How politics threaten an adequate approach of SARS: the topic of prevention and containment of zoonotic pandemics has no political-economic priority (1999 -...)
Since 1999, scientists worldwide have been actively engaged in developing a SARS script. In 2004, the Institute of Medicine Forum on Microbial Threats published a comprehensive summary of the SARS script under the title "Learning from SARS: Preparing for the Next Disease Outbreak" (link: read the book for free through NCBI).
The script is clear and concise: the SARS coronavirus outbreak and the following 2003 epidemic were over and a return was not imminent, but a new corona epidemic would emerge if governments would not adjust their policies to an adequate response to global health threats. The first major threat was the lifting of the ban on the wholesale of wild, coronavirus-infected animals in China in the aftermath of the SARS epidemic. Globalization is a foremost factor in the international spread of coronaviruses following outbreaks from the Southern regions of China.
In 2009, the "Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases" script highlighted the importance of strenghtening global surveillance and monitoring of threats and zoonotic diseases, including coronaviruses. As a threat to international health, the political-economic reluctance to invest in adequate surveillance and an adequate approach to emerging zoonotic pandemics has been mentioned. Conflicting political interests so far stand in the way of combating and limiting the spread of zoonotic viruses, including SARS-CoV (Political: Governance of Global Efforts to Improve Surveillance and Response Capabilities, Chapter 8: Recommendations, Challenges and looking to the Future, in: "Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases", National Research Council, 2009, read via NCBI). It is the cutbacks that have caused governments to fail to implement an adequate approach to SARS-CoV-2 (2019-2020).
The situation in 2020: government action fails again after 20 years of SARS experience
The WHO calls on all European countries to take the most drastic measures. "Every country without exception must take the most drastic measures to stop or slow down the threat," said regional director Hans Kluge on March 17, 2020. The Netherlands has not yet taken any drastic measures, because the appearance of a 'lockdown' should be avoided at all costs. It has not been a week and a half since social distancing was recommended and people are already fed up with all of this 'strictness', when there have not been imposed strict measures. From the beginning, from the imported cases of SARS, the government should have proceeded to active testing, extensive contact tracing and isolation. The faster a government imposes measures, the sooner results can be achieved.
Why is testing so important?
Testing is crucial to deal with a pandemic. In fact, performing a sensitive RT-PCR in a timely manner is the most important method of determining whether measures should be taken to prevent spread and local transmission. Positive tested cases should be isolated immediately and contacts traced, tested and possibly insulated. Contact tracing is an absolute precondition for the containment of this pandemic (How much is coronavirus spreading under the radar?, Nature News Explainer, March 13, 2020). This can mean that hundreds of contacts must be monitored for at least 14 days.
According to detailed estimates, asymptomatic infections and cases involving mild complaints account for 60% of the total number of corona cases. Testing is necessary as this group continues to spread the virus (Covert coronavirus infections could be seeding new outbreaks, Nature News, March 20, 2020).
The importance of serological research: antibodies
The spread from the first SARS-CoV-2 cases in China, Wuhan, took place under the radar. In such a case, transmission routes cannot be directly mapped. At that point, serological research offers a solution: it is necessary to test on a large scale the number of people who carry antibodies against the coronavirus. Serological research is a step forward in achieving a still highly hypothetical "group immunity". For another reason, serological testing is needed: patients who are tested relatively late may show viral values too low to be detected by RT-(q)PCR/ real-time RT-PCR. Antibodies are observed from 10 days after onset, so serological research is preferred for this group (Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study, The Lancet Infectious Diseases, March 23, 2020).
On March 14, 2020, a pre-publication on MedRxiv announced that 2019 nCoV-infected rhesus macaques had developed antibodies to 2019 nCoV. After a second exposure to the coronavirus, no relapse or repeated infection has occurred. Population immunity is not achieved by exposing everyone; the importance of this pre-publication lies in the fact that the affected antibodies form the frame of reference for the vaccine to be developed (Reinfection could not occur in SARS-CoV-2 infected rhesus macaques, bioRxiv, March 14, 2020). The plasma of people who have survived COVID-19 can be used to prevent the admission of persons infected with coronavirus to the ICU. This requires permission from the national government (How blood from coronavirus survivors might save lives, Nature News, March 24, 2020).
Testing is the "backbone" in tackling this pandemic. Without tests and contact research, the pandemic worsens. It is not the capacity of the laboratories that is insufficient to perform adequate and extensive testing; it is a matter of political considerations that made the allocation of resources insufficient. It cannot be emphasized enough that testing and contact research are crucial methods to prevent further spread ('Scientists exposed to coronavirus wonder: why weren't we notified?', Nature News, March 20, 2020).
