Covid-19 Editorial
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BULLETIN of the NETHERLANDS SOCIETY for TROPICAL MEDICINE and INTERNATIONAL HEALTH N O 0 2 / AUGUST 2 0 2 0 - V O LUME 5 8 COVID-19 EDITORIAL COVID-19: CONTENT CONTRADICTIONS, EDITORIAL - 2 CONFUSION, AND REVIEW COMPLEXITY Management of Covid-19 - 4 It is mid-July 2020. Some A novel virus, a recurring countries are experiencing threat: looking at past the peak of the Covid-19 pandemic threats to understand pandemic, while others have how SARS-CoV-2 has evaded loosened their lockdown global control efforts - 7 With pleasure we measures, anticipating a continued slowdown of In the shadow of the announce our renewed the epidemic. Meanwhile coronavirus: a global rise media pages: scientists around the of infectious diseases due world are working on the to Covid-19 containment linkedin.com/company/mtbulletin development of an effective measures - 13 vaccine. facebook.com/BulletinoftheNVTG PERSONAL REFLECTIONS FROM CONTRADICTIONS THE FIELD - 9 In Japan, the management of a sea Covid-19 in context - 9 aquarium invites visitors to video chat How Ebola prepared us to fight with their 300 sea eels and wave at them Covid-19 in the DRC - 9 Corona free country? - 10 as they showed signs of stress because The heritage of a highly lethal virus of the absence of the public in the outbreak - 11 past months. Hundreds of thousands Suddenly working in the intensive care of mainly female garment workers unit - 12 YOUare invited to visit these in Bangladesh ignore the nationwide INTERVIEW lockdown in order to earn back some of Moria, 20,000 refugees waiting pages for additional the income loss they experienced over for a disaster to happen - 15 articles, blogs, and other the past months. More than 49 million posts on topical issues in women are lacking contraceptives, a OPINION global health and tropical situation which according to the WHO Covid-19 and the Trojan horse is likely to result in a baby boom. Donald that eroded the World Health medicine. Also, on these Trump asks scientists to research the Organization - 17 pages you can access effect of injecting disinfects into a per- previous editions of MTb son in order to fight the virus. While the Pooling of knowledge, and International Health Italian government still provided food know-how and intellectual rations for the needy, shrewd business- property to counteract vaccine Alerts. men developed protective plastic shields nationalism - 22 for the sunbeds – in anticipation of the tourists that would come as soon as RESEARCH lockdown restrictions in Italy were to Outbreak of Covid-19 like be released. State prisons in California illness in a remote village in are releasing 3,500 inmates to protect Papua, Indonesia - 19 them from potential exposure to the virus as a result of the conditions in BOOK REVIEW the prisons. Research from Stanford Epidemics and pandemics - 21 University shows that, in a country were some 1.6 million people die each year A constant state of emergency: of respiratory diseases, the improved Paul de Kruif, microbe hunter air quality has saved the lives of more and health activist - 23 than 1,400 children under age 5, and 51,700 adults above 70 years of age. Meanwhile the virus has spread to 188 countries, with more than 13,876,441 2 MT BULLETIN OF NVTG 2020 AUGUST 02 EDITORIAL confirmed cases of Covid-19 (7.3 million of the USA the situation is spinning in the Americas), including 593,087 out of control, and African countries deaths reported to the WHO.[1,2] are experiencing an early state of the epidemic. Europe seems to be some- CONFUSION where in between.[6] It feels like we are at In the absence of a vaccine we have wit- a crossroads, and much will depend on nessed a wave of containment measures, the choices that we the public, our gov- roughly ranging from total lockdown ernments, and world leaders are mak- to the so-called intelligent lockdown ing - choices that will have an impact (relying on the idea of group or herd on societies at large, impacting on all immunity and a sense of responsibility aspects of life. The Covid-19 crisis is on the part of the population) intro- testing our capa city to deal with the soci- duced in the Netherlands. The Dutch etal consequences of pandemics and to were accused of lacking solidarity with balance economic interests without los- neighbouring countries’ approaches - an ing sight of the (health) risks involved. interesting observation, given the overall lack of solidarity and coordination at With this edition of MTb, we intend to European (and global) levels.[3] With challenge these three Cs in a construc- this approach, the Dutch government tive manner with articles shedding wanted to ‘cushion the social, economic light on the clinical management of and psychological costs of social isola- the disease, Covid-19 against a his- tion and make the eventual return to torical perspective of epidemics, field normality more manageable’.