The emergence of the recent COVID-19 virus has not only challenged the entire scientific community, but has also brought about a profound change in our working and personal lives, and has dealt a severe blow to the economy of the affected countries.
What started in a seemingly isolated situation in Wuhan, China, has turned into a global pandemic that we are still struggling with today. But unlike with nightmares, this won’t go away by simply waking up. In fact, it’s likely that the reality which we are facing every day will be with us for some time to come. After all, there is no exact science that can help us predict the course of evolution of the disease.
However, there is an ancient science that can help us get some initial answers, a classic science which until now has gone unnoticed by a large part of the population: epidemiology and the study it provides of the distribution of health and disease within populations, and of how there are determinants and associated factors that could be involved in the control of diseases and other health problems.
Over time, experts in this field have been analyzing the various diseases that humanity has suffered and how these have been changing. This is because, historically, epidemiology has been focused on the prevention and control of communicable diseases (such as cholera, plague, typhoid, etc.). For many decades now, in developed countries, the main focus has been on the prevention of chronic diseases. Because, as we should not forget, the main cause of death in these places is related to coronary diseases, followed by oncological diseases. This is why the emergence of such a contagious new disease has broken the scientific patterns that we were accustomed to, and should serve to make us all aware that, as a species, we are not invincible and that one microorganism, no matter how small, can have the capacity to be ubiquitous, cross borders very easily and even produce high mortality among the most vulnerable population.
Over the course of these months, we have seen how each country has acted independently. This way of acting has been widely criticized with regards to the management and health management models that have been applied in some countries, and has also been praised in other cases. However, we should bear in mind that there are many variables that make us unable to compare ourselves with other countries, such as social and behavioral characteristics, the longevity of the adult population, the characteristics of the country, population density, available resources, and a long list of other factors.
There is therefore no universal formula that we can copy that will guarantee success in reducing the disease, and that does not also involve losses in other sectors. Indeed, in many cases there is a direct conflict between health and the economy. Faced with the serious situation that we have been experiencing, the balance of actions has logically had to be shifted towards health; however, although the measures implemented have been strict, with lockdowns and a standstill in normal activity, they have not managed to completely eliminate the disease and have only helped to control it. That is why we must be constantly vigilant and must not lower our level of alert. Because if we become complacent at an individual level and do not comply with the basic recommendations indicated to us by the competent authorities, outbreaks will become more and more frequent. The greatest danger of this is that cases will once again escalate exponentially and it will be impossible to adequately trace cases in order to contain them.
We must act accordingly and be accountable for our actions. We must prioritize collective health, leaving aside selfish behavior that could compromise the safety of not only ourselves, but also others. The use of facemasks, social distancing and frequent hand hygiene are simple tools that, when included in our normal routine, will help immensely to reduce the incidence of the disease.
And, in the meantime, the global race to find a vaccine is gaining momentum. At present there are 25 prototype vaccines already being tested in humans, with favorites emerging from research groups in the UK, USA, Germany and even China. Some groups, such as that from Oxford University, are rushing to publish their first preliminary results. The so-called phase two of the most advanced trials have just finished with a positive and hopeful result, with few and mild adverse effects and capable of generating immunity with the type of vaccine and dose chosen. Even so, we will have to be patient to calmly evaluate how they continue to develop phase 3 of their studies, since this is the phase that determines the results obtained in tens of thousands of volunteers. Without a doubt, this will be the phase that makes it possible for the characteristics of efficacy, safety and immunogenicity that are being sought to be consolidated before a possible marketing.
However, it is still early to know the approximate date when a possible vaccine(s) will be available. Some unknowns continue to be generated regarding the variable duration of the immune response produced in the organism after the administration of it or the suffering of the disease itself. In this sense, it would be interesting if not only antibodies but also T cells were involved in the stimulation of the defences.
A discovery of a vaccine would be the most effective way to stop the spread of the disease in the world, but until this is achieved we must continue to investigate and compare the best therapeutic alternatives, depending on the degree to which the patients who test positive are affected.
In this line, treatments with monoclonal antibodies obtained from the plasma of recovered patients, the use of Remdesivir (antiviral) and that of Dexamethasone (steroids) are in the lead in terms of choice and the possible combination between several of them to successfully cure and reduce mortality.
Patricia Guillem is professor of Epidemiología