Since 1999, scientists worldwide have been actively engaged in developing a SARS script. In 2004, the Institute of Medicine Forum on Microbial Threats published a comprehensive summary of the SARS script under the title "Learning from SARS: Preparing for the Next Disease Outbreak" (link: read the book for free through NCBI).
The script is clear and concise: the SARS coronavirus outbreak and the following 2003 epidemic were over and a return was not imminent, but a new corona epidemic would emerge if governments would not adjust their policies to an adequate response to global health threats. The first major threat was the lifting of the ban on the wholesale of wild, coronavirus-infected animals in China in the aftermath of the SARS epidemic. Globalization is a foremost factor in the international spread of coronaviruses following outbreaks from the Southern regions of China.
In 2009, the "Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases" script highlighted the importance of strenghtening global surveillance and monitoring of threats and zoonotic diseases, including coronaviruses. As a threat to international health, the political-economic reluctance to invest in adequate surveillance and an adequate approach to emerging zoonotic pandemics has been mentioned. Conflicting political interests so far stand in the way of combating and limiting the spread of zoonotic viruses, including SARS-CoV (Political: Governance of Global Efforts to Improve Surveillance and Response Capabilities, Chapter 8: Recommendations, Challenges and looking to the Future, in: "Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases", National Research Council, 2009, read via NCBI). It is the cutbacks that have caused governments to fail to implement an adequate approach to SARS-CoV-2 (2019-2020).
The situation in 2020: government action fails again after 20 years of SARS experience
The WHO calls on all European countries to take the most drastic measures. "Every country without exception must take the most drastic measures to stop or slow down the threat," said regional director Hans Kluge on March 17, 2020. The Netherlands has not yet taken any drastic measures, because the appearance of a 'lockdown' should be avoided at all costs. It has not been a week and a half since social distancing was recommended and people are already fed up with all of this 'strictness', when there have not been imposed strict measures. From the beginning, from the imported cases of SARS, the government should have proceeded to active testing, extensive contact tracing and isolation. The faster a government imposes measures, the sooner results can be achieved.
Why is testing so important?
Testing is crucial to deal with a pandemic. In fact, performing a sensitive RT-PCR in a timely manner is the most important method of determining whether measures should be taken to prevent spread and local transmission. Positive tested cases should be isolated immediately and contacts traced, tested and possibly insulated. Contact tracing is an absolute precondition for the containment of this pandemic (How much is coronavirus spreading under the radar?, Nature News Explainer, March 13, 2020). This can mean that hundreds of contacts must be monitored for at least 14 days.
According to detailed estimates, asymptomatic infections and cases involving mild complaints account for 60% of the total number of corona cases. Testing is necessary as this group continues to spread the virus (Covert coronavirus infections could be seeding new outbreaks, Nature News, March 20, 2020).
The importance of serological research: antibodies
The spread from the first SARS-CoV-2 cases in China, Wuhan, took place under the radar. In such a case, transmission routes cannot be directly mapped. At that point, serological research offers a solution: it is necessary to test on a large scale the number of people who carry antibodies against the coronavirus. Serological research is a step forward in achieving a still highly hypothetical "group immunity". For another reason, serological testing is needed: patients who are tested relatively late may show viral values too low to be detected by RT-(q)PCR/ real-time RT-PCR. Antibodies are observed from 10 days after onset, so serological research is preferred for this group (Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study, The Lancet Infectious Diseases, March 23, 2020).
On March 14, 2020, a pre-publication on MedRxiv announced that 2019 nCoV-infected rhesus macaques had developed antibodies to 2019 nCoV. After a second exposure to the coronavirus, no relapse or repeated infection has occurred. Population immunity is not achieved by exposing everyone; the importance of this pre-publication lies in the fact that the affected antibodies form the frame of reference for the vaccine to be developed (Reinfection could not occur in SARS-CoV-2 infected rhesus macaques, bioRxiv, March 14, 2020). The plasma of people who have survived COVID-19 can be used to prevent the admission of persons infected with coronavirus to the ICU. This requires permission from the national government (How blood from coronavirus survivors might save lives, Nature News, March 24, 2020).
Testing is the "backbone" in tackling this pandemic. Without tests and contact research, the pandemic worsens. It is not the capacity of the laboratories that is insufficient to perform adequate and extensive testing; it is a matter of political considerations that made the allocation of resources insufficient. It cannot be emphasized enough that testing and contact research are crucial methods to prevent further spread ('Scientists exposed to coronavirus wonder: why weren't we notified?', Nature News, March 20, 2020).
