Health-related Topics : Did we handle the Covid-19 pandemic effectively?

Dr. James Manos (M.D.)

microbiologist

March 25, 2023

Covid-19: Did governments handle the pandemic effectively?

Image (free to use): Respiradores da USP utilizados do Incor (July 16, 2020). Source: https://www.flickr.com/photos/governosp/50119127303/ Retrieved from: Wikipedia. Link: https://en.wikipedia.org/wiki/File:Respiradores_da_USP_utilizados_do_Incor_(50119127303).jpg

I expected something more from the governments rather than being dealers of pharmaceutical companies!

As a microbiologist, I was surprised that some preventive measures were not evidence-based, and their negative impact was not considered. Kneeling the economies had adverse effects on well-being.

Overview

During the coronavirus COVID-19 pandemic the epidemiologists irrationally imposed worldwide lockdowns and curfews. In Europe, countries had not experienced curfews since the Nazis' occupation in WW2! The low mortality rate of the virus did not excuse those extreme restrictions, as if it were for Ebola, in which case-fatality rate exceeds 40 percent! The public's instructions on wearing a protective mask and keeping social distancing should be enough to deal with the pandemic and avoid curfews that kneeled the economies. The states had to pay colossal amounts, most of them debts, to compensate for the financial catastrophe. Eventually, because of the coronavirus measures, the countries were in a fiscal crisis when the war in Ukraine broke out in 2022, causing a global energy crisis and recession.

Introduction

There was no international agreement about effectively containing a pandemic. As with the 2003 SARS, the 2009 swine flu H1N1, and the 2006 avian flu H5N1 pandemics, a dangerous virus emerged from Asia, and in early spring of 2020, it spread across the planet like a plague. The human and financial losses of the COVID-19 pandemic were tremendous. The COVID-19 pandemic showed that although we live in the 21st century, there is much to do with health crises.

I) Several issues that arose during the crisis

The overwhelmed healthcare systems

The pandemic showed that healthcare systems worldwide are labile and fragile, even in the West. The hospitals of many Western countries soon became overcrowded, and the chaos resembled a war period. Hospitals were brought into overdrive. In many cases, sick people were laid on the floor covered with a blanket or were left on a bed in the corridor rather than a ward. In many cases, dying patients said their final goodbye to their family via video or phone!

The crisis showed that the access of a considerable number of patients to ventilators and monitored beds in intensive care Unit (ICU) facilities was limited. That was especially true in the U.S., where the healthcare system is semi-private. Doctors had to decide between life and death in Italy and Spain. Younger patients were more likely to be hospitalized in an ICU than senior patients, as they were more likely to survive. Unacceptably, many older adults who paid for their healthcare insurance during their working lives did not have access to a ventilator when they needed it most! Instead, they died in deplorable conditions inside a hospital, home, or nursing home.

Negligence in protecting senior citizens. The ''decimation'' in nursing homes and the tremendous death toll in Northern Italy

At the beginning of the pandemic, many deaths occurred at nursing homes. A dreadful matter was the negligence in doing something for the senior citizens staying alone at home or living in a nursing home. For instance, in Spain, many were found dead by the police at elderly care homes. In many cases, the staff failed to keep the protective measures. In many countries, vaccination rates were satisfying neither for the personnel nor the residents of the old people's homes. Also, many middle-aged people and the elderly caught the disease from their children who neglected to take precautionary measures.

The death toll in northern Italy was high, which can be explained by the significant percentage of senior citizens who quickly overwhelmed the hospitals. Another reason is the temperament of the Italians, who use warm gestures such as hugs when they meet, contrary to other countries such as Japan, where relative social distancing has always been the norm.

Primary healthcare vs. secondary healthcare. The critical role of family physicians/GPs

Primary healthcare with family physicians (US) or GPs (UK) with adequate population coverage is vital. Free access to them, as in the UK, is also essential. The role of primary care means hospitals will not be congested with mild cases, but those who need it more will have faster access to advanced medical care.

Primary healthcare providers assess all sick people. In coronavirus-afflicted patients, the diagnosis is facilitated with lung auscultation and a pulse oximeter. Patients who need it urgently are referred to a hospital with a referral letter. Minor cases are treated at home. The hospital has the means of secondary healthcare for definite treatment.

Did lockdown and quarantine make matters worse at home?

