key: cord-0910252-9n8ic2ms
authors: Troya, Jesús; Seijo, Luis Miguel; Pérez, Mario; Sentchordi, Lucia; Martín, Álvaro
title: Improvisation in times of pandemic, a reason for reflection
date: 2020-05-16
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.05.038
sha: f0967ce1a0892492a6733603ae0198febdae3ee0
doc_id: 910252
cord_uid: 9n8ic2ms

nan

lessons that involve the whole spectrum of medical practice; human, scientific, technical, and social.

First of all, solidarity remains essential. In the human aspect of our practice, this pandemic has transformed the hospital routine. In countries such as Spain, the health care system has undergone a complete transformation of its organizational structure in a matter of weeks, to provide urgent care for COVID- Another lesson of this pandemic is that, from a scientific standpoint, not everything goes. The medical practice must always be grounded in the scientific method and respect the Hippocratic principle of "primum non nocere". Clinicians have been faced with resorting to treatments with little or no scientific evidence to back them up, often basing therapeutic decisions on "in vitro" studies or on small case series. For example, we have used lopinavir/ritonavir based on "in-vitro" studies with SARS [1], or we have generalized the use of hydroxychloroquine and azithromycin based on 6 patients in an uncontrolled study [2] . Follow up studies have failed to identify a clear benefit of these drugs [3, 4] or revealed toxicity. The urgency of the pandemic has prompted a weakening of robust J o u r n a l P r e -p r o o f publication criteria and peer review standards, leading to the publication of articles of questionable scientific and methodological value. Consequently, some scientific societies such as the European AIDS Clinical Society [5] or the Infectious Diseases Society of America [6] , have recently insisted on the need to circumscribe the use of untested drugs for SARS-CoV-2 in the context of clinical trials. When this health crisis is over, we must reflect on the need to achieve a balance between clinical urgency and due scientific process.

From a technical standpoint, we were prepared, yes, but not adequately enough.

The unparalleled abruptness of the pandemic has overwhelmed public health and epidemiology experts, saturating health care systems at all levels, including primary care, hospitalization, and intensive care units. It has rendered them incapable of providing adequate and proportionate care, including the lack of intensive care beds.

Finally, as a consequence of globalization, we should have reacted sooner.

Many countries have allowed COVID-19 to take hold in their territories without heeding the warnings from neighboring countries despite evidence in favor of some strategies to stop the spread of infection. Public health agencies in many countries have reacted slowly, working as an independent unit, often skeptical of the preventive measures implemented in countries such as China and Korea [7] .

Perhaps, the focus was more centered on boasting the strengths of the classical system of detection and containment of diseases than in assuming a new more global epidemiological reality.

This pandemic has revealed the vulnerability of our health care systems to the appearance of new infectious agents. We have to be prepared for the future with robust but flexible healthcare systems, providing timely scientific evidence safely, and always true to the scientific method. Only then will we be prepared for a new outbreak, because, as is often said in our country, "rush is not a good counselor".

☒ All the authors (Jesús Troya, Luis Miguel Seijo, Mario Pérez, Lucia Sentchordi, Álvaro Martín) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compounds

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19

No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection

EACS & BHIVA Statement on risk of COVID-19 for people living with HIV

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19 Infection

Estimating the reproductive number and the outbreak size of COVID-19 in Korea