key: cord-031100-ih1ci5cl authors: Overby, Madison; Pu, Qinqin; Wei, Xiawei; Wu, Min title: Calling for a United Action to defeat COVID-19 date: 2020-08-06 journal: Precis Clin Med DOI: 10.1093/pcmedi/pbaa027 sha: doc_id: 31100 cord_uid: ih1ci5cl The widespread and lingering pandemic of COVID-19 is partly due to disjointed international countermeasures and policies enforced by different countries. And we have been witnessing disparity in policies and measures in different countries or regions, some in much better control. To effectively deal with this and future devastating pandemics, we as human beings must work together to coordinate a concerted, cooperative international policy to reduce or possibly avoid unnecessary health crisis, life and economic losses. portion of the international communities with irrational approaches to make the job much more difficult in curbing this disease and future pandemics. Here, we attempt to discuss the lack of collaborations and how we can work in parallel internationally to avoid further devastating damages and contain the pandemic as soon as possible. Policy changes implemented by central governments have been the single most effective way of controlling the spread thus far. "Flattening the curve" has become a household term, which emphasizes the effect of staying home and preventing mass spread of COVID-19 to decrease both infection rates and mortality rates. China was one example especially in Asian countries that was able to lower transmission rates to near zero in the early months. They did this by enforcing the strictest isolation strategy: the suppression strategy 2 . "Traffic control, limitation of travel, extension of the Chinese New Year vacations, delay of returning to work, rigorous management of communities and even the wartime management have ensured that the susceptible population stay home" 3, 4 . More countries are going to need to look towards the strict governmental action of China in order to get the virus under control sooner rather than later and prevent the potential "second wave and even multiple waves". The suppression strategy adopted by China and other Asian countries such as South Korea, Japan, Singapore, etc. is in contrast to the mitigation strategy which is most commonly executed in the western nations. The goal of the mitigation strategy is to slow the spread of the disease and mitigate the effects of the virus on the healthcare system as well as the social perception of the epidemic whereas the suppression strategy aims to reduce the transmission rate (R 0 ) to less than one which essentially reverses the epidemic 2 . Policy implementations thus far are the only way all people will stay home and commit to social distancing. This was also seen more recently in Spain, which was originally projected to have a similar outcome to the high mortalities of Italy 5 . Spain hit its peak in late-March to early-April (ECDC, 2020 November, particularly frequently seen in old populations, like COVID-19" 6 . This information has not been confirmed with other reports. However, had the Italian authority taken strong action earlier after seeing the first case at the end of January 2020, the situation would have not been such devastating. This suggests that the Italian nation may have suffered the problem without sufficient awareness before the disease progressed to almost uncontrollable. Policy changes are required to combat this type of pandemic. Policy changes and an increase in social distancing will also ensure that medical personnel and supplies are not exhausted. The key to a successful pandemic response is control of medical supplies. There needs to be an abundance of supply in reserves in the case of disease outbreak as well as sufficient allocation of emergency medical supplies 7 . The challenge for policy change is to make a unified and internationally coordinated effort to counteract an emerging pandemic, which is urgently lacking at the moment. Due to the currently disorganized actions, people have witnessed COVID-19 waves in multiple areas, countries and continents, which seems impossible to control in a timely manner and may result in continued and lingering recurrence. This is compounded by the mutations of the SARS-CoV-2 virus, which seems to be gaining strength during the spreading. As a typical example, the small spike in Beijing from June 11 -16, 2020 was possibly a reentry from Europe, appearing more lethal than the original Wuhan strains 9 infected with COVID-19 while working with these patients. In the Lombardy region of Italy, which was faced with extreme shortages of both medical supplies and workers, 20% of healthcare workers contracted COVID-19 during their attempt to diagnose and treat patients 6 . The situation in Lombardy got much worse before it got better, where medical personnel were being forced to distribute supplies based on personal discretion: deciding which patients were more likely to live or die with the assistance of medical support 6 . In contrast to the situation in Lombardy, a hospital in Belgium had a high availability of PPE, high standards of infection prevention, PCR screening for symptomatic staff, and focused intensely on contact tracing and quarantine 9 .The hospital in Belgium tested 3056 hospital employees and 197 people tested positive for IgG antibodies for SARS-CoV-2, which is approximately 6.4% 10 . Finally, testing needs to be rapid and accurate to slow the spread of the virus both now and in the future. The high amount of asymptomatic cases makes this absolutely necessary. In order to return to normal life, people will have to be tested regardless of whether they are experiencing symptoms or not, which at this moment in time is not possible 3 . Early diagnosis, isolation, and treatment would ensue. This strategy of testing a majority of the population has seen success in South Korea. As of February 26, 2020, the average reproductive rate in Korea was determined to be 1.5 1110 . As a result of early widespread testing and an extremely fast social distancing response put in place by the government in Korea, the basic reproductive rate was able to be kept to less than half of the international average. This very clearly shows the importance of a fast and thorough response in the eye of a pandemic storm. We know that during the current time international collaboration is a great trend and may be the only path to develop effective drugs and vaccines to conquer the pandemic. It is a positive response from some of pharmaceutic and philanthropic entities to bring together the dollars and workforces to more quickly discover and validate effective therapeutics or prevention measures. sources and has shown promise in its short three-year history. Humanity will continue to foster this type of organization with more government involvement to expand efforts and funding levels. We believe that there will be bright future in front of us for vaccines and drug research. In summary, we have discussed the strategies and countermeasures from global levels to combat the insurmountable, devastating, lingering COVID-19 pandemic. The single most important factor is the policy changes, which may be evolved with time, but should be based on solid and up to date scientific evidence, other nations' successful examples, and experts' opinions from international communities rather than individual leadership preference, cultural variation and political opinion. Second, social distancing is widely applied internationally as a moderate means to curb the disease spread but requires high levels of individual cooperation. As the complete lockdown is highly effective to rapidly stop spreading it may be taken into Modeling the control of COVID-19: Impact of policy interventions and meteorological factors Effectiveness of the measures to flatten the epidemic curve of COVID-19. The case of Spain Impact of climate and public health interventions on the COVID-19 pandemic: a prospective cohort study International Public Health Responses to COVID-19 Outbreak: A Rapid Review COVID-19 and Italy: what next? Challenges to the system of reserve medical supplies for public health emergencies: reflections on the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in China Inter-hospital communication and transfer practices during COVID-19 Pandemic in Karachi, Pakistan. A brief overview Should the World Be Worried About the 'Explosive' New Outbreak of Coronavirus in Beijing? Time Hospital-Wide SARS-CoV-2 Antibody Screening in 3056 Staff in a Transmission potential and severity of COVID-19 in South Korea Covid-19: Oxford team begins vaccine trials in Brazil and South Africa to determine efficacy Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial An mRNA Vaccine against SARS-CoV-2 -Preliminary Report Remdesivir for 5 or 10 Days in Patients with Severe Covid-19 The authors acknowledge the National Institutes of Health for Grants R01 AI138203, R01 AI109317-01A1, and P20 GM113123. The authors declare no conflicts of interest. MO and MW wrote the manuscript, QP, XW made comments. QP, MO, XW and MW revised the manuscript.