Farsalinos Konstantinos, Poulas Konstantinos, Kouretas Dimitrios, Vantarakis Apostolos, Leotsinidis Michalis, Kouvelas Dimitrios, Docea Anca Oana, Kostoff Ronald, Gerotziafas Grigorios T, Antoniou Michael N, Polosa Riccardo, Barbouni Anastastia, Yiakoumaki Vassiliki, Giannouchos Theodoros V, Bagos Pantelis G, Lazopoulos George, Izotov Boris N, Tutelyan Victor A, Aschner Michael, Hartung Thomas, Wallace Heather M, Carvalho Félix, Domingo Jose L, Tsatsakis Aristides
Laboratory of Molecular Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece.
School of Public Health, University of West Attica, L Alexandras 196A, Athens, 11521, Greece.
Toxicol Rep. 2021;8:1-9. doi: 10.1016/j.toxrep.2020.12.001. Epub 2020 Dec 3.
COVID-19 pandemic mitigation strategies are mainly based on social distancing measures and healthcare system reinforcement. However, many countries in Europe and elsewhere implemented strict, horizontal lockdowns because of extensive viral spread in the community which challenges the capacity of the healthcare systems. However, strict lockdowns have various untintended adverse social, economic and health effects, which have yet to be fully elucidated, and have not been considered in models examining the effects of various mitigation measures. Unlike commonly suggested, the dilemma is not about health vs wealth because the economic devastation of long-lasting lockdowns will definitely have adverse health effects in the population. Furthermore, they cannot provide a lasting solution in pandemic containment, potentially resulting in a vicious cycle of consecutive lockdowns with in-between breaks. Hospital preparedness has been the main strategy used by governments. However, a major characteristic of the COVID-19 pandemic is the rapid viral transmission in populations with no immunity. Thus, even the best hospital system could not cope with the demand. Primary, community and home care are the only viable strategies that could achieve the goal of pandemic mitigation. We present the case example of Greece, a country which followed a strategy focused on hospital preparedness but failed to reinforce primary and community care. This, along with strategic mistakes in epidemiological surveillance, resulted in Greece implementing a second strict, horizontal lockdown and having one of the highest COVID-19 death rates in Europe during the second wave. We provide recommendations for measures that will reinstate primary and community care at the forefront in managing the current public health crisis by protecting hospitals from unnecessary admissions, providing primary and secondary prevention services in relation to COVID-19 and maintaining population health through treatment of non-COVID-19 conditions. This, together with more selective social distancing measures (instead of horizontal lockdowns), represents the only viable and realistic long-term strategy for COVID-19 pandemic mitigation.
新冠疫情缓解策略主要基于社交距离措施和医疗系统强化。然而，欧洲及其他地区的许多国家由于社区内病毒广泛传播对医疗系统能力构成挑战，实施了严格的全面封锁。然而，严格的封锁产生了各种意想不到的负面社会、经济和健康影响，这些影响尚未得到充分阐明，且在研究各种缓解措施效果的模型中也未被考虑。与通常所认为的不同，困境并非在于健康与财富之间的抉择，因为长期封锁造成的经济破坏肯定会对民众健康产生不利影响。此外，它们无法为疫情防控提供持久解决方案，可能导致连续封锁与中间间歇交替的恶性循环。医院准备一直是政府采用的主要策略。然而，新冠疫情的一个主要特征是在没有免疫力的人群中病毒快速传播。因此，即使是最好的医院系统也无法应对需求。初级、社区和家庭护理是能够实现疫情缓解目标的唯一可行策略。我们以希腊为例，该国遵循了侧重于医院准备的策略，但未能加强初级和社区护理。这一点，再加上流行病学监测中的战略失误，导致希腊实施了第二轮严格的全面封锁，并且在第二波疫情期间成为欧洲新冠死亡率最高的国家之一。我们针对相关措施提出建议，这些措施将通过保护医院避免不必要的入院、提供与新冠疫情相关的初级和二级预防服务以及通过治疗非新冠疾病来维持民众健康，从而将初级和社区护理重新置于应对当前公共卫生危机的前沿。这一点，连同更具选择性的社交距离措施（而非全面封锁），是缓解新冠疫情唯一可行且现实的长期策略。
