COVID 19 - Lesson for all

Bacteria, viruses, parasites and fungi that are resistant to drugs cause 700,000 deaths each year.

Pandemics, drug resistance and neglected diseases framing health as a “global security issue”. as the recent example of COVID-19 and previously Ebola and MERS, SRAS ....and simple flu variations .

 In 1980 the smallpox vaccine had eradicated the naturally circulating virus worldwide without generating resistance . Recent development of LATV for pertussis shows positive off target effects where not only antibodies but also innate and cellular immunity play crucial roles.

Like any other models, the projections of how the outbreak will unfold, how many people will become infected, and how many will die, are only as reliable as the scientific information they rest on. And most modelers’ efforts so far have focused on improving these data, rather than making premature predictions.

Diagnostic tests availability for all given asymptomatic carriers risk, basic protection accessible to all, accelerated development of accessible vaccines providing protection against severe consequences and fatal outcomes and providing indirect cross protection through training of the immune system, treatment for population at risk .

Currently Sanofi and Gilhead drugs, interferon, immune plasma transfer but already new innovative original and accessible drugs from several countries are also on the path to development to be used in most vulnerable risk groups and guidelines to follow development and hopefully for fast track approval were released.

A smart advice is calling for all countries to follow WHO instructions but also highlights the importance of inter-governmental cooperation as driver to intervene on a national scale and take lesson to prioritize health , research on economic agendas for obvious reasons.

High need to get all countries mobilized jointly which might open the doors for next cooperations for crucial pillars of economy of any nation - research, healthcare system , education.

Real strong involvement of the public and private sectors is needed, given the fact resources are cruelly missing in developed countries and showing how fragile we are to face pandemics and maintain healthcare functioning . Imagine also the Ebola lesson where infrastructures and services are and we are still facing this fatal disease.

Earlier this month, Tedros Adhanom Ghebreyesus, the head of the World Health Organization, dismayed disease modelers when he said COVID-19 (the disease caused by the SARS-CoV-2 coronavirus) had killed 3.4 percent of reported cases, and that this was more severe than seasonal flu, which has a death rate of around 0.1 percent. Such a simple calculation does not account for the two to three weeks it usually takes someone who catches the virus to die, for example. And it assumes that reported cases are an accurate reflection of how many people are infected, when the true number will be much higher and therefore the true mortality rate much lower. Many carriers are asymptomatic.

Outbreak analytics rather than true modelling, and he says the results of various specialist groups around the world are starting to converge on COVID-19’s true case-fatality ratio, which seems to be about 1 percent.

Deaths are the most useful data points for these analyses. For example, if modelers assume a case-fatality ratio of 1 percent, and that it usually takes 15 days for an infected person to die, then they know a death reported today in a specific region means that 100 people were likely infected there 15 days ago. Add in the time it takes cases to double, which seems to take five days then modelers can estimate that over those 15 days the number of cases swelled to 800. So, for every death in a region, that means about 800 others are already infected, most of whom will not have been identified. This pattern was verified in Italy, . When officials tested people living near where someone had died from the disease, in many cases they found that hundreds of others were already carrying the virus.

Left unchecked, infectious outbreaks typically plateau and then start to decline when the disease runs out of available hosts.

The path to follow is to look at the people that are infected(testing all) but stay asymptomatic as a consequence of natural immunity, which may help to identify correlates of protection and fast vaccine development.

The world needs to improve preparedness for outbreaks and epidemics and the way data are handled and made available.

Creation of new data banks in which researchers can share results on, for example, how much virus is shed by infected people and when that starts might be helpful. This backed by better information, models could help determine policies to control spread,

 Nice examples are Taiwan and South Corea which slowed down the progression of the propagation of the virus .

After the 2003 SRAS outbreak Taiwan quickly reacted with a robust plan of management and filtered people coming from risk zones and than strictly followed containment measures. They implemented rapid and immediate production of masques with many measures in health and economy and very clear communication to avoid panic. March 19, in Taiwan where 23 million people are living, has registered 108 cases of Covid -19 and only one death. In South Korea massive daily ?depistage? (15 000 tests by day) was implemented, in addition the population is followed by smartphones. In general sterilisation and utilisation and implementation of new technologies (AI included) showed good results in Asia.

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 The crucial point is that Ebola did not touch developed countries, hence this time might be a lesson for all to be and do our best in preparedness prioritization of science, research, health cooperation and shared information and knowledge. Maybe the creation of consortia driven by governments with all stakeholders mentioned would bring more strength and avoid heavy economic consequences. Economic experts and analysts fear that the global economy may tip into a recession unless the virus turns out to be seasonal. (A recession sets in when the economy shows two consecutive quarters of contraction.)

The problem with current predictions is that no one knows how long the virus will remain in circulation, how authorities around the world are able to stanch new cases and the resources they pull out to treat old ones. What business hates is uncertainty and uncertainty is the only thing that abounds when it comes to predictions about the vitality, endurance and longevity of the new virus.

Economists from Nomura have warned that a global recession might be inevitable.

This year, in early March, the Institute for International Finance said that global economic growth could turn out to be as low as 1%, and this was even before the OPEC club and Russia fell out on production agreements to maintain stable oil prices. Oil prices have had a free fall, sending stock markets into a tizzy. The United Nations Conference on Trade and Development (UNCTAD), said the virus outbreak could cost the global economy up to $2-trillion this year and that the pandemic could cause a recession in some countries causing global economic growth to clock in below 2.5%.

To conclude , this is an call for joint cooperation of scientists and research, healthcare workers, public, shared knowledge, involvement of all stakeholders and prioritizing public health for upcoming years in form of close partnership for interest of all.

Thank you for your attention, hoping that I did not make you asleep nor a pessimist, because there is no problem to get us down but strategies and solutions to bring us forward together.