Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registriesBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n415 (Published 24 February 2021) Cite this as: BMJ 2021;372:n415
All rapid responses
The vaccine candidate Abdala, from the Center for Genetic Engineering and Biotechnology (CIGB), is positioned as the second specific Cuban immunogen against SARS-CoV-2 that goes to phase III of clinical trials, after the Center for State Control of Medicines, Equipment and Medical Devices (CECMED) will approve the change of stage according to the established regulations.
Abdala is a specific vaccine against Sars-CoV-2 that has been developed by the CIGB and in collaboration with Aica Labs we have managed to turn it into that bulb that we have been able to appreciate today. The protein that composes it has been modeled by our bioinformatic scientists in our laboratories. It is formed by the receptor-binding domain, which is responsible for infecting human cells in the individual. This protein has been widely used for vaccine candidates, regardless of the technological platform used. In this case, Abdala uses the smallest portion of the spike protein, or protein S, responsible for the spread of the virus.
This antigen has the characteristic that, because it is expressed in the pichia pastori yeast cell, it also has modifications that move it evolutionarily away from the molecule as seen in the virus and that it infects. This then makes it a very attractive molecule, from the antigenic point of view, in order to obtain high levels of immune response in individuals. This protein binds to a well-known immunological adjuvant such as aluminum hydroxide, “which is used in many vaccines that have already been tested and are widely used in humans. "The union of these two components is what makes us have this vaccine candidate, which is administered intramuscularly.
Competing interests: No competing interests
Re: Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries
I have grave concerns regarding the veracity of the data and findings reported in this article.
China, is an unaccountable secretive police state, and has repeatedly impeded the global inquiry into the emergence of the coronavirus. It has also micromanaged the narrative to ward off its responsibility and blame for the pandemic. China has also denied the WHO team access to important data sources. I would not trust their publications, which are state approved.
Evidence has emerged to support the view that Wuhan was not the only part of China having an outbreak of Sars-cov-2. There is also evidence that the virus entered Europe far earlier.
Apolone et al reports sars-cov-2 antibodies present in samples taken from Cancer patients as early as September 2019 (1). Giuseppe Remuzzi reported patients presenting with Covid-19 symptoms in November 2019 (2-3). Waste water analysis of sewage samples collected in Spain detected Sars-cov-2 in March 2019 (4). Clearly the narrative of the pandemic began much earlier. I would postulate that Italy received two inoculums, one during the summer of 2019, the main one in New Year 2020, which would explain why Italy was so overwhelmed.
Cadogan West MSc, PhD
Competing interests: No competing interests
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented a global health challenge, and the prevention of COVID-19 transmission has been the most important task for every country in 2020 and 2021. Different countries have taken various strategies to curb the increasing trend of COVID-19. Wuhan, China, took one of the most severe strategies to lock down the whole city with over 10 million population. The strategy has received a lot of critical and negative comments, but it is very difficult to tell if the strategy worked efficiently at the very beginning without enough data .
Recently, Liu and colleagues published an article to investigate the mortality in Wuhan City and other parts of China during the first three months of COVID-19 outbreak using data from the death registries, and showed that Wuhan has recorded increases in mortality, but the other parts of China did not show substantial increase . Findings of the study suggest that the lockdown of Wuhan City was a great success to prevent the wide transmission of the SARS-CoV-2 and protect people’s lives in the other parts of China, despite the great loss and sacrifice in Wuhan at that moment. Due to the modern transportation and human migration, it is becoming much easier and quicker for the national and global transmission of SARS-CoV-2 . If without lockdown of Wuhan City, it would be much quicker for the virus to widespread to the whole world. There would be less time for the other cities, provinces, and countries to prepare and respond to the public health emergence. In other words, Wuhan lockdown has saved a lot of time for the other parts of China as well as the other countries over the world to take actions against the virus.
Another study that compared the epidemiologic curves of COVID-19 across three geographic strata (i.e., Wuhan City, Hubei Province excluding Wuhan City, and China excluding Hubei Province) also showed that lockdown of Wuhan substantially flattened the curve in other parts of China, suggesting the great contribution from the citywide lockdown .
The COVID-19 pandemic has showed two important patterns.
First, due to the large population and people’s fast movement benefited from the modern transportation technique (e.g., airlines, trains, cars, etc.), the metropolitan cities in the middle-high income countries (e.g., Wuhan, New York, London, etc.) have been the hot zones or Epicenters for the infectious diseases, instead of the remote rural area that was traditionally known as the hot zones for infectious disease outbreaks [3,5]. If the city with the outbreak did not lock down, the virus would transmit to other cities and countries at a very high speed, even within hours.
Second, the transmission path was moving from the urban to the rural area after first wave outbreak in the urban area. Recent data from China (i.e., the COVID-19 outbreak in the rural area of Hebei Province ) and US  have both shown that the urban-to-rural transmission of COVID-19 played an important role after the first wave of the outbreak. However, the rural areas usually lack medical and public health professionals as well as medical equipment and facilities, leading to a low detection rate and high delays in testing, quarantine, and treatment, which may cause wider transmission and great loss in people’s lives. If the transmission from urban to rural did not block after the first wave outbreak, it might cost much more efforts and resources to test, quarantine and treat the infected people in the rural area. Therefore, lockdown of the city or part of the city may become an efficient way to control the transmission.
COVID-19 will not be the only one, and more infectious diseases outbreaks and pandemics are on the way, although we don’t know when they will arrive. In the globalization era, the transmission between cities within country or between different countries, and from urban to rural cannot be avoided, and may even become the main transmission paths. Lockdown of cities or part of cities with outbreaks would be an option, but it is not an easy decision. In addition to the physical lockdown, there are several concerns should be considered, including, but not limited to the medical and public health assistance from other cities, provinces and countries, food and water supply, information release, mental health care, social panic prevention, etc . The COVID-19 pandemic and the Wuhan lockdown provided a lessen we should learn from about the prevention and control of infectious diseases pandemic in the era of globalization.
1 Chen X, Yu B. First two months of the 2019 Coronavirus Disease (COVID-19) epidemic in China: real-time surveillance and evaluation with a second derivative model. glob health res policy 2020;5:7. doi:10.1186/s41256-020-00137-4
2 Liu J, Zhang L, Yan Y, et al. Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries. BMJ 2021;372:n415. doi:10.1136/bmj.n415
3 Mo Q, Chen X, Yu B, et al. Levels of economic growth and cross-province spread of the COVID-19 in China. J Epidemiol Community Health Published Online First: 28 January 2021. doi:10.1136/jech-2020-214169
4 Yu B, Chen X, Rich S, et al. Dynamics of the coronavirus disease 2019 (COVID-19) epidemic in Wuhan City, Hubei Province and China: a second derivative analysis of the cumulative daily diagnosed cases during the first 85 days. Glob Health J Published Online First: 6 February 2021. doi:10.1016/j.glohj.2021.02.001
5 Liao H, Marley G, Si Y, et al. A Tempo-geographic Analysis of Global COVID-19 Epidemic Outside of China. medRxiv Published Online First: 23 March 2020. doi:10.1101/2020.03.20.20039602
6 Health Commission of Hebei Province. Hebei Province COVID-19 updates Jan 17 2021. 2021.http://wsjkw.hebei.gov.cn/html/yqtb/20210118/375645.html (accessed 26 Feb2021).
7 Wang Y, Liu Y, Struthers J, et al. Spatiotemporal Characteristics of the COVID-19 Epidemic in the United States. Clin Infect Dis 2021;72:643–651. doi:10.1093/cid/ciaa934
Competing interests: No competing interests