20% DTIR）可预防大多数 COVID-19 死亡，而每天招募所有成年有症状感染者的 6%，可使所有国家的死亡率降低 20%以上。此外，我们的模型预测，将抗病毒治疗针对最年长的年龄组（65 岁及以上，DTIR 为 20%）可以预防超过 30%的死亡。我们的研究结果表明，需要进行早期抗病毒治疗（在感染开始后尽快开始），以减轻传播，与晚期治疗（在症状出现后 3 至 5 天开始）相比，可预防多达 50%的感染。我们的结果强调了疫苗接种和抗病毒治疗的协同作用：随着疫苗接种率的提高，抗病毒治疗对人群传播的相对影响更大。最后，我们的模型预测，即使在高接种率的人群中，添加抗病毒治疗也可以非常有助于减轻 COVID-19 死亡。
这些结果表明，抗病毒治疗可以成为一种战略工具，与疫苗接种相结合，可以显著减少 COVID-19 住院和死亡人数，并有助于控制 SARS-CoV-2 的传播。
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