Ironically, in many cases, this policy of lockdowns and quarantines increased fatalities as the whole family gathered at home. Therefore, parents and grandparents caught the disease from their children, and many died. The reason was that they trusted their children as they were watching them all day for symptoms, forgetting that they may be asymptomatic and often did not follow the necessary precautions thoroughly when meeting with friends.

The recklessness of the authorities

Recklessness was also a great matter. Reports allege the virus expanded in Spain after the stupid decision to allow a football game with Italy. Recklessness was even more prominent in North Italy, where it took weeks and thousands of lives to consider taking strict measures.

The role of China

The crisis showed that close contact with wild animals and their consumption in China has been a significant cause of pandemics in recent history as in the past. Unless this issue is tackled, pandemics will continue from time to time.

Could the virus have leaked from a Chinese lab?

An important matter is that the virus could have leaked from a lab in Wuhan, the Chinese city where it was first detected. The U.S. administration accused China of failing to contain the spread of the disease during lab investigations on animals. According to the allegations, the lab staff did not follow the necessary security measures to prevent its spreading to humans. Surprisingly, it was claimed that the USA participated financially in the above lab studies. Republican Senator Rand Paul alleged that the U.S. funded research in Wuhan labs that made some viruses more infectious and lethal, known as "gain-of-function."

The lack of preventive measures to contain the pandemic early

Another critical issue was that there were no measures to prevent the pandemic from the very beginning. The most straightforward step was for international airports to forbid arrivals from China, at least those from Hubei province, and later from Italy. Only the Taiwan government was wise enough to ban the Chinese from entering its airports.

The failure of the WHO to declare the pandemic early

A matter of discussion was the World Health Organization's (WHO) failure to declare the pandemic early. That undermined the credibility of the organization. But the director-general did not resign. The reason for this hesitation was the fear of global financial turmoil. The U.S. President alleged that the WHO failed to do so as it did not wish to harm the robust Chinese economy.

Nevertheless, reports say that in December 2019, there were increased cases of respiratory infections in North Italy. That means perhaps there was a cover-up of the epidemic by China initially. Some even spoke about a manufactured virus in the Chinese labs. In any case, China was the least affected country in the pandemic.

CDC vs. ECDC vs. WHO. Which organization is the most reliable?

During the pandemic, there was also a lack of a global consensus on the most trustworthy health organization to provide international medical guidelines and protocols and give instructions to the public. The Centers for Disease Control & Prevention (CDC) in the U.S., the ECDC in Europe, and the WHO issued somewhat different guidelines.

Epidemiologists vs. Infectious disease specialists. Who should be in charge? Did their decisions help to contain the disease?

During the coronavirus pandemic, infectious disease specialists were responsible for the decisions that affected public health. As (supposedly) experts, their opinion was considered by the governments. Therefore, they should be held accountable for all the unreasonable preventive measures, including the lockdowns and the curfews. In Europe, countries had not experienced curfews since the Nazis' occupation in WW2. The low mortality rate of the virus did not excuse those extreme restrictions.

In most countries, experts failed to inform senior citizens, who had the highest mortality rate, to wear a protective mask, especially at home, as most caught the disease from family members, especially their children and grandchildren. They also failed to contain the pandemic in elderly care homes in which the death toll was high. Regarding the transmission in the family, the lockdown and curfew worsened matters as the junior members who were a reservoir for the virus stayed home. Measures, such as wearing a protective mask outdoors, were ridiculous unless the area was overcrowded.

Infectious disease doctors are good at treating patients. So, they should not lead the committees that make decisions during a pandemic. Those who are experts in public health, including epidemics and pandemics, are epidemiologists. The word 'epidemiologist' includes the word 'epidemic' (outbreak). They would be more capable of making more intelligent decisions if they were in charge. They are accustomed to assessing if a preventive measure is statistically significant to contain an epidemic or a pandemic. Practically, many restrictions were not. The most important is that they undermined people's faith in the authorities.

However, it is not very certain if epidemiologists would avoid lockdowns and curfews. The main question is why experts did not advise them in the past, especially in pandemics caused by germs with much higher mortality? Importantly, there is a worry that they will be used on any occasion in the future, including staying-at-home orders issued by the government to avoid riots, or can be used stupidly again for epidemics or pandemics with a low mortality rate. Additionally, experts failed to recognize that curfews and lockdowns increased the non-coronavirus mortality of the population in many countries. They also increased depression and suicides, homicides, and indirect deaths from poverty. Most importantly, people are still reluctant to greet someone with warm gestures but keep their social distance.