[4] And experiences in LMICs, the effect of while social distancing in high-income the pandemic on the refugee crisis countries may have saved lives, the in Greece, the role of the WHO, and question is at what cost? Low-income efforts to counteract vaccine national- countries are anticipating counterpro- isms. We look forward to your reflec- ductive effects, including a potential tions and invite you to react using rise in other (infectious) diseases and one of our (social) media channels. rising morbidity and mortality figures caused by other diseases, as well as a Esther Jurgens, Ed Zijlstra devastating effect on fragile economies and informal sector workers. Adding to the confusion are the many variations in tracking and reporting approaches and misleading or missing data. Reflecting REFERENCES on the past months challenges us to 1. World Health Organization [Internet]. Geneva: World Health Organization. WHO coronavirus decide on a “new” normal. Can we disease (COVID-19): dashboard; [updated 2020 push a “reset” button, thereby building Jul 21]. Available from: https://covid19.who.int 2. Contradictions collated in the magazine 360 (2020 on some of the (positive) lessons – for Jul 9-Aug 20;183), based on experiences from correspondents of the Swiss magazine Reportagen. example working from home and reduc- 3. Deen B, Kruijver, K. Coronavirus: EU’s existential ing our ecological footprint by (r)evolu- crisis: why the lack of solidarity threatens not only the Union’s health and economy, but also [5] tionizing international conferences. it’s security [Internet]. The Hague: Clingendael Institute; 2020 Apr. 5 p. Available from: https:// www.clingendael.org/sites/default/files/2020-04/ COMPLEXITY Alert_Corona_Existential_Crisis_April_2020.pdf 4. Holligan A. Coronavirus: why Dutch lockdown Currently it still feels like a global Catch- may be a high-risk strategy. BBC News [Internet]. 2020 Apr 5. Available from: https://www. 22. Without a concrete prospect of a vac- bbc.com/news/world-europe-52135814 cine or treatment, the virus will hold the 5. Bousema T, Yakar D, et al. Opinie: wetenschappers, het is niet van deze tijd de wereld over te vliegen voor ieder world in its grip for months and possibly congres. De Volkskrant [Internet]. 2020 Jul 1. Available from: https://www.volkskrant.nl/columns-opinie/ years to come. While some countries opinie-wetenschappers-het-is-niet-van-deze-tijd-de- seem to have succeeded in containing wereld-over-te-vliegen-voor-ieder-congres~b4ed69ab/? referer=https%3A%2F%2Fwww.radboudumc.nl%2F Covid-19 (China, Taiwan, Vietnam), 6. The new normal: Covid-19 is here to stay: the world is working out how to live with it. The Economist others are experiencing a peak in infec- [Internet]. 2020 Jul 4. Available from: https://www. tions (countries in Latin America and economist.com/international/2020/07/04/covid-19-is- here-to-stay-the-world-is-working-out-how-to-live-with-it South Asia). Meanwhile, in some part AUGUST 02 2020 MT BULLETIN OF NVTG 3 REVIEW Management of Covid-19 The Covid-19 (corona virus di sease, SARS-CoV-1. The virus enters the body RISK FACTORS AND DIAGNOSIS detected in 2019) pandemic is through person-to-person airborne Risk factors for a severe course of the keeping a firm grip on the world transmission. There is no proven animal disease are co-morbidities such as and affects the health of those reservoir; in the Netherlands, the infec- chronic heart disease, diabetes mellitus, ill with Covid-19 as well as those tion was detected in mink farms but was underlying respiratory conditions such with other illnesses; it overbur- thought to originate from humans. The as COPD and asthma, malignancy and dens health services and causes virus is spread in crowded conditions obesity. In addition, the risk for severe delays in diagnosis and treatment and mass gatherings: the celebration of disease increases with advanced age of other conditions. While there is carnival (province of North Brabant, the >60 years. In contrast, young children universal fear of infection, this is Netherlands), winter ski holidays (North are usually asymptomatic. The diag- especially evident among service Italy, Austria) and (international) foot- nosis is made by demonstrating the providers and people accessing ball matches like the Champions League virus via PCR in a nasal and/or throat health facilities. Population-based match between Atalanta Bergamo vs swab. Serological tests for IgM and IgG screening programmes to detect Valencia on February 19 with 40,000 antibodies are currently continually breast, cervix and colon cancer have Italian and Spanish supporters (with being improved in terms of sensitivity been suspended; the waiting lists subsequent outbreaks in Italy and and specificity; these tests only indi- for elective surgical procedures are Spain) are thought to have contribu- cate past exposure and are not suitable becoming longer.