"When My Information Changes, I Alter My Conclusions." What Can We Learn From the Failures to Adaptively Respond to the SARS-CoV-2 Pandemic and the Under Preparedness of Health Systems to Manage COVID-19?

Playing vaccine roulette: Why the current strategy of staking everything on Covid-19 vaccines is a high-stakes wager

“…), without appropriately targeting vulnerable populations, without taking sufficient account of the harms of restrictions imposed while waiting for vaccines to be delivered [35] , [36] , [37] , and without taking account of long-proven public health and health promotion experience [38] . In particular, Covid-19 response has focused on virus control, paying insufficient attention to other factors such as social determinants, age, co-morbidities, and previous exposure to a certain range of infections [39] , which play a determining role in explaining the ‘transition’ from SARS-CoV-2 infection to severe forms of Covid-19 [40] . In terms of hedging one’s bet, overextending a single wager within a complex problem like Covid-19 undermines efficiency [41] .…”

COVID-19: an ‘extraterrestrial’ disease?

“…In terms of policy landscape, public health policies need to be decided and designed in a transparent way, in collaboration with all relevant disciplines and stakeholders including populations, social and healthcare workers, and regularly evaluated to ensure continuous adaptation and improvement (Paul et al, 2020a).Moreover, there needs to be a normative shift in how we think about prevention and preparedness, particularly a mindset that understands long-term preventative health as an investment, not an expense. Lastly, it is crucial to move beyond current understandings of health security, which has traditionally favoured surveillance, exceptionalism, ‗countermeasures' and an overreliance on vaccine discovery, often at the expense of routine health.…”

“…This led to the further exacerbation of existing disparities in health systems and services, especially in low-and middle-income countries (Baral, 2021). Despite the fact that Covid-19 could be categorised a ‗syndemic' (Horton, 2020) -a synergy of epidemics that ‗co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers' (Swinburn et al, 2019) control measures were exclusively focused on -the virus‖ and delay tactics, not taking into account other biological and social factors that contribute to determining severe forms of the disease (Paul et al, 2020a). After several inconclusive results, it is only in July 2020 that one of the two large international randomised control trials aimed at testing the efficacy of existing treatments against Covid-19 published a preliminary report showing that dexamethasone (a glucocorticoid) resulted, on average, in lower mortality rates in patients requiring supplemental oxygen or invasive mechanical ventilation (The RECOVERY Collaborative Group, 2020).…”

“…Although it is understandable that Covid-19 was considered a form of ‗exceptionalism' in early 2020, which justified exceptional response measuresparticularly since SARS-CoV-2 can trigger a variety of symptoms, some of them extremely severe (Hu et al, 2020;Wiersinga et al, 2020) the situation has changed. So should our response (Paul et al, 2020a). In this piece, we argue that now that we far better understand the complex functioning of Covid-19, we should adapt our response strategy in a way that responds to its heterogeneity, and embraces proven, traditional medical and public health practices.…”

Key success factors of Mauritius in the fight against COVID-19

“…6 Countries around the world have experienced very different epidemic profiles, with contextual factors, including social and environmental factors, playing an important role in shaping the outcomes 7 -hence the importance of shaping response policies to local contexts 8 and of adapting policies and interventions in light of emerging knowledge (evidence-based policy-making), engaging in transparent dialogues with stakeholders and developing appropriate communication strategies that build public trust and support. 9 The purpose of this article is to analyse the success factors of Mauritius that could inspire other countries-if properly adapted to their context-in future outbreaks.…”