Do experts make mistakes?

During the first months of the crisis, many health organizations and even experts wrongly claimed that face masks do not protect from the virus. Therefore, the public needed clarification about their ambiguous declarations concerning the usefulness of wearing a mask!

The lack of global consensus on how to deal with the pandemic

The most important in this crisis was the lack of global agreement on what countries should do during a pandemic. Several questions arose. Should governments inflict strict quarantine on the positive for the virus individuals and their close contacts as many European countries did? Should they close their borders and ports, as Taiwan immediately did with China? Should they choose a cost-effective approach to sustain their economy, not mind the victims? Should they force a curfew and lockdown from the beginning, overlooking the financial catastrophe? Should they recommend only the elderly and those more prone to severe disease (obese, smokers, patients with comorbidities) to stay home, as many countries did, or should they impose this on everyone? Should they ask people with mild symptoms to stay home or seek medical advice at overcrowded hospitals? Should this advice be from a family doctor? Should patients pile up in the hospitals' emergency departments? Many answers to the above questions are obvious.

The lack of population screening for the virus

A discrepancy was also noted between countries regarding whether a substantial part of the population should be screened for the virus, as in South Korea and Taiwan, or if only the suspected cases should be tested by tracing their contacts to isolate them. There needed to be a global consensus on which diagnostic methods were better. Some countries chose the costly molecular PCR method for screening the population with high sensitivity and specificity. Others chose cheaper rapid tests with more false-positive results than in high-risk groups when used in a large population.

The lack of solidarity between countries

At the beginning of the pandemic, the population had insufficient protective masks and sanitizers. Every country had its own policy, and there was no universal path to shared measures. The COVID-19 crisis showed no solidarity in the European Union (E.U.) countries, especially Italy and Spain, where the death toll from the virus was substantial. It is despicable that during the coronavirus crisis, many European countries tried to withhold medical equipment, including masks and ventilators, from their soil, prohibiting their export to other countries that needed them more! Even the U.S. did not show solidarity when it made a higher offer to obtain Chinese face masks that Germany initially purchased for its police! Ironically, China provided Italy with protective health equipment, including face masks, and sent expert healthcare personnel to help.

The West's deindustrialization

Lastly, the West's deindustrialization was evident during the COVID-19 crisis in the Spring of 2020. Initially, most countries relied on China to provide them with protective hospital supplies, including ventilators and even face masks and gloves.

The misleading role of the media

During the crisis, the media did not play any significant role apart from spreading panic. They misled the public instead of intoning the necessity of preventive measures that everyone should take. These steps involved simple germ prevention rules that many people neglected, including washing hands and not touching the face unless washed. The media's misleading role was related to overemphasizing the scarce adverse effects of the vaccines. That had deadly results, as it prevented many people from vaccinating.

Cost-effectiveness at the expense of human life

Cost-effectiveness at the expense of human life was a heinous decision that some countries made. A cost-effectiveness example was when the U.K. delayed enormously to impose strict measures as it found it cost-effective not to do so! The British authorities did so only when the coronavirus-related death rate rose significantly. Then the British Prime Minister, who opposed stern measures, was hospitalized in the ICU with severe pneumonia after being infected with the virus. Similarly, the U.S. administration delayed taking precautionary measures in cities apart from New York. The populist President was eager to quickly terminate these measures as they had a damaging effect on the economy! However, the death toll in NYC was tremendous.

Immunotherapy only for the wealthy!

Unfortunately, many people in critical condition did not have access to experimental treatment. Initially, there was no agreement on which experimental treatment would benefit moderate or severe cases. Effective treatment with monoclonal antibodies was a breakthrough that soon became available. But only for the rich, as this therapy was costly. Initially, the President of the USA was one of the few who tried this immunotherapy. Surprisingly, he recovered in a couple of days. Notwithstanding, myriads of people died as this therapy was too extravagant for the health systems to afford.

Politics and vaccines

Unacceptably, at the advent of the coronavirus vaccines, the media overemphasized the scarce adverse effects of the vaccines, especially those of AstraZeneca, which was the cheapest. But this may not be a coincidence, as the costly mRNA vaccines had a lot of publicity despite having rare adverse effects. Initially, the British-Swedish AstraZeneca company rescinded its obligation to supply the EU with the agreed number of vaccines that the EU ordered.

