How to survive the inevitable flare-ups of COVID-19

The Ministry of Health has collected more than 260,000 confirmed cases and about 28,500 deaths in Spain since the pandemic began. Of course, these figures are an underestimate of the true number and unconfirmed cases could be multiplied by ten.

In Spain, more than 125,000 patients with COVID-19 have been hospitalized, about half of the confirmed cases. In the last week there have been more than 200. 10% of the total hospitalized required admission to Intensive Care. It’s been 15 in the last week.

After the euphoria of de-escalation in phases in the different autonomous communities, the growing number of outbreaks (close to 200 throughout the country) has aroused great concern. There is fear of a second confinement, like the one that has already been enacted in areas of Aragon and Catalonia. And there will be more elsewhere.

It is more than likely that coronavirus outbreaks will follow one another and increase throughout the summer. They are the inevitable consequence of displacement. Diagnostic tests are now more readily available to confirm or exclude any suspected cases and then proceed to isolation and examination of the contacts. Fortunately, many of the current diagnoses are made in younger, asymptomatic people.

How to reduce the damage of a second wave of COVID-19?

The experience of the first wave of the COVID-19 tsunami has left an indelible mark on each one of us. We have learned a lot and we have to minimize the damage of a new lockdown and a second wave. Without being pessimistic and still in a good scenario, it is unlikely that we will benefit from a vaccine before next summer. Everything indicates that we will have outbreaks of COVID-19 for a year and we have to learn to combine health and the economy with new living conditions.

The damages of prolonged confinement are devastating to the economy and, worse still, to the personality. Humans are social and we need the stimulation derived from contact with others. This is easily recognizable in children, in whom isolation impairs psychomotor and cognitive development; but also in the elderly, where the absence of stimulation accelerates the deterioration associated with age.

Actions that could be taken to deal with the SARS-CoV-2 pandemic are described below until a protective vaccine is available.

How to reduce the damage of a second wave of COVID-19?

Strengthen the health system

It is necessary to plan that the holidays of health personnel do not coincide, avoiding deficiencies in the face of a recrudescence in August. Home health care and telemedicine should be promoted in a special way, to avoid collapses in hospital emergency services.

In the crisis of March and April, little use was made of the services that private healthcare could provide, which could have relieved the pressure that existed in many public services. Faced with an unprecedented crisis such as COVID-19, the principle of subsidiarity is the best strategy to ensure citizens the best healthcare. It is about making collaboration agreements with hospitals and private Spanish diagnostic companies, which allow to expand the use of what already exists and works. We must use all the resources already available in our country, without depending on others.

To decongest emergency rooms and hospital beds, home care must be improved by Primary Care teams. Many COVID-19 patients do not require hospital admission and can benefit from follow-up at home with daily phone or face-to-face checks by a medical team.

In hospitals, easily convertible areas into COVID-19 areas should be planned, with separation from the rest. Sufficient health personnel must be hired and beds must be ensured. In the same way, it is necessary to ensure the supply of protective material and diagnostic tests that are of sufficient quality.

Finally, it is necessary to promote training programs in management and treatment of COVID-19, with criteria for home monitoring; transfer to hospital; use of corticosteroids, remdesivir and immunomodulators; prevention of bacterial superinfections, etc. Online training allows you to provide much of this knowledge without unnecessary travel and with easy adaptation to difficult schedules. It is necessary to encourage both public and private universities, with the support of the administration and pharmaceutical companies, to develop training programs of excellence.

Protect the most exposed

Health personnel, public order agents (policemen, etc.), the military, cleaning personnel, workers with direct exposure to the client (cashiers, etc.) must have sufficient protective material and use it properly.

24% of the confirmed cases of SARS-CoV-2 infection up to June occurred in health personnel, mostly doctors and nurses. The high risk of exposure and the lack of protective material (masks, gloves, caps and disposable gowns) contributed to this. We cannot meet again without this material in hospitals.

Protect the most vulnerable

People with a higher risk of developing pneumonia and severe forms of COVID-19 are the elderly, patients with other chronic diseases (diabetes, obesity, cancer, etc.). More than 75% of those who died from COVID-19 in Spain were over 75 years old. This group must be specially protected from exposure to SARS-CoV-2.

Sufficient medicalization of nursing homes and other institutions for the disabled and other dependent personnel (for example, the mentally ill) must be sought. More than 40% of those who died from COVID-19 in Spain lived in nursing homes or homes for the disabled. These centers must have a sufficient allocation of health personnel and protective equipment.

In addition, other measures can be taken, such as early vaccination against influenza A and B; and against pneumococcus, to reduce the risk of co-infections.

Educate in the personal responsibility of social distancing

The transmission of SARS-CoV-2 occurs almost exclusively by air, especially by proximity to an infected person. The viral inoculum (infective dose) determines the risk of infection and the severity of the disease. There is little evidence of transmission from contact with potentially contaminated surfaces or objects. Therefore, the effort must be focused on living social distancing. The use of masks outside the home must be made mandatory and crowds of people must be suspended in closed spaces.

Unify regulations: simple and for the whole country

Centralized coordination at the state level is essential to avoid misleading messages and interpretations. There should be no disparity of criteria between autonomous communities.

It is necessary to intensify the identification of positive cases and proceed to their isolation and medical control. On the other hand, risk contacts must be identified, quarantined and the diagnosis excluded as soon as possible.

Facilitate diagnostic tests

Rapid screening tests for SARS-CoV-2 antigen and antibodies is a priority. Ideally, these tests should be able to be done in saliva and provide the result in 10-15 minutes. In addition, they should be for sale in pharmacies and can be done by the patient himself in case of suspicion, as many times as appropriate. To avoid dependence on other countries and failures with poor quality purchases, it is necessary to help the Spanish diagnostic companies committed to this task.

A study of 37 people with CRP + but asymptomatic has revealed that almost all those infected develop antibodies within 2-3 weeks. Studies in macaques have shown that it is immunity that protects against reinfection. However, after 2-3 months, antibody titers are reduced and are not detected in 20% of asymptomatic cases. Although this does not mean that the protection disappears, it must be confirmed whether these antibodies can prevent a new infection in the longer term (for example, after 2-3 years). Protection may decrease over time, but prevent severe forms of COVID-19 from occurring.

Promote Spanish antiviral research

This moment of crisis must unite us. It is a good time for good protectionism. We must support the initiatives of our compatriots committed to moving forward. It is of the utmost interest to finance scholarships and grants to research groups and Spanish companies that develop antivirals and immunomodulators, exploring new drugs, aerosol forms, delayed-release antivirals, etc.), both for treatment and prevention. As the cliché that Anglo-Saxons say about Spaniards says: “We are a country with well-trained and resourceful people, but we lack perseverance and organization. For this reason, Spaniards are valued and triumph over all abroad… ”.

In the absence of a vaccine that confers immune protection, long-acting antivirals are being developed that could act as “chemical vaccines.” Following the model of pre-exposure prophylaxis (PreP) that is used to prevent the spread of HIV, an attractive alternative to protect against coronavirus while the protective immune vaccine does not appear could be the administration of prolonged-release antivirals.

Thus, an American group has just described nanoformulations of cabotegravir, an antiretroviral that only requires one annual administration. Let’s imagine that an equivalent formulation could be obtained for remdesivir or another antiviral effective against SARS-CoV-2. Pending an immune vaccine, these ‘depot antivirals’ could allow the protection of the most vulnerable populations against COVID-19.

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By Vicente Soriano – Faculty of Health Sciences & Medical Center, UNIR – International University of La Rioja | Source: The Conversation

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