We are increasing our knowledge about COVID-19 and, although many questions remain to be answered, we now have a much greater knowledge of the disease and its containment.
We understand two hard facts, firstly that the spread of the virus can be contained by early lockdown, public cooperation, and strong government.
Countries such as Greece and the Czech Republic have shown how these measures have worked very effectively.
Those such as Italy, Spain, the United Kingdom, and the United States, who have been slow to react, who flirted with the idea of “herd immunity” and who have had decision-making not based on scientific evidence, have suffered huge caseloads and death rates.
Secondly, we now appreciate that the definitive way to stop this pandemic is through vaccination and globally more than 40 hi-tech companies are working on this project.
Fortunately, COVID-19 has similar genetic properties to SARS – a virus that can be viewed as a cousin and upon which vaccine work was already started– and this will speed the process.
A challenge will be the production of huge quantities of the vaccine, but interestingly Glaxo Smith Kline and Sanofi, two of the world’s largest vaccine producers, will cooperate in this challenge.
However, even with rapid trials and huge investment, a vaccine before the autumn is unlikely. However, American Medical Centers has a long history of cooperation with these companies and hopes to be able to source vaccines as they become available.
Few countries, perhaps with the exception of China, have successfully exited lockdown.
However, the principles will be localized: easing starting with areas of very low caseload, possibly maintaining restrictions of travel into those areas and obvious attention to economically important areas of society.
The public will have to be strongly motivated to report symptoms and a high level of testing and contact tracing will be necessary, possibly with the use of apps.
At present, it is unknown if COVID-19 always produces antibodies (the long-lasting biological products that are produced by infection and give us future immunity) or if those antibodies are either efficient, produced in the initial period when there are no symptoms, subject to accurate testing or long-lasting.
Hopefully, all these questions will be answered in the coming months.
For countries to move forward on the basis of antibody testing, and thus identifying people who are “safe,” all these factors will need to be strongly positive. It is for some of these factors that the concept of “herd immunity” was suspect and abandoned.
PCR testing – which essentially matches a patient’s genetic material with that of the virus – is extremely accurate (nearly 100%), but requires expensive reagents and laboratory work.
It gives results in two days but can only tell if the patient currently has the disease. It will not identify patients who have had the disease and recovered. So in terms of exiting lockdown, it is only helpful with rapid contact tracing and patient isolation.
For now, we will have to continue to rely on containment and lockdown and to assess how countries with effective and scientific plans will manage this process.
Dr. Richard Styles is the chief medical officer of the American Medical Centers Group in Ukraine.
