EDITORIAL
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2021 - Universidad Ricardo PalmaDOI 10.25176/RFMH.v21i2.3751
HAVE WE LEARNED ANYTHING FROM THE 10TH MOST DEVASTATING PANDEMICS OVER THE PAST 3000 YEARS?
¿HEMOS APRENDIDO ALGO DE LA DÉCIMA PANDEMIA MÁS DEVASTADORA DE LOS ÚLTIMOS 3000 AÑOS?
Cristian Dragos Stefanescu(1,2,3)
1 "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
2 “Gen. Dr. Aviator Victor Anastasiu” National Institute of Aeronautical and Spatial Medicine, Bucharest, Romania.
3 University Emergency Hospital, Bucharest, Romania.
When I received the invitation to write an editorial about the Romanian perspective on the SARS-CoV-2 pandemics, I instantly knew that George Santayana’s quote: “Those who forget the past are condemned to repeat it” would be most apt to describe the Pan-European approach against this global epidemiological crisis.
The five coronaviruses outbreaks reported over the past century should have prompted precautionary measures and specific guidelines strong enough to contain outbreaks from progressing toward events of pandemic proportions. However, it was not the case for Romania nor for the WHO.
SARS-CoV-2 is a virus belonging to the Coronaviridae family transmitted through aerosols and droplets. It was first documented in humans in December 2019 in Wuhan, China, considered to be the epicentre of the latest pandemic. As cases started to spread around the Globe, World Health Organization announced on 11th of March 2020 that the COVID 19 outbreak meets criteria for a pandemic event and advised all countries to take appropriate measures for limiting the dissemination. The official recommendations, as found on the WHO statement from that day, referred to proper hand hygiene with water and soap and hand sanitizing gel, social distancing (1meter from a symptomatic person), avoidance of touching the eyes, the nose and the mouth as well as appropriate respiratory hygiene. But there was no mention about wearing a facial mask or any kind of respiratory protection equipment which later proved to be the best strategy for avoiding infection. Sluggish responses to reports from the affected regions and an alleged resistance to declare a pandemic event sooner might have delayed the implementation of appropriate containment measures. Despite the fundamental differences between the Spanish flu and the SARS-CoV-2 infections there is an undeniable truth: both pandemics were caused by air born pathogens hence wearing facial masks would have been the most logical first step to be adopted.
The five coronaviruses outbreaks reported over the past century should have prompted precautionary measures and specific guidelines strong enough to contain outbreaks from progressing toward events of pandemic proportions. However, it was not the case for Romania nor for the WHO.
SARS-CoV-2 is a virus belonging to the Coronaviridae family transmitted through aerosols and droplets. It was first documented in humans in December 2019 in Wuhan, China, considered to be the epicentre of the latest pandemic. As cases started to spread around the Globe, World Health Organization announced on 11th of March 2020 that the COVID 19 outbreak meets criteria for a pandemic event and advised all countries to take appropriate measures for limiting the dissemination. The official recommendations, as found on the WHO statement from that day, referred to proper hand hygiene with water and soap and hand sanitizing gel, social distancing (1meter from a symptomatic person), avoidance of touching the eyes, the nose and the mouth as well as appropriate respiratory hygiene. But there was no mention about wearing a facial mask or any kind of respiratory protection equipment which later proved to be the best strategy for avoiding infection. Sluggish responses to reports from the affected regions and an alleged resistance to declare a pandemic event sooner might have delayed the implementation of appropriate containment measures. Despite the fundamental differences between the Spanish flu and the SARS-CoV-2 infections there is an undeniable truth: both pandemics were caused by air born pathogens hence wearing facial masks would have been the most logical first step to be adopted.
The progression of the Covid 19 pandemic in Europe was fulminant and affected many European countries simultaneously. In Romania, the first case of SARS-CoV-2 infection was on the 26.02.2020 in a young male patient who was a direct contact to an Italian male who had recently travelled in Romania from Italy. On the 16th of March, a few days after the WHO declared Covid 19 pandemic, the president of Romania declared State of Emergency and closed the borders, aiming to limit the spread of the SARS-CoV-2, but again no decision for mandatory face masks in public places. Many infectious diseases doctors considered the recommendations proposed by the WHO on the 12th of March enough for putting an end to the pandemic. During the State of Emergency many public places were closed and, in some cases, work from home was implemented. As time got by, wearing a mask in outdoor and indoor public places became mandatory which led to an increase in prices for these PPE: a surgical mask was sold with 2 euros, a FFP2/N95 with 10 euros and a FFP3/N99 with up to 50 euros. Many local producers started making facial masks but only few received the Quality Control approval. On the 15th of May State of Emergency ended and the President declared a State of Alert. As shown by the epidemiological studies and articles, the pandemic had the same two peaks as the entire Europe but with a few weeks lag. I believe that the velocity of the spread was related to the national number of flights and the complexity of the transport systems. The compliance of the population to the recommended measured played an equally important role.
