The number of covid-19 deaths worldwide has exceeded 1 million. Perhaps another million has not been registered. Since the beginning of the pandemic, 9 months ago, the weekly cases registered by the World Health Organization (WHO) have shown a very slow tendency of increase and, in the 7 days until September 20, they exceeded 2 million for the first time.
The virus is destroying regions in the emerging world. India records more than 90,000 cases per day. Some European countries that thought they had eliminated the disease are facing a second wave. In the United States, the official death toll has exceeded 200,000 and the total number of cases has increased in 26 states.
These numbers represent a lot of suffering. Approximately 1% of survivors have long-term viral damage, such as disabling fatigue and scarring of the lungs. In developing countries, especially, mourning is compounded by poverty and hunger. Winter in the northern hemisphere will force people to stay indoors, where the disease spreads more easily than outdoors. Seasonal flu can increase the burden on health systems.
In the dark, keep three things in mind. The statistics contain both good and bad news. Treatments and drugs are making covid-19 less lethal: new vaccines and drugs will soon increase their effects. And societies have the tools to control the disease today. Still, it is in the basics of public health that many governments are still failing their citizens. Covid-19 will remain a threat for months, possibly years. They have to do more.
The increase in diagnosed cases in Europe reflects reality. Our model suggests that the total number of real infections has decreased substantially from its peak of 5 million a day in May. More tests are one of the reasons why the disease’s death rate appears to be falling. In addition, countries like India, with an average age of 28, suffer fewer deaths because the virus is milder in young people than in the elderly.
The drop in fatalities also reflects medical progress. Health professionals now understand that organs other than the lungs, such as the heart and kidneys, are at risk and treat symptoms early. In British ICUs, 90% of patients used ventilators at the beginning of the pandemic. In June, it was only 30%. Medicines, including dexamethasone, a cheap steroid, reduce deaths in critically ill patients by about 20% to 30%. The number of deaths in Europe is 90% lower than in the spring, although that gap narrows as the disease spreads again in vulnerable groups.
Further progress is expected. Monoclonal antibodies, which weaken the virus, may be available by the end of the year. Vaccines will certainly appear, possibly very soon. Since different drugs use different lines of attack, the benefits can be cumulative.
However, in the best of all possible worlds, the pandemic will continue to be part of everyday life until 2021. Even if a vaccine emerges, no one expects it to be 100% effective. Protection may be temporary or weak in the elderly, whose immune systems are less responsive. Producing and administering billions of doses will take much of next year.
The first vaccines may need two doses and complex “cold chains” to stay cool. Medical supplies may be insufficient. Research from several countries suggests that a quarter of adults (including half of Russians) would refuse vaccination – another reason why the disease may persist.
Therefore, for the near future, the first line of defense against covid-19 will continue to be testing and tracking, social detachment and clear government communication. There is no mystery as to what this involves. Even so, countries like the United States, the United Kingdom, Israel and Spain continue to get this disastrously wrong.
One problem is the desire to escape a balance between shutting everything down and keeping people alive and keeping everything open for life to continue. The right praises Sweden for allegedly allowing the virus to spread while giving priority to the economy and freedom. But Sweden has a death rate of 58.1 per 100,000 and saw its GDP drop by 8.3% in the second quarter alone, worse in both cases than Denmark, Finland and Norway. The left applauds New Zealand, which closed everything to save lives. The country suffered just 0.5 deaths per 100,000, but in the second quarter, its economy shrank by 12.2%. In contrast, Taiwan remained more open, but had 0.03 deaths per 100,000 and a 1.4% drop in GDP.
The total blockades, like the most recent in Israel, are a sign that the policy has failed. They are expensive and unsustainable. Countries such as Germany, South Korea and Taiwan have used testing and screening to detect individual over-propagation sites and delay new infections using quarantines. Germany has identified slaughterhouses. South Korea contained outbreaks in a bar and churches. If testing is slow, as in France, it will fail. If contact tracking is unreliable, as in Israel, where the work fell on intelligence services, people will evade detection.
Governments must identify the combination that makes the most economic and social sense. Masks are inexpensive, convenient and work. Opening schools, as in Denmark and Germany, should be a priority. As for noisy and uninhabited places like bars, no. Governments, such as the United Kingdom, that bark a series of orders that are broken with impunity by their own officials will have low efficiency.
When covid-19 emerged, governments were taken by surprise and pulled the handbrake. Today they don’t have that excuse. In the rush to normalcy, Spain let its guard down. Testing in Britain is not working, although cases have increased since July. The US Center for Disease Control and Prevention, once the most respected public health agency in the world, has been plagued by errors, weak leadership and presidential defamation. Israel’s leaders were victims of arrogance and infighting. The pandemic is far from over. It will decrease, but governments need to compose themselves. / TRANSLATION OF AUGUSTO CALIL
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