That delay may have had to do with politics related to Brexit and undermining the European Union, as the specific company prioritized Britain and limited its exports to the EU. Ironically, it should be mentioned that although the Oxford AstraZeneca vaccine was made cheap and available in the poorer countries, South Africa's cost was much higher than in the West (14).

The misuse of the words ''quarantine'' and ''lockdown''

In the crisis, the words ''quarantine'' and ''lockdown'' had the wrong meanings. These words suit a region or a building but not a whole country. Instead, the words ''stay-at-home order'' and ''curfew'' in some countries with many fatalities would be more appropriate. However, the term ''herd immunity " is the most ridiculous,'' as if people are livestock.

Were precautionary measures effective? How can we prove this?

Statistics are the only ones that can prove the effectiveness of any measure. Many measures advised or imposed by the authorities were ineffective in preventing disease transmission. Some, such as wearing a protective mask outdoors, were stupid (unless the area was overcrowded). Measures such as opening doors and windows in buildings and opening windows in cars to bring fresh air were of unproven benefit. The transmission was mostly from close interpersonal contact, especially between family members and friends.

Were lockdowns and quarantines justifiable?

Lockdowns and curfews would be justifiable only if the case-fatality rate of a pandemic was high. For example, Ebola would excuse those strict measures as the case-fatality rate exceeds 40 percent! Relating to COVID-19, the population-weighted infection fatality ratio (IFR) was 0.5 to 2.5 percent.

A 2006 paper on managing pandemic flu co-written by Donald Henderson, a prominent epidemiologist and leader of smallpox eradication, concluded that lockdowns were likely to do far more harm than good and would ''result in significant disruptions of the social functioning of communities and result in possible significant economic problems.'' The authors added that there was simply no evidence that lockdowns reduced the toll of a contagious virus. Until a vaccine is available, societies ''respond best and with the least anxiety when the normal social functioning of the community is least disrupted.'' They also concluded that handwashing and personal hygiene should form the staple of pandemic alleviation approaches. In other words, Henderson does not propose lockdown as a practical measure. Contrary, it undermines public trust in the authorities.

This trust was breached after the highly contagious delta variant domination, as a proportion of the vaccinated people were infected, and a small percentage died. Countries exaggerated the need for vaccination without focusing on the vaccination of high-risk groups (elderly and those with comorbidities, smokers, and obese). They also did not stress the need to keep protective rules even after vaccination (mask and social distancing). One year after the initiation of vaccinations, the drug companies sold the original vaccines that did not cover the delta and, later, the omicron variant. They rather wished to get rid of the stock of the old vaccines.

Until late 2021 many vaccinated had their third shot. However, in many cases, it still did not prevent the disease from the delta and omicron variant or their contamination, which caused frustration. In many European countries, citizens' trust in the authorities was also breached when they insisted on lockdowns even after the third cycle of population vaccination, as the community's immunity was not achieved.

Were lockdowns and quarantines effective?

Whether lockdowns and curfews effectively prevented coronavirus deaths is a matter of debate. Total fatalities were similar in countries with comparable populations, such as Sweden and Greece. However, the former did not impose a lockdown, while the latter did. Despite the colder weather in Sweden, total deaths were similar, which increases staying at home and crowdedness. Another critical issue is that lockdown increases the crude death rate, as described below.

Ironically, the policy of lockdown and curfew, in many cases, increased fatalities as the whole family gathered at home. Therefore, parents and grandparents caught the disease from their children. Many died, forgetting that they may be asymptomatic and often did not follow the necessary precautions thoroughly when meeting with friends.

Was the shutdown of schools effective?

Schools were shut down in most countries, and kids stayed home, transmitting the virus to their parents and grandparents. In other words, children ''killed'' their parents, especially their grandparents! That occurred because children could not be restrained and avoid peer relationships, so they caught the virus, often without symptoms. Then they quickly transmitted it to their family.

Did lockdowns and curfews cause collateral deaths? Did they affect the non-covid mortality rate?

Various factors caused indirect deaths. Lockdowns and curfews had adverse effects on human health. Lockdown in some countries increased the non-covid mortality rate while hospital admissions decreased (16). Mental problems from isolation at home increased depression and suicide rates worldwide. Homicide rates increased as well. Working at home was associated with financial difficulties, including unemployment. Poverty raised the death toll additionally. In some countries, the crude death rate increased during lockdowns and shortly afterward.