All infectious diseases hospitals and some multidisciplinary hospitals in Romania started on 16th of March treating only Covid 19 patients. At first, because there was insufficient data about the contagious period of a positive patient and the lack of surveillance options all positive patients were hospitalized until two consecutive negative test results were available, no matter the severity of the cases.
On the 27th of December, almost ten months after the first positive patient was discovered, the vaccination program started using a Pfizer Biontech vaccine. The population was divided in three categories, according to the risk of contacting the disease and the risk of developing severe forms. In the initial stage, of vaccination first line workers, all medical personnel, received the Pfizer Biontech serum. At the moment, along with the Pfizer vaccine, Moderna and AstraZeneca are also available and are administered according to the producer’s recommendations. Johnson&Johnson vaccine will also be available in the next weeks in Romania. Like all European Union countries, Romania suffered a delay of the vaccination program due to the lack of sufficient doses. Unfortunately, the vaccination process is taking very long, having at the moment only 630.000 people who received the full scheme with either of the vaccines available.
This fact is due to multiple factors, the most important ones being the low temperature needed to store some of the vaccines, the best before date and the small number of doses delivered by the manufacturing companies. In order to gain herd immunity, as studies show, a minimum of 60% of a country’s population need to receive the full vaccination protocol. At the moment, unfortunately achieving this goal in the next six months seems almost impossible.
Countries like Israel should be an example for the whole world because of their aggressive vaccination campaign, succeeding to vaccinate a 52.4% of the population with the first dose and 39% with the second dose.
In December, two new strains of Covid 19, B.1.1.7 from The United Kingdom and B.1.351 from South Africa, were discovered and started to spread around the world. Many countries report an increased number of new positive cases with these new strains which may lead to a third wave of this pandemic.
The increasing number of positive cases could be secondary to the general relaxation promoted by some governments, with the reopening of the borders, of the indoor restaurants and schools but mostly due to the lack of personal responsibility of wearing a mask and keeping social distancing. One can say that we haven’t learnt anything in the past year from all the suffering and the death around us and that humanity is doomed to repeat the same mistakes.
Special thanks to Ruxandra Oana Alius(2) and Catalin Alius(3), who have made a substantial contribution to the concept and design of the article.
All infectious diseases hospitals and some multidisciplinary hospitals in Romania started on 16th of March treating only Covid 19 patients. At first, because there was insufficient data about the contagious period of a positive patient and the lack of surveillance options all positive patients were hospitalized until two consecutive negative test results were available, no matter the severity of the cases.
On the 27th of December, almost ten months after the first positive patient was discovered, the vaccination program started using a Pfizer Biontech vaccine. The population was divided in three categories, according to the risk of contacting the disease and the risk of developing severe forms. In the initial stage, of vaccination first line workers, all medical personnel, received the Pfizer Biontech serum. At the moment, along with the Pfizer vaccine, Moderna and AstraZeneca are also available and are administered according to the producer’s recommendations. Johnson&Johnson vaccine will also be available in the next weeks in Romania. Like all European Union countries, Romania suffered a delay of the vaccination program due to the lack of sufficient doses. Unfortunately, the vaccination process is taking very long, having at the moment only 630.000 people who received the full scheme with either of the vaccines available.
This fact is due to multiple factors, the most important ones being the low temperature needed to store some of the vaccines, the best before date and the small number of doses delivered by the manufacturing companies. In order to gain herd immunity, as studies show, a minimum of 60% of a country’s population need to receive the full vaccination protocol. At the moment, unfortunately achieving this goal in the next six months seems almost impossible.
Countries like Israel should be an example for the whole world because of their aggressive vaccination campaign, succeeding to vaccinate a 52.4% of the population with the first dose and 39% with the second dose.
In December, two new strains of Covid 19, B.1.1.7 from The United Kingdom and B.1.351 from South Africa, were discovered and started to spread around the world. Many countries report an increased number of new positive cases with these new strains which may lead to a third wave of this pandemic.
The increasing number of positive cases could be secondary to the general relaxation promoted by some governments, with the reopening of the borders, of the indoor restaurants and schools but mostly due to the lack of personal responsibility of wearing a mask and keeping social distancing. One can say that we haven’t learnt anything in the past year from all the suffering and the death around us and that humanity is doomed to repeat the same mistakes.
Special thanks to Ruxandra Oana Alius(2) and Catalin Alius(3), who have made a substantial contribution to the concept and design of the article.
Authorship Contributions: .
Financing: Self-financed.
Conflicts of interest: None.
Correspondence: Cristian Dragos Stefanescu.
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BIBLIOGRAPHIC REFERENCES
