Battle against COVID-19: Key lesson

Dr. Chandana Jayawardena DPhil

When?

Over the last 12 months, the whole world has battled against the greatest pandemic it has faced in 100 years. Retrospective studies consider that the 2019 Coronavirus Disease (COVID-19) evolved in China in November 2019. In late December, 2019, scientific comprehension of this new kind of coronavirus took place in Guangzhou Province, and clinical apprehension of a pending epidemic started at Hubei Provincial Hospital in Wuhan. Soon after that the Wuhan Health authorities issued a case statistic, and this information reached the World Health Organization (WHO), as well as the Centers for Disease Control and Prevention (CDC) in USA, soon after that.

What?

COVID-19, which undoubtedly is the worst pandemic during our lifetime, but it is not the worst pandemic that the world has faced. The Spanish Flu, also known as the 1918 Flu Pandemic, lasted over two years from February 1918. In four successive waves, it infected 500 million people – close to a third of the world’s population at the time, and is believed to have killed between 17 and 50 million people. As the world’s population has grown in 100 years by 4.33 times, from 1.8 billion to 7.8 billion; 17 million deaths 100 years ago are equal to 74 million deaths today. In that context, the number of COVID-19 deaths (which is currently at 1.57 million) is significantly low, as a percentage of the present global population. However, as advanced and knowledgeable as we are today, should not the world have dealt with COVID-19, in a better way?

Why?

In a global context, there are many reasons for the unexpected spread of COVID-19. The following eight reasons can be identified for handling the current pandemic well or poorly, particularly among the 50 countries with the largest populations:

1. Proactive political leadership (or lack of it)

2. Crisis management skills (or lack of it)

3. Mature national cultural attitude (or lack of it)

4. Quality and quantity of medical facilities

5. National wealth

6. Population density

7. Size of the country

8. Experiences in dealing with other pandemics.

How?

So far, what are the countries that have handled the COVID-19 pandemic better? As countries have populations of highly varied levels, it is meaningless to judge the effectiveness of handling of the pandemic, by simply looking at the total cases or deaths per country. Therefore, ‘deaths per million people can be considered as the best criteria for such an analysis. On assumption that all countries are honest with their reporting, and based on the rate of deaths per million, as published on December 9th, 2020 (reference: https://www.worldometers.info/coronavirus/), the worst performance of COVID-19 ‘deaths per million people are the following two small European countries:

* Belgium 1,508 deaths per million

* San Marino 1,443 deaths per million.

In the same analysis, the world average is 201 deaths per million. Sri Lanka recorded 7 deaths per million, which is relatively very good.

Who?

Based on the 50 countries with the world’s largest (over 28 million) populations, can be ranked based on ‘deaths per million people, in the following (worst first, best last) order:

1. Peru 1,097

2. Italy 1,014

3. Spain 998

4. UK 912

5. USA 885

6. Argentina 882

7. France 862

8. Mexico 856

9. Brazil 836

10. Colombia 746

11. Iran 606

12. Poland 559

13. South Africa 376

14. Canada 340

15. Ukraine 326

16. Iraq 308

17. Russia 306

18. Germany 242

19. Turkey 181

20. Morocco 172

21. Saudi Arabia 171

22. India 102

23. Philippines 79

24. Indonesia 66

25. Egypt 66

26. Algeria 57

27. Nepal 56

28. Afghanistan 49

29. Bangladesh 42

30. Myanmar 40

31. Pakistan 38

32. Sudan 30

33. Kenya 29

34. Yemen 20

35. Japan 19

36. Uzbekistan 18

37. Ethiopia 15

38. Malaysia 12

39. South Korea 11

40. Angola 11

41. Ghana 10

42. Madagascar 9

43. Nigeria 6

44. DR Congo 4

45. Mozambique 4

46. Uganda 4

47. China 3

48. Thailand 0.9

49. Vietnam 0.4

50. Tanzania 0.3

It is puzzling to see rich, advanced and well-developed countries such as: Italy, Spain, UK, USA and France, among the worst Covid19 affected countries in the world while some of the poorer and less developed nations in Africa and Asia are among the least affected. Perhaps, their less democratic political systems and experience in dealing with other recent pandemics helped these countries to fight the covid19 pandemic, better than the western world.

What Next?

* Globally, the COVID-19 pandemic has so far claimed well over one and half million lives. Medical science is progressing faster than even the optimists had expected. It is estimated by the WHO that between 65% and 75% of the population, either need vaccination or recovery against the virus to achieve immunity. Some countries have concluded that the vaccination is required for 70% of their population. A few vaccinations are now entering the national approval stage around the world.

* UK – On December 8th, 2020, ninety-year-old Margaret Keenan, a retired shop clerk from Northern Ireland was at the front of the line at University Hospital Coventry in UK to receive the vaccine that was approved by British regulators. She became the first person in the world (outside trials) to be vaccinated against COVID-19. She received the Pfizer-BioNTech COVID-19 vaccine, a week after the UK became the first country to approve its use. UK commenced this operation with 50 vaccination hubs with an aim of vaccinating (first dose) four million people by end of the year 2020. This is only 6% of the UK’s population of 66 million.

* Russia is emerging as the second nation after UK, to make an approved vaccination, available to selected public. According to the Russian President, more than two million doses of Sputnik V will be available by mid-November, 2020 for medical workers and teachers across Russia, but with a main focus on Russia’s pandemic epicentre – the city of Moscow.

* USA is expected to follow UK and Russia soon. The Wall Street Journal reports that Pfizer expects to ship half as many doses of its vaccine as planned in 2020. The medical news site STAT reports frontline US healthcare workers think the current administration’s pledge to vaccinate 20 million people in December seems unrealistic. USA’s President-Elect’s goal of getting 100 million shots in his administration’s first 100 days or by April 30th, 2021, appears to be more realistic. This is 30% of the USA’s population (of 331 million). Pfizer product is a double dose vaccination and most likely, these 100 million persons should get their second dose between 19 and 42 days, after the first dose. Ideal vaccination target of 70% of the population of USA equals 232 million. Therefore, it is unlikely that USA will reach its vaccination target before the end of 2021. Most likely, people vaccinated will also need annual boosters.

* The Rest of the World is expected to follow the UK, Russia and USA. Canada is expecting to receive up to 249,000 doses of the Pfizer-BioNTech COVID-19 vaccine. Soon after that Canadians will begin to get vaccinated. The European Medicines Agency (EMA) plans to give its opinion in favour of a first vaccine in EU countries by the end of 2020, with a view to distribution from early 2021. Mexico’s vaccination campaign against COVID-19 is expected to begin before the end of 2020. Brazil could begin its nationwide immunization program against Covid-19 by March, 2021. China’s need to both develop and introduce a COVID-19 vaccine has differed from other countries as it has effectively halted the spread of the virus. Japan and Korea look to begin distribution of COVID-19 vaccines by the end of March, 2021. India has a couple of vaccines which in their final trial stage, and may take around three months getting the required approvals from regulatory authorities.

The World Health Organisation, (reference: Research for COVID-19 Recovery) says: “Recovering better from COVID-19 will depend on bold efforts to strengthen health systems, shore up social protections, project economic opportunities, bolster multicultural collaboration, and enhance social cohesion.” There is a key lesson the world has to learn from the current global pandemic, particularly from mistakes made by highly developed countries such as the US. That is, global research and science (and not politics) represent the world’s best chance of recovering from the current pandemic and preparing for the future pandemics.