Non-coronavirus deaths were related to people not seeking medical advice when needed, as the hospitals were congested or, in many cases, dealt almost exclusively with coronavirus cases. That includes their ICUs. Many people died from other than COVID-19 causes, for example, from a heart attack, without seeking medical care as they were less keen on visiting a chaotic hospital piled high with coronavirus patients. Additionally, people with medical issues did not receive the necessary therapy when they needed it. For instance, cancer patients delayed chemotherapy and radiotherapy, while surgical patients delayed surgery!

Which should the target group for preventive measures be?

Rationally, the target group of precautionary measures should be the elderly. Many senior citizens died in deplorable conditions at homes, hospitals, or nursing homes. Often, the nursing home personnel did not take simple preventive measures predisposing the elderly to the virus.

Why, in the past, were there no quarantine and lockdown measures affecting countries?

Importantly, there is a question of why countries did not implement similar quarantine and lockdown measures affecting a whole country in the past. All cases involved only premises, ships, or isolated regions, not counties. Another question is if similar restrictions are expected to be taken. New pandemics in the future are expected again from China, as Chinese people live near wild or domestic animals, using them as a meal.

The violation of human rights

Apart from sanitation, another matter of discussion is the violation of human rights in countries that implemented lockdowns and curfews, as people were ''imprisoned'' at home. Most countries imposed curfew measures, often with fees for the offenders, without first asking for their consent to stay home. In Melbourne, Australia, the lockdown lasted nine months! In some countries, the authorities tracked the citizens' location from their cellphones' GPS to ensure they stayed home! In China, the police transferred with force sick people who refused to go to the hospital while drones with cameras spotted citizens not wearing masks.

Some argued that freedom is more important than health concerning human rights, while others worried about similar restrictions in future pandemics.

The aftermath of lockdowns in respect of human rights

The excuse that health comes first is misleading. In Europe, the last time curfew was imposed was in WW2, during the occupation of the countries by the Nazis in WW2. Why did countries not implement similar quarantine measures in the past? Undoubtedly, a lockdown is a strict measure that restricts human rights, specifically freedom. History has shown that freedom is the most important virtue. People give their lives for freedom.

During the last decades, with the excuse of the 'War on terror,' Western countries have imposed measures that violate human rights. With the excuse of health, the governments took even worse measures this time. In any case, people consent to confinement in the name of terrorism or health.

Do lockdowns and quarantines have negative ramifications for civilians in the future?

From my perspective, in a pandemic, the policy of lockdown and curfew would only be justifiable with a high mortality rate disease, such as Ebola, where the case-fatality rate exceeds 40 percent. It also raises issues of human rights violations and their potential misuse on any occasion in the future, even unrelated to disease. Governments may use them to prevent protests and riots! (For the difference between those two, you may read the article How Does the U.S. Government Define the Difference Between a Protest and a Riot? ) For instance, before the pandemic, the government issued a curfew during the Hong Cong protests.

Do lockdowns and quarantines have aftereffects on interpersonal relationships?

Regarding interpersonal relationships, the social distancing authorities imposed to protect from coronavirus has become a habit. Some fear it may be permanent as people will avoid hugs and other intimate gestures. From now on, people may be reluctant to greet someone with warm gestures, like the Italians, but keep their social distance, such as in Japan, where people greet each other by bowing.

Were mRNA vaccines safe? Were they under investigation?

The mRNA technology was used for the first time in vaccines. However, it is not that novel, as it has been used since 2011 in trials for cancer treatment. Only two drug companies used the mRNA technology, whereas the other vaccines were based on the old technology. The safety of the mRNA vaccines was proved by using them in massive vaccination in the community. Severe adverse effects were infrequent but involved both the mRNA and the conventional vaccines. However, the potential long-term side effects are unknown, as in any new drug. In any case, the vaccines' benefits in preventing death from COVID-19 outweighed their potential risks. About the mRNA vaccines, you may read the article Five things you need to know about: mRNA vaccine safety

Was there a conflict of interest regarding vaccines and drugs? Was there excessive confidence in vaccines and drugs under investigation?

The conflict of interest was that the authorities provided registration based on the drug companies' data. The initial trials involved a small sample. Consequently, the adverse effects were more apparent in the massive vaccination of a large population. The excellent data collection in many countries, especially Israel and the UK, recorded the efficacy of the vaccines and their rare adverse effects. But there is a question of whether the pharmaceutical companies were aware of these issues before they were granted provisional approval. The same is true for emerging drugs.

