- Without a vaccine and effective treatment for COVID-19, we could face continued infections and deaths until the end of 2020.
- To prevent the coronavirus from continuing to spread, we need to monitor what fraction of the population has come in contact with the virus and is potentially immune.
- Governments will need to assume important and unprecedented roles in securing both business continuity and jobs to avoid an economic collapse.
Even after a few months, it is still difficult to grasp the scale and scope of the global impact of COVID-19. One-third of the world’s population is under some form of containment. More than 200 countries are affected, and the number of new cases and deaths in many places increases exponentially. Meanwhile, a second crisis, in the form of an economic recession, is underway.
We all want to get out of this crisis as soon as possible. But as much as we are keen for social and economic life to resume its course, we must, to do so, give priority to public health. This is a huge cost, but the alternative would be even worse. Based on the latest scientific evidence, a collaboration between governments and businesses is our best chance to prevent a recession, hopefully in the short term, from turning into a global depression.
While governments and businesses that have seen a decrease in the death curve can cautiously start initiatives to revive a part of social and economic life, still under the watchful eye of public health officials, companies should leave temporarily put their competitive interests aside and work together to ensure that the most effective vaccine can be found as soon as possible and that the necessary production starts on a large scale as soon as possible. This is the only real way out of this crisis.
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Let’s start by taking stock of the medical information we have today. While we do not yet fully understand the subject of COVID-19, it is clear that it will pose an exceptional risk to global public health for at least a year more and possibly much longer, for three crucial reasons. . First, this new coronavirus is extremely infectious. Second, the COVID-19 disease it causes is very serious. And third – and this is a key point – the population has no immunity due to a history with the virus, and there is no vaccine yet.
First, take its infectious nature. Anyone infected with this new virus infects an average of two to three other people, and no one is immune. In a matter of weeks, the virus has infected millions of people (the official number of cases is still below 2 million, but unofficially the number is probably at least five times higher, and it is not over). And over the next few months, COVID-19 will endanger most of the world’s population.
This means that we are all facing a large-scale pandemic and no silver bullet to get out of it. Looking at the past 100 years, this virus is only comparable to the Spanish flu of 1918, which in two years killed around 50 million people and was followed by an economic depression from 1920 to 1921. This flu was also a very virulent and infectious virus to which the world population had no immunity. If this catastrophe is repeated, we will face the prospect of millions of deaths and prolonged depression.
Second, we now know that the death rate for confirmed COVID-19 cases is in the order of 5%. The death rate in all cases (including those not yet recognized) is still unknown, but it is most likely at least 1%. These percentages are of great concern: they are at least 10 to 50 times higher than for the seasonal flu and comparable to the infamous Spanish flu. All the epidemiological parameters (infectivity, virulence, and lack of immunity) of Spanish influenza and COVID-19 are similar.
As a result, hospitals around the world are now inundated with patients. From New York to Tokyo, and from Barcelona to Tehran, thousands of people are dying every day, in what can only be described as a very exceptional global health emergency: all “frontline” healthcare professionals worldwide claim to have never seen this.
And third, this is the most problematic fact: there is no vaccine or even a very effective treatment. A flu shot is useless against COVID, like most other existing drugs that have been tested. Reports on the (partial) effectiveness of chloroquine or anti-HIV drugs should be confirmed. This leaves us with the prospect of continued infection and death until at least the end of 2020.
If this eventuality weren’t dramatic enough, tell yourself that the virus’s impact has so far been felt mainly in the developed world, the planetary “North”. However, the final death toll and much of its socio-economic impact will be determined by its spread and death rate in low- and middle-income countries, the planetary “South”, which numbers several billion people who do not. Are only at the start of the pandemic.
Comforting observation, the population there is much younger and less affected by cardiovascular diseases and other comorbidities (which increase the risk of serious disease in the North). However, people in the South are much more at risk of contracting infections and have less access to quality food and sufficient medical services. What is happening in the poor neighborhoods of “downtown” New York is probably in part predictive of what will happen soon in the planetary “South”, and this prospect is hardly reassuring.
