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This post is based on a July 28, 2022 article and the WHO living guidelines. The links appear at the end.
Epidemic is when a disease is temporarily present in a locality, spreading from person to person, but restricted to the locality.
Pandemic is when a disease is prevalent in a country, continent, or the whole world.
Endemic is when a disease is persisting in a population or region, generally having settled to a relatively constant rate of occurrence.
COVID19 has entered the endemic stage in many countries, including United States and Europe. The cases are being regularly reported in many countries, in Pakistan also. The occurrence is on the rise, but the severity is less because the BA.5 variant is not causing severe, fatal levels of disease. The public and governments, therefore, are more relaxed, and are not thinking of putting up or facing restrictions. Contradictions also exist; New Zealand dropped all restrictions today which were there since March 2020, but China is observing zero-COVID policy, and Wuhan was put under lockdown after four cases were reported there. In the developed countries, the greater focus is on managing endemic disease.
The previous memory of disease pattern in a country also plays an important role in defining the public response. Pakistan saw huge number of cases, and many deaths, but we have a habit of taking life as it comes.
Building immunity in large communities has also shaped up the current pattern of COVID19 resurgence and spread. It might not have decreased the incidence significantly, but it certainly reduced the severity, morbidity, and mortality.
Coming winter is expected to cause a substantial increase in the number of cases, but it is unlikely to be as severe as the December 2021 – February 2022 wave. Subvariants of Omicron, especially BA.5, have challenged the world with highly transmissible versions of virus. There is also some initial evidence that BA.4 and BA.5 may have the ability to evade existing immunity, but the scientists still believe that the current, wide distribution of vaccines shall limit the overall damage.
Public health authorities in most countries are recommending a fourth dose for high-risk populations, however, strategies for timing of rollout of booster shots are still under consideration. Problem with boosters is that the public is not motivated to take another booster. At the same time, the real benefit of additional booster is still not clear. Some are, therefore, debating to combine annual flu shots with COVID19 boosters. It is estimated that without boosters, the current level of immunity will keep declining. Omicron-specific boosters, especially against BA.4 and BA.5 are being investigated and may become available soon.
Among the ongoing developments, COVID19 vaccines have been approved for use in children as young as six months of age. Anti-vaccine camp considers this to a tactic for enlarging and prolonging the stream of profits, and a continuity of the agenda behind vaccination.
Another very important development is the availability of PAXLOVID®, the antiviral tablet granted emergency authorization by the USFDA after it showed efficacy in 1,000 adult patients. The pill has been developed by Pfizer, who had earlier taken lead in the mRNA-based vaccine. Europe also approved it in April 2022, and WHO is strongly recommending it. It has been claimed that Paxlovid helps curb hospitalization and death among high-risk patients by 90%. Experts, however, say there is still much to be learned about the drug.
About other therapeutics, the WHO Therapeutics and COVID19: living guideline contains the most up-to-date recommendations for the use of therapeutics in the treatment of COVID19. There are around nineteen compounds which have been subjected to various trials and WHO guidelines are based on their results. It is called living guideline because it is regularly updated as new information comes in. A snapshot is given below.
- For patients with severe or critical COVID19
- Strong Recommendation for systemic corticosteroids, Interleukin-6 receptor blockers – tocilizumab, sarilumab, or baricitinib
- Conditional recommendation for casirivimab-imdevimab
- For patients with non-severe COVID 9 at highest risk of hospitalization
- Conditional recommendations for molnupiravir, sotrovimab, casitivimab-imdevimab
- For patients with non-severe COVID19
- Conditional recommendation against systemic corticosteroids
- Strong recommendation against convalescent plasma
- For patients with severe and critical COVID19
- Recommendation against convalescent plasms
- Conditional recommendation against ruxolitinib and tofacitinib
- For patients regardless of COVID19 disease severity
- Strong recommendation against hydroxychloroquine and lopinavir/ritonavir
- Recommendation against ivermectin
People in Pakistan may recall that our patients consumed tons of hydroxychloroquine and ivermectin on their own or their physicians’ recommendations. We now need to understand better.
To be Continued……
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