COVID-19: The Waterloo of governments, healthcare systems, and large health organizations

Abstract

The Waterloo of governments, healthcare systems, and large health organizations To the editor In our humble opinion, the current corona-virus disease 2019 (COVID-19) crisis presents the modern Waterloo of western authorities at multiple levels, both at the administrative, the scientific, and the social level. The aim of this letter to the editor is not to engage into a blame game; it is to highlight several black boxes in order to be avoided by rather unaffected countries or during the case of a second wave of the disease.The COVID-19 crisis started in China at the end of December and peaked in February. During this two-month period, both European and North American authorities severely underestimated the danger involved in this new respiratory virus. For example, in the words of President Donald Trump: "Because of all we've done, the risk to the American people remains very low. When you have 15 people, and the 15 within a couple of days is going to be down to close to zero. That's a pretty good job we've done." (February 2020). This attitude towards the invisible threat of corona-virus resulted in the lack of or the delay in taking precaution measures, applying traveling restrictions, and acquiring necessary supplies.Another type of governmental strategy towards the pandemic was the adoption of "herd immunity", mainly by the UK, the Netherlands, and Sweden [1]. These countries did not take restrictive measures, at least initially, to reduce the financial consequences from the restriction measures based on the assumption that after a short time more than 50-70% of inhabitants will be infected, thus providing a protective immunity shield to the whole society. This assumption carries two fundamental drawbacks: a) confronts the value of human life with the financial cost, b) neglects that many elderly individuals are at high risk, cannot be isolated, and are dependent by younger individuals (who may be asymptomatic carriers).Even however in countries which adopted restrictive measures very early (like my home country, Greece), many holes remained uncovered. For example churches remained open for 10-15 days after large gatherings were restricted, and while direct flights from Italy, Spain, and UK were forbidden, passengers from UK and elsewhere could come to Greece through other countries. Therefore, although Greece has to be applauded for the early implementation of restriction measures, it is a pity that small holes may blur the whole picture.The rapid spread of the corona-virus and the unprecedented number of deaths so far proved that the healthcare systems were not ready for this pandemic. The number of intensive care units (ICU) beds was not adequate or even close to cope for the needs created by the pandemic (Fig. 1). Therefore, physicians in Italy and Spain had to improvise and take advantage of every possible inch to increase the number of ICU and "pseudo-ICU" beds.Likewise, a significant shortage of respirators has been observed in countries heavily affected by the pandemic, which seems to be ex-

SARS-CoV-2 seroprevalence in the Vatican City State

“…The ongoing Coronavirus Disease 19 (COVID-19) pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has affected so far 218 countries with over 94 million cases, about 2 million deaths and over 67 million recovered ( 1 ), with dramatic effects on communities and healthcare systems ( 2 ). The beginning of mass vaccination campaigns in late 2020 in the USA and the UK, and from early 2021 in other countries, will help controlling the infection spread and limiting its consequences, also providing indirect protection to non-vaccinated individuals through the mechanism of “herd immunity” ( 3 , 4 , 5 ).…”

Mental Health Status of Healthcare Workers During the COVID-19 Outbreak

“…It seems that Chinese HCWs reported worse mental health being the first to suddenly be faced with an unknown and highly contagious virus. Healthcare systems and HCWs had to struggle with the rapid spread of the Coronavirus and the unprecedented number of deaths, also within healthcare systems that appear not to have been prepared for this pandemic (Doumas et al, 2020). The rapid increase of infected patients and the uncertainty of transmission in the early stage of the outbreak increased the enormous workload and psychological burden of medical workers (Q.…”

Emergency Medical Services Calls Analysis for Trend Prediction during Epidemic Outbreaks: Interrupted Time Series Analysis on 2020–2021 COVID-19 Epidemic in Lazio, Italy

“…It has been observed that EMS calls forecast the ICU admission trend more than the actual number of people tested positive; given the mentioned considerations, this does not come as a surprise. Actually, it should be considered as a point of interest in this research, since COVID clinical presentation has been switching in the past few months, and the main focus (from a public health perspective) is still on its impact on health structures and systems, whose resilience has been heavily tested in the last two years [37,38]. A growing amount of positive, yet asymptomatic or mildly symptomatic cases, is of little interest when compared to the warnings of a possible imminent surge in ICU demand: in such scenarios, EMS calls analysis, alone or in combination with other indicators, can be useful in health programming on a short-time period, and on a local level.…”