COVID-19 Pandemic and stratified shielding: Some more matters for the works
The ‘COVID-19 Pandemic’ is, indeed, a ‘COVID Phenomenon’ as it continues to impact on ‘Virtually Every ASPECT of Human Existential and Developmental Domains’ [1]! It is not only an ‘Unprecedented Ravaging and Devastating Scourge’, it has, in fact, continued to be the basis for ‘New Normals’ impacting on our ‘Common Humanity’. Much as there are ‘Immense Devastations’ [2-4] wreaked by the ‘Pandemic’, there are also ‘Increasing Benefits’ [5,6] from its existence in the ‘Annals of our Humanity’! The spectrum of ‘COVID-19 Pandemic Negatives’ and ‘COVID-19 Pandemic Positives’ has been the subject of previous ‘Communications’ [2-6] and will not be exposed further in the current piece!! It is, however, expedient to reiterate the fact that the ‘Unprecedented 21st Century Pandemic’ has excited the emergence of an ‘Avalanche of COVID-19 Research Data/ Information’ but the hurried approach to the ‘Pandemic Research’ has resulted in a ‘Huge Body of Questionable and Poor Quality Data’ now largely regarded as ‘Waste in COVID-19 Research’ [7-10]!!
A ‘New Normal’ occasioned by the ‘COVID-19 Pandemic’ is ‘LOCKDOWN’ which is part of the ‘Non-Pharmaceutical Interventions (NPIs)’! The NPIs are the ‘Pandemic Interventions that Work’!! The ‘Interventional Lockdown’ in the ‘COVID-19 Pandemic Era’ includes, among others: Country Lockdown, Business Shutdown, Economic Shutdown, Public Worship Prohibition, Travel Lockdown, Schools Shutdown, World Sports Championships/ Tournaments Shutdown etc! While the ‘Interventional Lockdowns’ are effective in contributing to slowing and reducing the spread of the ‘Pandemic’, they are also known to result in increasing ‘Economic Burden’ and ‘Untoward Human Survival Difficulties’. It has, in fact, been suggested that ‘Interventional Lockdowns’ should be short-lived because of the ‘Untold Negative Effects’ of the ‘COVID-19 Pandemic’ [11]! In an attempt to minimize the ‘Economic Burden’ of the ‘Interventional Lockdown’, several ‘Programmatic interventional Lockdown Models’ have been proposed [12-16]!! Different perspectives of ‘Stratified Shielding’ by ‘Identified Risks/ Vulnerability’ are disposed. Those in the Population, ‘Stratified’ as ‘Most Vulnerable’, are offered greater ‘Protection against the Pandemic’ by ‘Shielding’ as an Intervention. Therefore, people are only ‘Shielded by Lockdown’ according to the identified recognized ‘COVID-19 Pandemic Risks’ [2,3]!!! The ‘Risk Factors’ disposed include, among others: Age, Sex, Immune Status etc, and it is, in fact, proposed that ‘Shielding through Lockdown’ can be ended with reasonable level of ‘Herd Immunity’ [3]!! There is ‘More Work in the Works’ concerning the role of ‘Antibodies and Immunity’ in the ‘COVID-19 Pandemic’. Are the detected ‘SARS-CoV-2 Antibodies’ proven to be ‘Neutralizing Antibodies’ and do they, in fact, confer ‘Protection or Immunity’? [17] Are the ‘Monoclonal Antibodies (mAbs)’ also ‘Neutralizing Antibodies (Abs)’ and do they target the ‘Receptor Binding Domain (RBD)-epitope’ and block the ‘ACE2 Site’: the ‘Neutralization Mechanism’ [17]? The ‘Shield Immunity’ has also been explored as an ‘Interactional Intervention’ in the ‘Global Fight’ against the ‘COVID-19 Pandemic’ as ‘Recovered Patients’ are deployed in ‘Interactions’ involving ‘Essential Goods and Services’ [14]!! The ‘Differential Levels and Neutralizing Potency’ of ‘Convalescent Serum Antibodies’ among ‘Recovered Patients’ is also an ‘Issue in Contention’ [17]!! The relationship between the ‘Identified Antibodies’, ‘Different Targetted RBD-epitopes’ and ‘Disease Manifestations Variability’ are also ‘Issues in the Works’!! The ‘Issues’ of ‘Cross-Neutralization’, ‘Somatic Hypermutation (SHM)’, ‘Clonal Expansion’ etc related to ‘Disease Severity’ remain ‘More Work in the Works’ [17]!!
Further still, other ‘Communications’ have explored the role of ‘Risks Scores’ for the ‘Stratified Shielding Intervention’ for managing the ‘Interventional Lockdown’ in checking the spread of ‘COVID-19 Pandemic’ while assuring that the ‘Economic-Survival Burden’ is minimized and differentially distributed within the Population [15,16,18]! The ‘OpenSAFELY’ uses ‘Risks Score’ based on Prescription Drugs Use (Evidence of Comorbidities), Postcode (Evidence of Socioeconomic Status and Urbanicity), Ethnicity, Cardiometabolic Problems, Obesity, Local SARS-CoV-2 Epidemiology etc! This ‘Risks Score’ is dichotomized into ‘Updatable Chance of getting Infected Score’ and ‘Risk of Dying if Infected Score’ which can be used for ‘Stratifying’ and, therefore, ‘Shielding’ the Populace to inform the ‘Differential Exit from a Lockdown’ [18]!! The ‘Differential Predisposition or Susceptibility’ to the ‘COVID-19 Pandemic’ is not a ‘Concluded Matter’ or ‘Taken as Given’ with the increasing ‘Pandemic Information’ increasingly transmuting and unearthed by the day re: the ‘Variables’ subsumed into the ‘Risks Score Computation’!! For ‘Age’ as a Case-in-Point, the ‘Elderly’ are generally regarded to be more ‘At Risk’ for ‘More Severe Disease’ when ‘Infected’ and, hence, should be ‘More Shielded’! More recent ‘COVID-19 Pandemic Information’ suggests ‘Very Severe Kawasaki-like Disease’ in ‘Children’: ‘Paediatric Inflammatory Multi-System Syndrome (PIMS)’ or ‘Multi-System Inflammatory Syndrome (MIS)’!! There is also the ‘Cytokines Storm’ in ‘Previously Healthy Young Adults’ infected with SARS-CoV-2 with ‘More Severe Disease’!! Therefore, ‘Age’ is not a ‘Simple Binary Classifier’ for the ‘Risk Factors’ to undergird ‘Disease Severity’ and the ‘Stratified Shielding Intervention’ with ‘Interventional Lockdown’ in the ‘COVID-19 Pandemic Mitigation Measures’!!! The role of ‘Sex’ is ‘Information in a flux’ and may not be exposed further but certainly also requires ‘More Work in the Works’!!!!
The use of ‘Postcode’ as a ‘Proxy for Socioeconomic Status’ is interesting and requires some critiquing! This assumes proper ‘Planning and Development’ of Cities/ Towns and also the location of Citizens predictably by ‘Socioeconomic Standing’ and this may not be exactly true for all Cities globally!! How effectively 'Socioeconomic Status’ correlates with ‘Economic Endowment’ and/ or ‘Educational Attainment’ is another basis for critiquing the ‘Postcode-influenced Risks Score’ for the ‘Interventional Stratified Shielding’ in the ‘Lockdown’ to slow the spread of the ‘COVID-19 Pandemic’. Citizens are placed in ‘Categories 1 to 5’ and ‘Individuals’ can opt for ‘Shift’ in ‘Risk Categories’ according to ‘Risk Appetite’ [19]! This introduces ‘Subjectivity’ and may affect the ‘Scores Sensitivity’! The ‘Acceptability’ of the ‘Stratified Shielding’ by the Public is yet another ‘Issue’ re: ‘Stratified Shielding’ as a ‘Public Health Intervention’ against the ‘COVID-19 Pandemic’ [20]!!
The ‘Interventional Lockdown’, part of the NPIs, is effective against the ‘COVID-19 Pandemic’ but comes with ‘Huge Economic Burden and other Negative Consequences’! There are ‘Communications’ criticizing ‘Interventional Precocity’ in ‘Easing the Lockdown’ [21,22]!! The proposed ‘Stratified Shielding’ as an ‘Interventional Lockdown’ needs critical scrutiny as a ‘Public Health Strategy’ against the ‘Pandemic’ using ‘Risk-related Differential Protection’ needing to address ‘Some More Matters for the Works’!!!
REFERENCES
1. Eregie C. O. COVID Phenomenon: An innovative conceptual coinage in human development and sustainable development in the 21st Century. https://www.bmj.com/content/368/bmj.m1199/rr-17 of 9th April 2020
2. Godlee F. COVID-19: Weathering the storm. BMJ 2020; 368:m1199 of 26th March 2020
3. Eregie C.O. COVID-19 Pandemic: Still on the difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-13 of 2nd April 2020
4. Eregie C.O. COVID-19 Pandemic: Further perspectives on the difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-16 of 5th April 2020
5. Kickbusch I, Leung GM, Bhutta ZA, Matsoso MP, Ihekweazu C, Abbasi K. Covid-19: how a virus is turning the world upside down. BMJ 2020; 369:m1336 of 3rd April 2020
6. Eregie C.O. COVID-19 Pandemic: The daunting challenges of assuring sustainable benefits from weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-14 of 8th April 2020
7. Yan W. Coronavirus tests science’s need for speed limits. New York Times 2020 Apr 14. https://www.nytimes.com/2020/04/14/science/coronavirus-disinformation.html
8. Clinical Trials.gov. History of changes for study. NCT04280705, 1 May 2020. https://clinicaltrials.gov/ct2/history/NCT04280705?A=10&B=15&C=Side-by-S....
9. Glasziou PP, Sanders S, Hoffmann T. Waste in covid-19 research. BMJ 2020; 369:m1847
10. Eregie CO. COVID-19 Pandemic: The multifaceted picture of compromised COVID-19 research and the ‘COVID Phenomenon’. https://www.bmj.com/content/369/bmj.m1847/rr-12 of 10th June 2020
11. Ioannidis JPA. Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest 2020; 50:e13222
12. Triggle N. Coronavirus: is it time to free the healthy from restrictions? BBC News 2020 May 7. https://www.cidrap.unm.edu/sites/default/files/public/downloads/cidrap-c...
13. McKeigue PM, Colhoun HM. Evaluation of ‘stratify and shield’ as a policy option for ending the COVID-19 lockdown in the UK. medRxiv 2020.0425.20079913 (Preprint) doi:10.1101/2020.04.25.20079913
14. Weitz JS, Beckett SJ, Coenen AR et al. Intervention serology and interaction substitution: modeling the role of ‘shield immunity’ in reducing covid-19 pandemic spread. medRxiv 2020.04.01.20049767 (Preprint) doi:10.1101/2020.04.01.20049767
15. Acemoglu D, Chernozhukov V, Werning I et al. A multi-risk SIR model with optimally targeted lockdown. National Bureau of Economic Research working paper. 2020. https://www.nber.org/papers/w27102
16. Smith GD, Spiegelhalter D. Shielding from covid-19 should be stratified by risk. BMJ 2020; 369:m2063
17. Brouwer PJM, Caniels TG, Straten K et al. Potent neutralizing antibodies from COVID-19 patients define multiple targets of vulnerability. https://science.sciencemag.org/content/2020/06/15/science.abc5902
18. Williamson E, Walker AJ, Bhaskaran KJ et al. OpenSAFELY: factors associated with covid-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv 2020.05.06.20092999. (Preprint) doi:10.1101/2020.05.06.20092999
19. Dasvison C, Frankel S, Smith GD. The limits of lifestyle: re-assessing ‘fatalism’ in the popular culture of illness prevention. Soc Sci Med 1992; 34:675-85
20. Rose G. The strategy of preventive medicine. Oxford Medical Publications. 1993
21. Godlee F. Covid-19: It’s too soon to lift lockdown. BMJ 2020; 369:m2202
22. Eregie CO. COVID-19 Pandemic Interventions: Lockdown is not lockout; avoid interventional precocity with easing lockdowns. https://www.bmj.com/content/369/bmj.m2202/rr-4 of 14th June 2020
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.
Competing interests:
No competing interests
18 June 2020
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria. Also, UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementaion. Also a Technical Expert/ Consultant on FMOH-UNICEF-NAFDAC Project on Code Implementation in Nigeria
Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria.
Rapid Response:
COVID-19 Pandemic and stratified shielding: Some more matters for the works
The ‘COVID-19 Pandemic’ is, indeed, a ‘COVID Phenomenon’ as it continues to impact on ‘Virtually Every ASPECT of Human Existential and Developmental Domains’ [1]! It is not only an ‘Unprecedented Ravaging and Devastating Scourge’, it has, in fact, continued to be the basis for ‘New Normals’ impacting on our ‘Common Humanity’. Much as there are ‘Immense Devastations’ [2-4] wreaked by the ‘Pandemic’, there are also ‘Increasing Benefits’ [5,6] from its existence in the ‘Annals of our Humanity’! The spectrum of ‘COVID-19 Pandemic Negatives’ and ‘COVID-19 Pandemic Positives’ has been the subject of previous ‘Communications’ [2-6] and will not be exposed further in the current piece!! It is, however, expedient to reiterate the fact that the ‘Unprecedented 21st Century Pandemic’ has excited the emergence of an ‘Avalanche of COVID-19 Research Data/ Information’ but the hurried approach to the ‘Pandemic Research’ has resulted in a ‘Huge Body of Questionable and Poor Quality Data’ now largely regarded as ‘Waste in COVID-19 Research’ [7-10]!!
A ‘New Normal’ occasioned by the ‘COVID-19 Pandemic’ is ‘LOCKDOWN’ which is part of the ‘Non-Pharmaceutical Interventions (NPIs)’! The NPIs are the ‘Pandemic Interventions that Work’!! The ‘Interventional Lockdown’ in the ‘COVID-19 Pandemic Era’ includes, among others: Country Lockdown, Business Shutdown, Economic Shutdown, Public Worship Prohibition, Travel Lockdown, Schools Shutdown, World Sports Championships/ Tournaments Shutdown etc! While the ‘Interventional Lockdowns’ are effective in contributing to slowing and reducing the spread of the ‘Pandemic’, they are also known to result in increasing ‘Economic Burden’ and ‘Untoward Human Survival Difficulties’. It has, in fact, been suggested that ‘Interventional Lockdowns’ should be short-lived because of the ‘Untold Negative Effects’ of the ‘COVID-19 Pandemic’ [11]! In an attempt to minimize the ‘Economic Burden’ of the ‘Interventional Lockdown’, several ‘Programmatic interventional Lockdown Models’ have been proposed [12-16]!! Different perspectives of ‘Stratified Shielding’ by ‘Identified Risks/ Vulnerability’ are disposed. Those in the Population, ‘Stratified’ as ‘Most Vulnerable’, are offered greater ‘Protection against the Pandemic’ by ‘Shielding’ as an Intervention. Therefore, people are only ‘Shielded by Lockdown’ according to the identified recognized ‘COVID-19 Pandemic Risks’ [2,3]!!! The ‘Risk Factors’ disposed include, among others: Age, Sex, Immune Status etc, and it is, in fact, proposed that ‘Shielding through Lockdown’ can be ended with reasonable level of ‘Herd Immunity’ [3]!! There is ‘More Work in the Works’ concerning the role of ‘Antibodies and Immunity’ in the ‘COVID-19 Pandemic’. Are the detected ‘SARS-CoV-2 Antibodies’ proven to be ‘Neutralizing Antibodies’ and do they, in fact, confer ‘Protection or Immunity’? [17] Are the ‘Monoclonal Antibodies (mAbs)’ also ‘Neutralizing Antibodies (Abs)’ and do they target the ‘Receptor Binding Domain (RBD)-epitope’ and block the ‘ACE2 Site’: the ‘Neutralization Mechanism’ [17]? The ‘Shield Immunity’ has also been explored as an ‘Interactional Intervention’ in the ‘Global Fight’ against the ‘COVID-19 Pandemic’ as ‘Recovered Patients’ are deployed in ‘Interactions’ involving ‘Essential Goods and Services’ [14]!! The ‘Differential Levels and Neutralizing Potency’ of ‘Convalescent Serum Antibodies’ among ‘Recovered Patients’ is also an ‘Issue in Contention’ [17]!! The relationship between the ‘Identified Antibodies’, ‘Different Targetted RBD-epitopes’ and ‘Disease Manifestations Variability’ are also ‘Issues in the Works’!! The ‘Issues’ of ‘Cross-Neutralization’, ‘Somatic Hypermutation (SHM)’, ‘Clonal Expansion’ etc related to ‘Disease Severity’ remain ‘More Work in the Works’ [17]!!
Further still, other ‘Communications’ have explored the role of ‘Risks Scores’ for the ‘Stratified Shielding Intervention’ for managing the ‘Interventional Lockdown’ in checking the spread of ‘COVID-19 Pandemic’ while assuring that the ‘Economic-Survival Burden’ is minimized and differentially distributed within the Population [15,16,18]! The ‘OpenSAFELY’ uses ‘Risks Score’ based on Prescription Drugs Use (Evidence of Comorbidities), Postcode (Evidence of Socioeconomic Status and Urbanicity), Ethnicity, Cardiometabolic Problems, Obesity, Local SARS-CoV-2 Epidemiology etc! This ‘Risks Score’ is dichotomized into ‘Updatable Chance of getting Infected Score’ and ‘Risk of Dying if Infected Score’ which can be used for ‘Stratifying’ and, therefore, ‘Shielding’ the Populace to inform the ‘Differential Exit from a Lockdown’ [18]!! The ‘Differential Predisposition or Susceptibility’ to the ‘COVID-19 Pandemic’ is not a ‘Concluded Matter’ or ‘Taken as Given’ with the increasing ‘Pandemic Information’ increasingly transmuting and unearthed by the day re: the ‘Variables’ subsumed into the ‘Risks Score Computation’!! For ‘Age’ as a Case-in-Point, the ‘Elderly’ are generally regarded to be more ‘At Risk’ for ‘More Severe Disease’ when ‘Infected’ and, hence, should be ‘More Shielded’! More recent ‘COVID-19 Pandemic Information’ suggests ‘Very Severe Kawasaki-like Disease’ in ‘Children’: ‘Paediatric Inflammatory Multi-System Syndrome (PIMS)’ or ‘Multi-System Inflammatory Syndrome (MIS)’!! There is also the ‘Cytokines Storm’ in ‘Previously Healthy Young Adults’ infected with SARS-CoV-2 with ‘More Severe Disease’!! Therefore, ‘Age’ is not a ‘Simple Binary Classifier’ for the ‘Risk Factors’ to undergird ‘Disease Severity’ and the ‘Stratified Shielding Intervention’ with ‘Interventional Lockdown’ in the ‘COVID-19 Pandemic Mitigation Measures’!!! The role of ‘Sex’ is ‘Information in a flux’ and may not be exposed further but certainly also requires ‘More Work in the Works’!!!!
The use of ‘Postcode’ as a ‘Proxy for Socioeconomic Status’ is interesting and requires some critiquing! This assumes proper ‘Planning and Development’ of Cities/ Towns and also the location of Citizens predictably by ‘Socioeconomic Standing’ and this may not be exactly true for all Cities globally!! How effectively 'Socioeconomic Status’ correlates with ‘Economic Endowment’ and/ or ‘Educational Attainment’ is another basis for critiquing the ‘Postcode-influenced Risks Score’ for the ‘Interventional Stratified Shielding’ in the ‘Lockdown’ to slow the spread of the ‘COVID-19 Pandemic’. Citizens are placed in ‘Categories 1 to 5’ and ‘Individuals’ can opt for ‘Shift’ in ‘Risk Categories’ according to ‘Risk Appetite’ [19]! This introduces ‘Subjectivity’ and may affect the ‘Scores Sensitivity’! The ‘Acceptability’ of the ‘Stratified Shielding’ by the Public is yet another ‘Issue’ re: ‘Stratified Shielding’ as a ‘Public Health Intervention’ against the ‘COVID-19 Pandemic’ [20]!!
The ‘Interventional Lockdown’, part of the NPIs, is effective against the ‘COVID-19 Pandemic’ but comes with ‘Huge Economic Burden and other Negative Consequences’! There are ‘Communications’ criticizing ‘Interventional Precocity’ in ‘Easing the Lockdown’ [21,22]!! The proposed ‘Stratified Shielding’ as an ‘Interventional Lockdown’ needs critical scrutiny as a ‘Public Health Strategy’ against the ‘Pandemic’ using ‘Risk-related Differential Protection’ needing to address ‘Some More Matters for the Works’!!!
REFERENCES
1. Eregie C. O. COVID Phenomenon: An innovative conceptual coinage in human development and sustainable development in the 21st Century. https://www.bmj.com/content/368/bmj.m1199/rr-17 of 9th April 2020
2. Godlee F. COVID-19: Weathering the storm. BMJ 2020; 368:m1199 of 26th March 2020
3. Eregie C.O. COVID-19 Pandemic: Still on the difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-13 of 2nd April 2020
4. Eregie C.O. COVID-19 Pandemic: Further perspectives on the difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-16 of 5th April 2020
5. Kickbusch I, Leung GM, Bhutta ZA, Matsoso MP, Ihekweazu C, Abbasi K. Covid-19: how a virus is turning the world upside down. BMJ 2020; 369:m1336 of 3rd April 2020
6. Eregie C.O. COVID-19 Pandemic: The daunting challenges of assuring sustainable benefits from weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-14 of 8th April 2020
7. Yan W. Coronavirus tests science’s need for speed limits. New York Times 2020 Apr 14. https://www.nytimes.com/2020/04/14/science/coronavirus-disinformation.html
8. Clinical Trials.gov. History of changes for study. NCT04280705, 1 May 2020. https://clinicaltrials.gov/ct2/history/NCT04280705?A=10&B=15&C=Side-by-S....
9. Glasziou PP, Sanders S, Hoffmann T. Waste in covid-19 research. BMJ 2020; 369:m1847
10. Eregie CO. COVID-19 Pandemic: The multifaceted picture of compromised COVID-19 research and the ‘COVID Phenomenon’. https://www.bmj.com/content/369/bmj.m1847/rr-12 of 10th June 2020
11. Ioannidis JPA. Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest 2020; 50:e13222
12. Triggle N. Coronavirus: is it time to free the healthy from restrictions? BBC News 2020 May 7. https://www.cidrap.unm.edu/sites/default/files/public/downloads/cidrap-c...
13. McKeigue PM, Colhoun HM. Evaluation of ‘stratify and shield’ as a policy option for ending the COVID-19 lockdown in the UK. medRxiv 2020.0425.20079913 (Preprint) doi:10.1101/2020.04.25.20079913
14. Weitz JS, Beckett SJ, Coenen AR et al. Intervention serology and interaction substitution: modeling the role of ‘shield immunity’ in reducing covid-19 pandemic spread. medRxiv 2020.04.01.20049767 (Preprint) doi:10.1101/2020.04.01.20049767
15. Acemoglu D, Chernozhukov V, Werning I et al. A multi-risk SIR model with optimally targeted lockdown. National Bureau of Economic Research working paper. 2020. https://www.nber.org/papers/w27102
16. Smith GD, Spiegelhalter D. Shielding from covid-19 should be stratified by risk. BMJ 2020; 369:m2063
17. Brouwer PJM, Caniels TG, Straten K et al. Potent neutralizing antibodies from COVID-19 patients define multiple targets of vulnerability. https://science.sciencemag.org/content/2020/06/15/science.abc5902
18. Williamson E, Walker AJ, Bhaskaran KJ et al. OpenSAFELY: factors associated with covid-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv 2020.05.06.20092999. (Preprint) doi:10.1101/2020.05.06.20092999
19. Dasvison C, Frankel S, Smith GD. The limits of lifestyle: re-assessing ‘fatalism’ in the popular culture of illness prevention. Soc Sci Med 1992; 34:675-85
20. Rose G. The strategy of preventive medicine. Oxford Medical Publications. 1993
21. Godlee F. Covid-19: It’s too soon to lift lockdown. BMJ 2020; 369:m2202
22. Eregie CO. COVID-19 Pandemic Interventions: Lockdown is not lockout; avoid interventional precocity with easing lockdowns. https://www.bmj.com/content/369/bmj.m2202/rr-4 of 14th June 2020
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.
Competing interests: No competing interests