The pandemic: mistakes and hits.

And do we learn? Do we know how to face the next pandemic? Do we know how to prevent the next pandemic?

We are still reflecting on what we have lived through since the beginning of 2020. We have experienced many stories of bravery, resilience, and kindness and stories of corruption and incompetence. An ingenious and sometimes confusing and misguided science. Leadership and absences.

But, COVID-19 has highlighted the deeper problems of societies with their enormous differences in national and global environments.

The question that needs to be answered is: Will we do better in the next pandemic? Shall we try to do better in the next pandemic?

The fact is that some smaller and less affluent countries have responded better to the pandemic than many nations with better resources. How did this happen?

India and New Zealand have implemented rigorous contact tracing and a high level of testing while Sweden has gambled badly letting SARS-CoV-2 flow through the population, in pursuit of an expected “herd immunity”.

It became evident that COVID-19 has highlighted how politics globally shape our health. Sridhar indicates in his recently published book that “it is not likely that the response to the pandemic can be equal and fair if society is not”.

There is no doubt that the proper response to COVID should come from international work, but repeated and surprising mistakes have been made in the richest countries. Ill-prepared leaders (bad leaders) contributed to this. The health of the economy was at an advantage over the health of the people.

On the other hand, there were several “scientific failures” with contradictory guidelines for the population that were often centered on the lack of resources and/or the misdirection of the activities of some industries. An example of this was a very late indication for the use of masks, either by “philosophical” discussions or by the insufficient amount of masks for the general population. There was no guidance from governments in the sense of some industries adapted their production lines for making masks. What we have seen is that many entrepreneurs, as the pandemic progressed, spontaneously adapted their factories for the production of masks.

I believe that once again governments have failed. I am not aware that governments have developed a subsidy program for the production of these masks to make prices more affordable for the general population. Certainly, with the subsidized prices of masks, a greater part of the population would have been able to use this effective means of protection, when vaccines were not yet available. Additionally, the costs for the use of masks were and are infinitely lower than the costs of a hospital stay.

Herd immunity plus protection of the vulnerable was the tactic proposed by government officials in the UK, as Sridhar commented. But how to identify the vulnerable, beyond the obvious risks related to age and comorbidities? Are diabetics and obese left out?

How could everyone be protected? Transmission happens more often within the family, so how to protect them effectively. Should they be the most vulnerable separated from their families? How? The vulnerable are often dependent on others. How to solve this?

At the beginning of the pandemic, we knew little or nothing about post-infection immunity. At that time, renowned scientists mistakenly said that large-scale diagnostic tests were unnecessary, but the truth is that there were no tests available for an effective strategy to identify those infected.

Politics prevailed early in the pandemic and some great leaders surrounded themselves with scientists willing to report what they wanted to hear. And so what is science supposed to say? Should it please the leaders? What prevails? The truth is that these types of recommendations are not, for the most part, apolitical.

And what has been the learning so far? Are we prepared for a new pandemic or the resurgence of the current pandemic? The omicron variant is still circulating and a more worrisome variant of SARS-CoV-2 could still emerge.

It still seems premature to say that the current pandemic is over. Many researchers still suggest an ongoing surveillance and vaccination program.

There is still an additional concern about the long COVID…

In the current pandemic, a lot of time has been wasted on identifying the origin of SARS-CoV2.

In the path of the pandemic, a lot of information and a lot of misinformation, resulting in an often confusing orientation for the population. Much distrust about the protective capacity of vaccines and their “rare” adverse reactions, leads to an initial lower acceptance of part of the population to receive the vaccines. Much damage has occurred and many lives have not been saved.

The repeated description of some unconfirmed adverse reactions to vaccines and the alleged “herd immunity” commented on by many leaders and scientists were important factors for the lower adherence to vaccination in some countries.

In the last hundred years, the world has faced several pandemics of respiratory contagions — such as the Spanish flu in 1918, the Asian flu in 1957, and SARS in 2003. Still, SARS-CoV-2, which emerged in 2019 in China, showed how vulnerable we are to a global disease. Compared to the time interval between previous pandemics, there was a marked shortening of the time interval for the emergence of the current pandemic (SARS-CoV-2) about the most recent pandemic (SARS).

The great fear of other pandemics is precisely the emergence of a new virus, which people’s immune systems do not recognize, as was the case with SARS-CoV-2.

It is not known when a new pandemic may arise, but it is possible to keep an eye on some viruses, such as influenza (the flu). The first pandemic of the 21st century was the swine flu or H1N1. The virus quickly spread around the world and the World Health Organization (WHO) declared it a pandemic in 2009.

Many countries are — undesirably, contrary to science — disabling systems for identifying and tracking new variants. Everyone should be — without a doubt — active in these processes and, at the same time, prepared for the new and inevitable pandemics. There is no way to go back with the “globalization of the world”, so everyone needs to be prepared for the new pandemics.

Countries — in general — need to be prepared so that they can develop their vaccines. Low-income countries cannot be dependent on the goodwill of high-income countries. International organizations should be aware of this.

A global surveillance system must be attentive to the identification of new infections and quickly identify new viruses. Resources for immediate sequencing of these new viruses must be ensured so that immediate and rapid production of the appropriate vaccines can then be available.

But, echoing Sridhar’s words, “it will not be possible to avoid another pandemic until we are willing to elect competent and ‘human’ leaders and start addressing the grotesque inequalities and injustices between and within societies.”

“It is not likely that the response to a pandemic can be equal and fair if society is not.”

References

• Ball P — Lancet Vol 399 May 7, 2022
• Sridhar D — Preventable How a Pandemic Changed the World & How to Stop the next one - Viking/Penguin, 2022