Knowing all this, what social, economic, and public health scenarios should we reasonably foresee, and what is the solution?
In the absence of a vaccine, this pandemic will only end when a large part of the population has acquired immunity after infection. This is the famous concept of ” collective immunity “.
Some will argue (as the UK has for a while), and the sooner, the better. But we see today in New York the problem with this strategy: before this collective immunity is installed, a very rapid exponential “natural spread” will occur. So many people are falling simultaneously sick, in desperate need of medical care, that the health care system is failing, and several (hundreds of) thousands of people will not be able to breathe, thus exacerbating social and political tensions.
Therefore, it is preferable to maintain the current containment measures to varying degrees: do not kill the virus or end the epidemic very soon. This is impossible without a vaccine. But it was slowing the epidemic enough to give our health systems a chance to cope: helping patients who have severe breathing problems with oxygen and mechanical ventilation to give their immune systems a chance to overcome the infection. We can achieve collective immunity, but only in a very gradual way.
In the future, the big question we still have to answer is:
how long should containment be maintained, and when and how to gradually lift it?
Ultimately, we need to allow the economy to restart and prevent a second outbreak of mental health or social issues while avoiding a new wave of the epidemic. China, Korea, Germany, and Austria are relaunching or already cautiously planning to partially resume their social and economic life. But they must do so in an extremely careful manner, led by public health experts. The opposite could lead to financial and mental health problems comparable to those of a public health crisis.
Two complementary strategies to prevent further epidemic growth can be deployed, allowing different governments to make decisions on how to gradually revive social life:
The first is the serological test: the search for antibodies specific to COVID in the general population. Doing so makes it possible to monitor which fraction of the population has contact with the virus and is potentially immune.
The second is to develop a reliable “rapid antigen detection test” to quickly diagnose those carrying the virus (without symptoms or with minimal symptoms) and to set up “contact tracing” through an app for quickly identify contacts of infected people, who could be quarantined to prevent further spread.
Combining these two strategies may be their best chance to get the economy going for governments and businesses. It is up to each country to decide what it prefers to reopen between schools, workplaces, shops, and restaurants. But once good practices are clear, countries will need to be willing to learn and coordinate. It is only together that we can emerge from this crisis. If we fail to help each other, we risk a serious relapse, which is the best way to turn a crisis into depression.
Let’s be clear: the only long-term strategy to eradicate this virus is a drug and vaccine against COVID. This type of development assumes that we have at least a few dozen candidates that work very well in vitro and animals. Then it usually takes several years to bring one or two to the market. Knowing this, we should not expect to plan for an economic and social recovery in a year.
Of course, luckily, an existing drug that has already been approved could work against this virus as well, or a drug against COVID could prevent patients from dying and promote recovery for those infected. Regarding the first solution, mass screening is underway, so we will soon be fixed. New systems for rapid testing of candidate vaccines are also being implemented, and a suitable candidate may emerge within a few months. But even then, it will take time to produce it and deliver it globally. Nevertheless, all global stakeholders should give their support, both financial and bureaucratic, to arrive at this solution as quickly as possible. The time is for collaboration, not competition.
In the absence of a widely available vaccine, and knowing that it will probably take more than a year, and perhaps several years, not a few months, we need to make fundamental changes to our economic system. Governments will need to assume important and unprecedented roles in securing both business continuity and jobs to avoid an economic collapse. The resulting public debt will have to be carried by the strongest shoulders – the businesses and individuals best able to shoulder it. The main principle, which everyone will have to adhere to, is that we are all in the same boat for a long time and will all have to come out together.
We have already faced serious crises. But if we are to emerge unscathed in the long term, we must anticipate unprecedented impact and collaboration in the short term. We will overcome this crisis, but only if we work together over time.
Due to COVID-19, mental health problems are immerging daily. If you want help and need psychiatry, then the best option is Telepsychiatry, the facility to access psychiatric care through electronic devices’ assistance. The telehealth psychiatry services offered to you will allow you to have a medical appointment with a psychiatrist through secure and interactive video equipment. You will be able to speak in real-time with the psychiatrist during your appointment, the same as a traditional visit.