The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper

Abstract

One year after the declaration of the COVID-19 pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Non-pharmacological interventions (NPI) are efficient mitigation strategies. The success of these intense NPI is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current issues: The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against SARS-CoV-2 and its variants. The need of a second and even third generation of vaccines and the possibility of potentially harmful side-effects of the vaccines (i.e. venous thromboembolism ) have already been acknowledged. Perspectives: There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion: The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organization (i.e. telemedicine, artificial intelligence and machine learning technology) is of major importance for the preservation of citizens’ health and life world-wide.

2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation

“…COVID‐19 vaccines are usually administered by intramuscular injection and are an important part of our pandemic response. 317 An opportunity to screen for AF amongst attendees for vaccination has been promoted. 318 In patients with AF treated with NOACs, it is advisable to follow the scheme for “minor risk” interventions, and therefore, it is not necessary to withhold any NOAC dosage before and after the injection procedure.…”

Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US

“…Our case illustrates that clinicians should not rely on rapid anti-PF4 testing and that management should be based on the combination of hematological (thrombocytopenia) and clinical parameters in the context of recent adenovirus-vector-based COVID-19 vaccination. Rapid functional assays such as HIMEA must be carried out by an expert center quickly (in less than 24 h) [ 17 ].…”

Vaccine-Induced Thrombotic Thrombocytopenia: Insights from Blood Smear

“…In addition to vaccination, early diagnosis of patients at risk of disease worsening or complication thereof and anticipating medical care is an important part for the management of the COVID-19 pandemic. 2 The consensus remains that the benefits of vaccination outweigh the risks. To reduce vaccine hesitancy, a tracking algorithm for vaccinated patients based on a 10-point guideline has been proposed, 3 including anti-PF4 antibody testing and confirmation by PIPA testing.…”