The coronavirus pandemic is unprecedented, and it is expected to have devastating consequences for health and the global economy. In recent decades there have been multiple viral pandemics, but none with the abrupt and profound socio-health impact that COVID-19 has. There is no doubt that COVID-19 will be a before and after. Furthermore, the immediate future is uncertain as we do not have effective antivirals or vaccines.
Everything has happened very quickly and containment measures have been taken with delays in most countries. The number of cases and deaths can be followed in real time on various websites, such as Worldometer or Johns Hopkins University.
Saturation of the health system
We have already been told ad nauseam that SARS-CoV-2 infection can be asymptomatic or with mild symptoms in a high proportion of children and young people. In adults the symptoms generally resemble those of a severe flu, with a cough, fever, headache and fatigue lasting 3-7 days . But it is in the elderly and in people with other pathologies – up to 20% of them – where the infection by this coronavirus can progress to pneumonia and require hospitalization. Up to 25-30% of this most vulnerable population with severe symptoms will require mechanical ventilation and intensive care.
Emergency services, hospital beds, and intensive care units are overflowing in many places. Very few times it had been necessary to prioritize the care of some patients to the detriment of others due to lack of personnel and / or health teams. For doctors and nurses, this dilemma is one of the most dramatic in the current situation. We wish we could save everyone.
Vaccines or antivirals, what is the priority?
SARS-CoV-2 is highly transmissible from the aerosols of sneezing patients, so the spread is very rapid. In the exponential growth phase of the epidemic that we are experiencing in Spain, the number of cases doubles every 3 days.
The accumulation of new cases in such a short time has overwhelmed the health services. This has been aggravated by the fact that some of the health personnel have fallen ill or are in isolation. In nursing homes and centers for the disabled, the minimum health care for the very vulnerable population has been insufficient. That is why mortality is being very high in these places.
The fundamental thing now is to implement and strictly comply with quarantines and social isolation. In Spain these measures have been taken late if we compare it with other countries such as Korea, but even now we can obtain a great benefit with their strict application.
Since there is no previous immunity against the coronavirus, the majority of citizens are going to get infected. In any case, for a symptom picture that generally self-resolves within a week, hopefully a protective vaccine (such as pneumococcus) would be best. On the contrary, the benefit of an antiviral could be rather reduced, shortening only the days of symptoms if it is administered early, as occurs in the flu with oseltamivir.
In this sense, the coronavirus is totally different from HIV, the AIDS virus, which produces a chronic infection for life. Antivirals are the main weapon against HIV, since the virus does not replicate and does little harm even if it is not eradicated. Regarding SARS-CoV-2, antivirals will be especially useful to treat the subgroup of patients who develop pneumonia and become complicated.
In conclusion, and still being complementary strategies, in terms of public health I consider it more important to develop a protective vaccine than an antiviral against COVID-19.
The return to normality, by when?
An epidemiological model published this week in Science , using data from China, has concluded that 86% of SARS-CoV-2 infections went unnoticed and were not diagnosed until January 23. From that moment, the Chinese authorities declared the quarantine of Wuhan province. These were mostly asymptomatic and / or minor infections. Its contagiousness was lower (55%) compared to symptomatic cases.
Studies on the dynamics of coronavirus transmission published in The Lancet suggest that in 4-6 weeks the peaks of new cases and daily mortality from COVID-19 will be reached. From that moment on, only people who have not done it until then can be infected, and that will be less and less. The rest will probably have developed protective immunity against SARS-CoV-2 and, in addition, they will no longer be contagious.
The post COVID-19 era
To prevent a second coronavirus outbreak from resurfacing, after the isolation measures cease, it is important that the return to work and social activities occurs in a staggered manner. Otherwise, people who are still susceptible could contract the infection en masse and the health services collapse again. The authorities have to foresee the management of the return to normality.
Later, it will be of great importance to have information and to evaluate through serological tests for the detection of antibodies against SARS-CoV-2, how the seroconversion rate has been during the epidemic crisis, which are the most susceptible groups and what was the impact of the social measures that have been taken.
Until that time comes, it is essential that there are groups of clinicians and epidemiologists in our country who collect the information well. We must act with rationality and serenity, without being overwhelmed by inaction, collective hysteria and individual emotional stress. You have to collect your own casuistry, analyze it and propose the best measures to stop and prevent the damage of the COVID-19 epidemic in Spain.
With the social isolation measures that have been taken in many countries of the world, it is likely that the COVID-19 coronavirus will become endemic and seasonal, like four other coronaviruses that cause respiratory symptoms every year for a long time.
In this regard, COVID-19 would differ from SARS, which appeared in 2002 and became extinct in 2003. It is foreseeable that SARS-CoV-2 will follow in the footsteps of the H1N1 flu virus (swine flu), which from Mexico and the United States. The US caused a pandemic in 2009, with the majority being mild infections. Since then, this influenza variant has established itself as an endemic virus in many countries and reappears every season, causing a low proportion of catarrhal symptoms.
Vicente Soriano, Faculty of Health Sciences & Medical Center, UNIR – International University of La Rioja
This article was originally published on The Conversation. Read the original.
