Mohamed Ibrahim Bassyouni
2020 / 4 / 25
In another world, a new virus appears in China. The state quickly identifies the pathogen virus, closes its borders, launches an unprecedented campaign to eradicate the virus, and ensures that very few cases leave the country. Other countries that report cases such as South Korea, Taiwan, Hong Kong and Singapore quickly identify the infected, track the people who have contacted them, isolate the carriers and contain the spread of the virus. Through this triple strategy - testing, tracking, isolation - eradication succeeds.
In fact, the new Sars-CoV-2 coronavirus has escaped the public health interventions of the Chinese government and has spread around the world. While other governments floundered in their early responses, the virus silently spread across societies, infected many people, hospitalized and killed some. The virus is remarkably dangerous - it spreads easily like a cold´-or-flu, even through individuals who have no visible symptoms, and the latest data shows that approximately 5% of people who become infected will be hospitalized. Among them, 30% will be accepted into the intensive care unit. An estimated 0.6-1.4% of those who contract the virus will die.
Antibody tests are not perfect, but they could be a way out of danger and ban.
There are now 2,845,85 in the world
Confirmed case of corona virus. The United States, having 925,75 cases and 52,217 deaths, surpassed China, where there were nearly 82,816 deaths and 4,632 deaths. Half of the confirmed cases are now in Europe. Low and middle income countries are only a few weeks late. While countries such as Senegal, Liberia, and Nigeria have shown themselves strongly prepared to meet this challenge, their governments are constrained by a lack of resources, health care, and the ability to test. Others, like Brazil, India and Mexico, seem to deny the next.
We still do not know the percentage of the world s population that has already been exposed to the virus. Without a reliable antibody test that can determine whether a person is infected with the virus and potentially immune, it is unclear how many people carry the virus but have no symptoms. Also, the role of children in the transmission of infection is unclear-;- children are not immune and do not appear to be severely affected.
So, what now? Depending on what you have learned from published modeling and other countries responses to the virus, there are four possible scenarios for how to end this.
One is that governments are gathering to agree a eradication plan that relies on a quick and cheap diagnosis of the point of care. All countries will close their borders simultaneously for an agreed period of time and launch a strong campaign to identify carriers and prevent transmission. This approach appears unlikely, the virus has spread strongly, and some countries have declined to cooperate with each other. But it can become more realistic for three reasons: the antiviral treatments used to prevent´-or-treat symptoms of Covid-19 may be weak-;- vaccine production may take decades-;- immunity may only be short-lived, leading to multiple waves of infection, even within the same individuals. New Zealand is currently trying a copy of this approach-;- the country closed its borders, imposed its closure, and began conducting community tests to eliminate the virus.
The second scenario, which seems somewhat more likely, is that early vaccine trials are promising. While waiting for the vaccine, countries will try to delay the spread of the virus within the next 12-18 months through intermittent closings. Health authorities will need to expect, three weeks ago, whether there are enough beds and staff to treat the injured. On this basis, governments can decide whether they wish to reduce´-or-increase quarantine measures. But this scenario is far from ideal. Health care systems will remain tense, and the economic and social costs of closing are high. Repeated closings can lead to group unemployment, an increase in child poverty and the spread of social unrest. In poor countries, more people can die due to the shutdown than the virus itself: from malnutrition´-or-vaccine-preventable diseases´-or-dehydration from lack of access to clean water.
The third and more similar scenario is that countries follow the example of South Korea while they wait for a vaccine: increase the test to identify all carriers of the virus, track the people they have contacted, and quarantine for up to three weeks. This will include extensive planning, rapid development of a contact tracking application, and thousands of volunteers to help with surveying, results processing, and quarantine monitoring. More relaxing expansion measures can be implemented to prevent the spread of the virus and relieve stress on health care systems.
In the absence of a vaccine applicable for the foreseeable future, the final scenario could include administering Covid-19 by treating its symptoms rather than its cause. Health workers can manage antiviral treatments that prevent patients from deteriorating to the point where they need intensive care,´-or-prevent them from dying when they reach a critical stage. The best solution would be to use preventive treatment to prevent the emergence of Covid-19, in combination with rapid diagnostic tests to identify the infected. In countries with resources, this can be sustainable - but for poor countries, this approach will be difficult, if not impossible. There is no easy solution. The coming months will see a fragile balance between the interests of public health, society and the economy, as governments depend more than ever before. While half of the battle will be in developing virus treatment tools - vaccine, antiviral therapies and a rapid diagnostic test - the other half will make adequate doses, distribute them in a fair and equitable manner, and ensure that they reach individuals across the world.