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| EDITORIAL |
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| Year : 2021 | Volume
: 8
| Issue : 1 | Page : 1-3 |
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Global scenario of COVID-19
Uwe Wollina1, Roxanna Sadoughifar2, Torello Lotti2
1 Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
2 Department of Dermatology, Guglielmo Marconi University, Rome, Italy
| Date of Submission | 11-Aug-2020 |
| Date of Decision | 04-Jan-2021 |
| Date of Acceptance | 06-Mar-2021 |
| Date of Web Publication | 07-Apr-2021 |
Correspondence Address:
Uwe Wollina
Professor, Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Friedrichstrasse 41, 01067 Dresden
Germany
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/Pigmentinternational.Pigmentinternational_
COVID-19, caused by SARS-CoV-2 virus, has developed into a pandemic that is still going on. The disease is transmitted mainly by aerosols. Here we discuss diagnostics and disease control measures. The social distortion by the pandemic has a negative impact on many facettes of society that potentially increase social tensions. Disease control warrants science and transparency. Vaccination provides hope to overcome the pandemic eventually.
Keywords: Covid-19, global effects, SARS-CoV-2, pandemic
How to cite this article:
Wollina U, Sadoughifar R, Lotti T. Global scenario of COVID-19. Pigment Int 2021;8:1-3 |
| Introduction | |  |
Since the turn of the year 2019 to 2020 the COVID-19 pandemic became the greatest medical, social, and economic threat since World War II. The pandemic has a negative impact on health care systems and global mobility that were unimaginable a couple of years ago and it demonstrates the vulnerability of modern society. More than 85 million people have been infected by the causative virus SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) globally, and more than 1.8 million have died of COVID-19.[1]
Diagnostics
Testing for SARS-CoV-2 infection seems crucial to identify individual patients and local hot spots. Not testing does not make the disease disappear as some politicians suggested.
Clinical suspicion is based on clinical symptoms such as dry cough, fever, and shortness of breath. More specific symptoms are ageusia and anosmia, especially when associated to lymphopenia and eosinopenia.[2] But the clinical symptoms alone do not replace confirmation by polymerase chain reaction test.
Recent trials suggest that a combined throat and nasal swab sampling for SARS-CoV-2 is equivalent to nasopharyngeal sampling, but the former is more easy to be done.[3] Only if we know, who is infected, measures can be implemented to slowdown the viral spread. This has been clearly demonstrated by the successful South Korean countermeasures.[4] On the other hand, cross-national mistrust and national self-interest in combination with a chronic underinvestment in a public health infrastructure increase the spread of SARS-CoV-2.[5]
Inequity is obvious, one-dimensional thinking is counterproductive
COVID-19 infection incidence is socially patterned. Lower income is a major determinant for the risk of infection and the severity of morbidity when acquiring COVID-19. Marginalized populations are hot spots for the disease, for example, the indigenous population in Brazil.[5]
COVID-19 pandemic collides with other global problems such as metabolic syndrome, obesity, and diabetes (“diabesity epidemic”). It has been observed that obese and diabetic patients have a worse prognosis when getting infected by SARS-CoV-2, which is in part mediated by viral interaction with angiotensin converting enzyme-2 receptor and related signaling pathways.[6],[7]
In other parts of the world, COVID-19 may be misdiagnosed for tropical arbovirus diseases such as chikungunya, dengue, or Zika fever.[8]
Efficient and safe treatment has to be a matter of fact
In the early weeks of COVID-19 pandemic, numerous drugs have been handled as possible antiviral wonder drugs. The most prominent example was chloroquine (CQ)/hydroxychloroquine (HCQ), which shows some antiviral activity in vitro while impairing antigen presentation and anti-inflammatory activity by reduction of cytokines.
A meta-analysis of recent trials found no evidence of improved virological clearance, mortality, clinical worsening of disease, and safety, when compared with the control or conventional symptomatic treatment.[9]
A randomized trial from China investigated HCQ administrated at a loading dose of 1200 mg daily for 3 days followed by a maintenance dose of 800 mg daily for 2 or 3 weeks for patients with mild to moderate or severe disease. HCQ did not result in a significantly higher probability of negative conversion than standard of care alone but adverse events were more frequent in HCQ recipients than in controls.[10]
A trial from Brazil with patients suffering from severe COVID-19 compared high-dosage CQ (600 mg CQ twice daily for 10 days) with low-dosage CQ (450 mg twice daily on day 1 and once daily for 4 days). Lethality until day 13 was more than double, that is, 39.0%, in the high-dosage group compared to the low-dosage group (15.0%). The authors concluded that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of safety hazards.[11]
A recent systemic review came to the following conclusions: “The results of efficacy and safety of HCQ in COVID-19, as obtained from the clinical studies, are not satisfactory, although many of these studies had major methodological limitations. Stronger evidence from well-designed robust randomized clinical trials is required before conclusively determining the role of HCQ in the treatment of COVID-19.”[12]
In conclusion, treatment options need scientific proof before popularizing their use in the public.
After COVID-19
Patients who survived moderate to severe COVID-19 need support to return to normal life. Support is provided by rehabilitation, which is founded on three pillars − preventive measures, therapeutic approaches, and health promotion. Rehabilitation services can be implemented in hospitals, rehabilitations centers, and in the community, depending on the needs of patients and their families.
In COVID-19 patients, improvement of pulmonary and cardiac function, joint mobility, and psychological health are major issues of an early rehabilitation.[13]
Transparency and solidarity
Transparency is the most powerful tool to combat irrationalism and conspiracy theories in our fight against COVID-19. Transparency should be accompanied by solidarity with underprivileged people and countries with limited resources. The virus does not accept borders, neither national nor social.[14]
Decision-making warrants solid data. Comparative health care research with performance intelligence is capable to collect sufficient data, develop indicators, and support to identify best strategies for taking actions. The most important dimensions of such an approach are effectiveness, safety, and responsiveness. The first months of the pandemic illustrated the need for better data quality and analysis, since governments often came to contradictory conclusions based on the available limited local and national evidence.[15]
With the availability of SARS-CoV-2 vaccine there is a new hope to better control the disease and to protect first those who are at special high risk to acquaintance COVID-19 disease. The aim is herd immunity in the general population.[16]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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