Project 465293

The Omicron wave provided real-world evidence that even when vaccine rates are high, a vaccine mismatch can lead to decreased efficacy. As we move towards the virus become endemic, we will need to pay attention to the patient populations that continue to have severe disease even after vaccination. The recent approval of oral antivirals offer promise, as they have the potential to further decrease the risk of severe disease, hospitalizations, and mortality. However, the emergence of drug resistance in SARS-CoV-2 is a potential threat to the health of Canadians and strategies must be implemented to lessen its potential impact. Antivirals for SARS-CoV-2 are expected to be in wide-scale use by the fall of 2022. This proposal will address key questions on antiviral resistance mutations and real-world efficacy, as well as develop tools that can be immediately shared with the clinical community for ongoing surveillance as new antivirals become available and are used clinically. Through the hospitals part of Toronto Invasive Bacterial Disease Network (TIBDN) we will collect patient data and samples among hospitalized patients as well as immunocompromised patients and monitor for drug resistance mutations. We will then fully characterize these mutations in the lab, to assess the level of resistance as well as viral replication. Collectively, the findings from this project have potential to better prepare Canada as SARS-CoV-2 becomes endemic.