There was a fast-track licensing concerning vaccines and coronavirus drugs. That is justifiable in a pandemic. However, scientists and authorities worldwide were more enthusiastic about them than they should be for medications used for such a brief time.

Which should the target group for the vaccination be?

In many Western countries, the vaccination rate was unacceptably low among the elderly. The media and the authorities stressed the need for vaccination for everyone. Instead, the senior citizens needed it more as they had a higher mortality risk. Advanced age plus comorbidities rose fatality even to 25 percent! The media's detrimental role was that they emphasized the scarce adverse effects of the vaccines that prevented many people, including senior citizens, from vaccination. Regarding the vaccination of children, the media and the governments did not offer the information that the risks may outweigh the benefits.

In a report from the Israeli Ministry of Health, 1 in 3000 to 1 in 6000 men aged 16-24 who received the mRNA COVID-19 vaccine developed myocarditis or pericarditis, a heart disease. However, symptoms of myopericarditis after the mRNA COVID-19 vaccination were usually mild and transient (8). On the other hand, in many Western countries, deaths from COVID-19 in children remained rare, up to 0.17 per 100,000 population (9). Of course, children and teenagers are the reservoir of the virus and put their parents and grandparents at significant risk. But still, parents should weigh up the risks and benefits. In November 2021, Germany and France restricted Moderna's COVID-19 vaccine for those under-30s due to the above rear heart risk (11). The cheap vaccine of Oxford was related to a thromboembolism risk (12).

Governments and media failed to persuade a significant percentage of the elderly to be vaccinated. In many western countries, this comprised 30 to 40 percent of the elderly. However, this age group is more likely to die from COVID-19. So, focusing on younger age groups was not wise unless they had comorbidities, were obese, or were tobacco smokers. This decision was deadly for people of advanced age, as the risk of dying from the virus was considerably higher than the risk of dying from the vaccine. The role of the media was prejudicial, as their insanity in stressing extremely rare adverse effects of the vaccines prevented many people from vaccinating.

Should vaccines be obligatory in some categories of the population?

Vaccination should be mandatory in those dealing with the senior population, especially healthcare professionals and nursing home personnel. Many countries delayed making them obligatory for these people.

Were vaccines effective? Did this affect the confidence of the public in the health authorities?

None of the available vaccines was satisfying. Neither do they prevent the disease in a sizable proportion nor the contamination of others. That was more evident for the delta and omicron variants. Additionally, the drug companies neglected to make early new vaccines covering these variants but used the initial vaccine. Perhaps they wished to sell out the stock of the old vaccines.

In any case, the vaccines were valuable as they prevented ICU hospitalization and deaths. Until late 2021 many vaccinated had their third shot. However, in many cases, it still did not prevent the disease from the delta and omicron variant or their contamination, which caused frustration. In many European countries, citizens' trust in the authorities was also breached when they insisted on lockdowns even after the third cycle of population vaccination, as the community's immunity was not achieved.

Were vaccines a panacea? The deadly delta variant

The vaccines were not a panacea. They just prevented severe disease and ICU hospitalization, namely, prevented death. However, a vaccinated person was not completely protected from becoming infected by COVID-19 or transmitting it. After the domination of the highly contagious delta (Indian) variant, a proportion of the vaccinated individuals were infected, and a small percentage died. Additionally, 30 to 35 percent of the population remained unvaccinated in many Western countries while the vaccinated neglected protective measures. Thus, in the autumn of 2021, some European countries went back into hard lockdown as the number of those with the disease rose dramatically.

It would be prudent for the governments to strongly advise vaccinated people to keep protective rules after vaccination, including masks and social distancing, as it did not entirely protect them from the disease. Countries also exaggerated the necessity for vaccination without focusing on the vaccination of high-risk groups such as senior citizens and those with comorbidities, smoking tobacco, and obesity.

Did drugs fill the gap in developing vaccines for the delta strain?

Pharmaceutical companies did not create a new vaccine specific for the deadly delta variant that expanded worldwide nearly one year after the initiation of the Wuhan strain-based vaccinations. The reason was that the drug companies had to sell the initial vaccine stock! Their negligence in making a new vaccine for the delta variant had detrimental effects on containing the disease.

