COVID-19 one year into the pandemic: from genetics and genomics to therapy, vaccination, and policy

Abstract

COVID-19 has engulfed the world and it will accompany us all for some time to come. Here, we review the current state at the milestone of 1 year into the pandemic, as declared by the WHO (World Health Organization). We review several aspects of the on-going pandemic, focusing first on two major topics: viral variants and the human genetic susceptibility to disease severity. We then consider recent and exciting new developments in therapeutics, such as monoclonal antibodies, and in prevention strategies, such as vaccines. We also briefly discuss how advances in basic science and in biotechnology, under the threat of a worldwide emergency, have accelerated to an unprecedented degree of the transition from the laboratory to clinical applications. While every day we acquire more and more tools to deal with the on-going pandemic, we are aware that the path will be arduous and it will require all of us being community-minded. In this respect, we lament past delays in timely full investigations, and we call for bypassing local politics in the interest of humankind on all continents.

Keywords: COVID-19; Coronavirus; Monoclonal antibodies; Pandemic; Politics; SARS-CoV-2; Vaccines; Variants.

Fig. 1

SARS-CoV-2 genomic surveillance. a Phylogenetic tree of 19,438 SARS-CoV-2 genomes. Up to December 31, 2020, more than 295,000 complete genomes were submitted to the GISAID database. Each circle in this tree represents a genome that was sequenced over time, since the beginning of the pandemic. As SARS-CoV-2 establishes new infections, its descendants form lineages of genetically related viruses, which can circulate more locally, as shown in lineages represented by threads of circles with similar colors (as shown in red, at the top of panel a), or may have more heterogeneous distributions, as depicted in lineages with multiple colors, highlighting the exchange of viruses between geographic regions (as shown at the bottom of panel a). b State level distribution of SARS-CoV-2 genomes shown in panel a (see acknowledgement Table S1). All regions of the world were impacted by the pandemic, some more than others. As a result, an imbalance in the distribution of genomes worldwide (depicted in panel b as bubbles of distinct sizes) is evident. The differences in genome sampling across continents and countries may not only be the result of epidemic control via distinct public health strategies (as observed in New Zealand and Australia, for example) but may also result from socioeconomic disparities at national and international scales, where some regions (e.g., South and Central America, most regions in Africa), despite being hard hit by the pandemic, are unable to conduct genomic surveillance at a scale comparable to that of rich countries in North America and Europe. Analyses and illustrations were respectively generated using augur and auspice (by nextstrain.org) [11]