COVID-19
Two years COVID-19:
Looking back and forward
Summary
This is a brief and simplified overview. For full argumentation and 400+ references, please refer to the full text.
The COVID-19 epidemic is a major healthcare threat that decreases the average life expectancy. The virus affects people in all age groups and all regions of the world - including developing countries. Controlling the virus is the most effective measure against the disease in terms of health, society and economics. Testing-based strategies are the most efficient way to control the virus.
SARS-2 is a deceptive virus that seriously dysregulates the immune system. Infection with this virus inhibits antiviral immunity and exacerbates inflammation by its superantigen properties. Morbidity after COVID-19 seems to cost more loss of quality-adjusted life years (QALYs) than mortality due to acute COVID-19. Acute SARS-2 infection could cause lung disease, brain disease, sepsis-like syndrome destroying the immune system and disseminated thrombosis. Long-covid cases might be different combinations of post-infection damage, oxygenation problems, persistent infections and immune dysregulation. Young and healthy people are also at risk for long covid.
Vaccination offers the best immunity against disease but does not contribute to herd immunity as no sterilizing immunity is achieved (Figure 1). Protection after vaccination loses efficacy after nine months starting in the most vulnerable, and people become reinfected and diseased, similar to the common cold coronaviruses. SARS-2 will most likely become a recurrent seasonal disease in temperate areas with severe health impact. Respiratory viruses spread through aerosols from apparently healthy but infected people.
The best way to stop the outbreak is to quarantine infected people only, aided by shielding or, if needed, a lockdown. Vaccination gives personal protection against disease. Other strategies are considered unethical and ineffective and four executed or proposed strategies are discussed: (a) me first and you not, (b) maximizing COVID-specific mortality, (c) stopping our healthcare system, and (d) repeating mistakes without lessons learned.
Crisis situations, like war and pandemics, reflect the dark and light in our hearts. The antivax lobby tries to distort data to suggest that vaccination is linked to high mortality. Leaders might be motivated by personal gain and destabilize society when a virus should be fought united (Figure 2). It should be noted that in countries like the Netherlands, not all governmental information is correct. In truth and love, everyone is responsible for their own actions. Mass infection is not an option: we must protect our young and old people. Costs can be calculated but the bottom-line question resumes to what is the value of human lives. We should seek the best for everyone.
Looking forward, it is not an option to take no measures, as it will overflow healthcare, and drown our carefully build system. Virus evolution predicts that SARS-2 would become more pathogenic by spreading faster, evading innate and antigen-specific immune responses. More people would become more severely ill and new vaccines would be necessary. Containment to the zero level is the best option for any severe pathogenic virus. This has been shown possible for SARS-2 in East- and South-East Asia. Europe and the USA have shown to be able to contain the highly contagious white plague over a century ago.
If we take concrete actions to aim for Zero-Covid, we would be able to minimize the impact of this epidemic, just as we did before.
The COVID-19 epidemic is a major healthcare threat that decreases the average life expectancy. The virus affects people in all age groups and all regions of the world - including developing countries. Controlling the virus is the most effective measure against the disease in terms of health, society and economics. Testing-based strategies are the most efficient way to control the virus.
SARS-2 is a deceptive virus that seriously dysregulates the immune system. Infection with this virus inhibits antiviral immunity and exacerbates inflammation by its superantigen properties. Morbidity after COVID-19 seems to cost more loss of quality-adjusted life years (QALYs) than mortality due to acute COVID-19. Acute SARS-2 infection could cause lung disease, brain disease, sepsis-like syndrome destroying the immune system and disseminated thrombosis. Long-covid cases might be different combinations of post-infection damage, oxygenation problems, persistent infections and immune dysregulation. Young and healthy people are also at risk for long covid.
Vaccination offers the best immunity against disease but does not contribute to herd immunity as no sterilizing immunity is achieved (Figure 1). Protection after vaccination loses efficacy after nine months starting in the most vulnerable, and people become reinfected and diseased, similar to the common cold coronaviruses. SARS-2 will most likely become a recurrent seasonal disease in temperate areas with severe health impact. Respiratory viruses spread through aerosols from apparently healthy but infected people.
The best way to stop the outbreak is to quarantine infected people only, aided by shielding or, if needed, a lockdown. Vaccination gives personal protection against disease. Other strategies are considered unethical and ineffective and four executed or proposed strategies are discussed: (a) me first and you not, (b) maximizing COVID-specific mortality, (c) stopping our healthcare system, and (d) repeating mistakes without lessons learned.
Crisis situations, like war and pandemics, reflect the dark and light in our hearts. The antivax lobby tries to distort data to suggest that vaccination is linked to high mortality. Leaders might be motivated by personal gain and destabilize society when a virus should be fought united (Figure 2). It should be noted that in countries like the Netherlands, not all governmental information is correct. In truth and love, everyone is responsible for their own actions. Mass infection is not an option: we must protect our young and old people. Costs can be calculated but the bottom-line question resumes to what is the value of human lives. We should seek the best for everyone.
Looking forward, it is not an option to take no measures, as it will overflow healthcare, and drown our carefully build system. Virus evolution predicts that SARS-2 would become more pathogenic by spreading faster, evading innate and antigen-specific immune responses. More people would become more severely ill and new vaccines would be necessary. Containment to the zero level is the best option for any severe pathogenic virus. This has been shown possible for SARS-2 in East- and South-East Asia. Europe and the USA have shown to be able to contain the highly contagious white plague over a century ago.
If we take concrete actions to aim for Zero-Covid, we would be able to minimize the impact of this epidemic, just as we did before.