Antiviral drugs came too late. PAXLOVID™ (a combination of PF-07321332 with ritonavir) by Pfizer was developed with high efficacy. They were expensive, but the government funded them in the US and the European Union. The costly monoclonal antibodies were shown to be remarkably effective, especially in the initial strains, but a Cochrane review was inconclusive (13). Currently, all but one of the monoclonal antibodies fail to cover the omicron variant. The vaccines developed later during the pandemic course for the omicron variant were somewhat useless, as in most patients, the disease from omicron was mild.

The prevalence of the omicron variant signifies the end of the pandemic

In November 2021, a new variant named ''omicron'' emerged in South Africa and spread to the rest of the planet. Notably, the cause of this variant was the low vaccination rates in Africa and the rest of the developing world. The most important contributing factor was the negligence of the West which did not donate vaccines to the developing world. In some cases, it supplied vaccines to Africa that were about to expire! Even the cheap Oxford vaccine that supposedly had a low price to help the poorer nations eventually was more expensive in Africa (14)!

Eventually, until late 2021 the omicron variant prevailed in the community as it was highly contagious. Still, data showed that it was milder and less likely to increase hospitalization rates, especially in the ICUs, compared to the delta variant. The omicron variant signified the end of the pandemic. Eventually, the community's immunity was achieved as most of the population passed the disease or was immunized. New drugs such as PAXLOVID™ were too expensive to be used extensively to accelerate the end of the pandemic.

II) Which was the best approach to prevent deaths?

The feat of Germany and the ''miracle'' of Taiwan and Japan.

According to the OECD, Germany has the most intensive care beds per capita. Austria, the USA, and Belgium follow it (10). The country with the most hospital beds is Japan. South Korea, Germany, and Russia follow it. Germany had 28,000 intensive care (ICU) beds at the outset of the pandemic, much more than neighboring countries. During the first months of the pandemic, those rose to 40,000. That had emerged as a significant advantage in the crisis (15).

Taiwan was one of the few countries where preventive measures succeeded. The contributing factors to the success were:

a) A healthcare system where everyone has access to all services, not only those with Medicare insurance, such as in the USA. In Taiwan, the population has a hospital card with all their medical data stored electronically and free healthcare services, including 24/7 emergencies.

b) A healthcare system with a high coverage of beds, especially Intensive Care Unit (ICU) beds, proportionately to the population. In Taiwan, the above coverage is appropriate.

c) Adequate population coverage with GPs/family doctors to whom the population has free access. They assess all the sick people and refer those who need it urgently to a hospital with a referring note.

d) A surveillance system that ensures that precautions are followed and that isolated cases are at home and not outside. The latter is feasible with simple measures such as using the cellphone's GPS. Those who break the quarantine and defy the precautionary measures showing antisocial behavior while exposing others to the virus, are fined.

Japan was another country with remarkable success. Two months after the end of the Olympics in Japan, the number of cases declined dramatically, reaching its lowest level in over a year. The vaccination campaign progressed fast as it did not meet reckless people who protested against the vaccine, such as in the USA. Another factor in the drastically reduced cases was the widespread use of protective masks. The Japanese used protective masks before the pandemic to protect themselves from the flu. So, they were used to them. Additionally, as mentioned above, Japan has the most hospital beds.

Epilogue

The inability to prevent the tremendous 2020-2022 coronavirus death toll was a disgrace to humanity. The main reason was the discrepancy in global healthcare that will continue in the future unless all countries realize that it is to the benefit of their citizens to follow a unified approach. That includes solidarity with the greatly afflicted countries utilizing financial aid and donating the necessary medical equipment.

Thanks for reading!

Reference:

1) https://www.bbc.com/news/world-52109792

2)https://metro.co.uk/2020/03/15/coronavirus-countries-currently-lockdown-delay-spread-covid-19-12400084/

3)https://www.sciencemag.org/news/2020/03/mass-testing-school-closings-lockdowns-countries-pick-tactics-war-against-coronavirus#

4)https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

5) https://www.bbc.com/news/57932699

6)https://www.newscientist.com/letter/mg24833080-200-is-there-a-better-way-than-having-another-lockdown-3/

7)https://www.biospace.com/article/comparing-covid-19-vaccines-pfizer-biontech-moderna-astrazeneca-oxford-j-and-j-russia-s-sputnik-v/

8) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321962/

9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946566/

(10) https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity