Getting it right in the pandemic
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2637 (Published 02 July 2020) Cite this as: BMJ 2020;370:m2637Read our latest coverage of the coronavirus pandemic
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Dear Editor
I write with reference to the front page headline ‘The covid gamble Sweden lost’, the comments in Editor’s Choice & the linked article by Heba Habib in BMJ 4th July 2020.
The relative benefits and costs of Sweden’s pandemic response will no doubt be the subject of intense study over the coming months and years. At present, there is a sense that lockdown countries are keen to disparage Sweden’s approach; Elizabeth Loder states ‘Sweden is everyone’s favourite example of a country that got it wrong’.
I am therefore concerned that a biased article with a heavily political undercurrent, written by a freelance non-science journalist, has been given such prominence within a medical journal.
At a time when politicians are keen to make us believe they are ‘following the science’, it is of utmost importance that, as scientists, we do not allow ourselves to be led by the politics.
Competing interests: No competing interests
Dear Editor
Firstly, Sweden does not have a herd immunity strategy. It is a common misconception that the internet has turned into a truth.
Secondly, voluntary physical distancing measures are not inherently synonymous with a laissez-faire response. The Swedish authorities have taken the virus very seriously. Yes, there have been problems with preparedness and with the organisation of social care. Early on many in Sweden, like in most other countries, did not anticipate that the disease would spread widely outside of China.
However, there are countries where leaders call Covid-19 a hoax or ’not any worse than the flu.’ Swedish leaders - both elected officials and civil servants - have taken Covid-19 seriously, and stressed the gravity of this situation in countless press conferences.
There are many reasons why Sweden took primarily voluntary measures. One reason why there were not more widespread societal closures is simply because many of these types of closures are not possible under Swedish law. A temporary law was put into place in April which would have allowed some closures, but - as a temporary law - it expired at the end of June without being used.
Competing interests: No competing interests
Dear Editor,
Before you compare "European neighbours" you should consider the very different ways of counting infected or sick people.
Please take into account that there are also very different ways to attribute dead people to COVID between the "European neighbours". The BBC has done it well and Ray Moniyhan/BMJ has pointed at the right issues some days ago. Please return to your well known critical appraisal.
Competing interests: No competing interests
Dear Editor
Motivated to read this Editorial published in the BMJ, we decided to express some considerations of a work team in our hospital that is in charge of leading the implementation of the plans for the prevention and control of covid-19 in our province, a territory of almost half a million population; in addition to planning clinical and epidemiological investigations of the behavior of the pandemic in the center-south of our country.
Epidemics of unknown emerging diseases test not only the technical and human capacity of health professionals who directly care for the sick, but of all those who make up the health systems and society in general.
For a proper understanding of these unpublished entities, they must be approached with a general approach that integrates many particular elements that, otherwise, can only give a partial vision of the matter. In addition, they have an important characteristic and that is that they generate great tension at all levels, especially when they threaten people's lives, so the answers to the questions that are generated must try to find them in the shortest possible time. That is the case in the covid-19 pandemic.
The Academician Prof. Espinosa-Brito states that covid-19 has been tinged with exclusive peculiarities as it is the first pandemic that has been followed in the entire world in real time through all the information and communication technologies available in the present.
Perhaps the most complex issue in this confrontation has been the need for the sudden change of a group of routines and lifestyles rooted in people and communities that, as is known, is not always achieved in all individuals, or in a short time, together with a complex socioeconomic context.
When there is a sustained collective response, the number of cases is greatly reduced and the epidemic is controlled over time. But we must insist on the collective response of everyone, of sectors and, above all, of the educated and disciplined community: this is the way.
References
1. Espinosa-Brito A. Acompañando la marcha de la pandemia de COVID-19. Una mirada desde Cienfuegos. Medisur. 2020 [citado 2020 May 30]; 18(3):[aprox. 8 p.]. Disponible en: http://medisur.sld.cu/index.php/medisur/article/view/4726
2. Schneider EC. Failing the Test-The Tragic Data Gap Undermining the U.S. Pandemic Response. N England J Med. 2 0 2 0 A v a i l a b l e f r o m : https://www.nejm.org/doi/full/10.1056/NEJMp201 4836.
3. Espinosa Brito A. Reflexiones a propósito de la pandemia de COVID-19 [I]: del 18 de marzo al 2 de abril de 2020. Anales de la Academia de Ciencias de Cuba. 2020 [cited 14 Abr 2020 ] ; 10 (2): [aprox. 21p]. A v a i l a b l e f r o m : http://www.revistaccuba.sld.cu/index.php/revacc/ article/view/765/797.
4. Rose G. Sick individuals and sick populations. International Journal of pidemiology. 2001; 30: 427-32.
5. Sethuraman, S. Jeremiah A, Ryo A. Interpreting Diagnostic Tests for SARS-CoV-2.JAMA. 2020 [ cited 16 May 2 0 2 0 ] A v a i l a b l e f r o m : https://jamanetwork.com/journals/jama/fullarticle /2765837.
6. Núñez Jover J. ¿Qué estamos aprendiendo en estos días de enfrentamiento a la COVID 19?. La Habana: UCI; 2020. [ cited 8 May 2 0 2 0 ] A v a i l a b l e f r o m : http://www.cubadebate.cu/opinion/2020/05/07/que-estamos-aprendiendo-en-e... amiento-a-la-covid-19/#.XrTZ0smuOZQ.
7. Sharmila D. Travel restrictions hampering COVID-19 response. The Lancet: 020; 395, 25 abr: 1331- 32. DOI: https://doi. org/10.1016/S0140-6736(20)30967
8. McCloskey B, Zumla A, Ippolito G, Blumberg L, Arbon P, Cicero A, Endericks T, Lim PL, Borodina M, on behalf of the WHO Novel Coronavirus-19 Mass atherings Expert Group. Mass gathering events and reducing further global spread of COVID-19: a political and public health dilema. Lancet Published Online March 19, 2020, https://doi.org/10.1016/S0140-6736(20)30681-4.
9. IHME. COVID-19 health service utilization forecasting team, Christopher JL Murray. Forecasting the impact of the first wave 1 of the COVID-19 pandemic on 2 hospital demand and deaths for the USA and European Economic Area 3 countries. medRxiv 2020.04.21.20074732; doi: https://doi.org/10.1101/2020.04.21.2 0074732.
Competing interests: No competing interests
Dear Editor
Current Scenario of the COVID-19 Pandemic
In the 27th week of this Pandemic, over 11 Million ( 11,033879 ) people in the world population (0.14%) are infected with COVID-19, in almost all countries.
World has recorded for the first time over 2 lakh COVID-19 cases (208864) in a single day during this Pandemic on 2.7.2020. Of this a quarter of the global COVID-19 cases are in the US.
Highest single day spike of over 20k (21948) cases has been reported in India on 2.7.2020.
Global scenario of COVID-19 cases are not yet reaching a plateau in a few countries like USA, Brazil and in India despite the low death rate.
During this 27th week of the COVID-19 Pandemic, 56% of the infected global cases are recovered from illness.
Among currently infected persons, 99% are mildly affected and 1% are seriously ill.
Infected cases which have an outcome in the form of recovery are noted in 92% of patients, and death was recorded in 8% of cases.
As primary prevention for COVID-19, many candidate vaccines are in the pipeline.
Oxford vaccine AZD1222 is under phase 3 trial. Covaxin a vaccine from India is in phase 1 trial. Definitely any one of the vaccines for COVID-19 will hit the market in August 15th or at the end of 2020 and even if delayed may be in the beginning of year 2021.
Competing interests: No competing interests
Re: Getting it right in the pandemic
Dear Editor
As Loder wrote: “The pandemic is far from over, but it’s already obvious some countries have done better than others”. [1] There was a human being dream that when a new universal disaster could menace the planet, all nations have to be integrated to face the catastrophe. However, this is not what occurred to face the unknown covid-19 pandemic, in spite the epoch of globalization and rapid communication by internet. In front of the new danger, the answer was: disintegration. What a pity!
Due to a heavy global nationalism and particular interests, each country had to manage this new situation, according to its conceptions and resources, especially those related to the priority and organization of the health system in each nation. So, there are different results among countries: Germany is one, with fewer infections and lower mortality from covid-19 than many of its European neighbours… Sweden is everyone’s favourite example of a country that got it wrong, and so on… [1] And those are developed countries. In low-income countries this issue is worse.
Cuba is an underdeveloped and blockade country but due to the high priority of health of citizens by the State, with a strong and organized, universal, accessible and freely for all National Health System, firmly anchored in disease prevention and primary care, and provides good health outcomes. Despite the severe constraints on resources that Cuba has had to endure, the country provides an interesting example of what can be achieved by prioritising health and education. [2] The nation have faced the present pandemic with good results. Since march 11, there were 2372 persons identified positive with PCR up to date, 1.3% of 183 143 tests in stratified high risk groups to SARS-CoV-2 (foreign travelers, patient contacts, persons with acute respiratory infections, homes for old persons, hospital admissions, active screening approach, etc.), and only 86 deaths (lethality: 3.62%). [3]
Policymakers and health system were involved from the beginning of 2020 in a strategy to face this epidemics which included the highest authorities of the nation, the commitment of all sectors of the society and the active community participation. [4] The role of Cuban scientists were also prominent in the organizational framework looking for new ways for a national and local action plan and achieving new and original biotechnological products for the management of severe patients. [5]
In addition to these results, as a model of solidarity with other peoples around the world, Cuba have sent more than thirty international brigades of medical doctors and nurses (named Henry Reeve, in honor to the American general who fought with Cubans for independence and died in 1876) to different underdeveloped countries. Few developed countries received brigades too, both cases, in response to solicitudes from governments to support them in the battle against the pandemia.
Now, our country is in a progressive post-covid-19 program for all provinces, according to their achievements in main epidemiological indicators, though preventive measures and surveillance of the new normality are included in these steps.
References
1. Loder E. Getting it right in the pandemic. BMJ 2020;370:m2637 Available in: http://dx.doi.org/10.1136/bmj.m2637
2. Editorial. Cuba: health lessons not under embargo. Lancet. 2015 Jan 3;385(9962):2. doi: 10.1016/S0140-6736(14)62463-6
3. Ministerio de Salud Pública: Cuba confirma tres nuevos casos de COVID-19, para un acumulado de 2372. [access 2020 Jul 6] Available in: www.granma.cu/cuba/2020-07-05/ministerio-de-salud-publica-05-07-2020-09-...
4. Durán F, Reed G. Stemming COVID-19 in Cuba: Strengths, Strategies, Challenges. MEDICC Review [internet] 2020 [access 2020 Jul 6]; 22(2): [aprox. 3 p.] Available in: https://mediccreview.org/stemming-covid-19-in-cuba-strengths-strategies-...
5. Díaz-Canel Bermúdez M, Núñez Jover J. Gestión gubernamental y ciencia cubana en el enfrentamiento a la COVID-19. Anales de la Academia de Ciencias de Cuba 2020;10 (2) especial COVID-19. [internet] [access 2020 Jun 23] [aprox. 10 p.] Available in: http://www.revistaccuba.cu/index.php/revacc/article/view/881
Competing interests: No competing interests