Updated: Feb 22, 2021
Authored by Gaëtan Fraikin, CEO, Addictive Health
You've probably been as frustrated as I have from not seeing progress in dealing with this COVID-19 pandemic. The main hurdles have been disinformation, dogmatic opinions, rejection of science, nationalism, lack of integrated thinking, and lately fatigue. There's now light at the end of the tunnel, but we have a lot of work to do to win this one, and avoid or prepare for the next one.
After a year into this pandemic, numbers are still getting worse and the only type of measure that seems to have any kind of immediate impact is shutdowns. Unfortunately, the benefits are always short lived. The next wave gets worse than the previous one. Vaccines are on the horizon, but they will take time to be produced, distributed, and inoculated with sufficient percentage of the global population to reach heard immunity. There is a better way. A smarter way. A more integrated way.
Since early 2020, the world has been caught in the biggest health challenge ever met for the past century. Despite numerous warnings and efforts by the World Health Organization, the CDC and equivalent institutions around the world, we were once again caught by surprise and unprepared to handle this pandemic at the local, regional and global level.
But this year's challenge is not the only one we have faced in this short beginning of the 21 century. Let’s look back for a moment and review a summary from “Managing Epidemics” by The World Health Organization (Managing epidemics: key facts about major deadly diseases. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.)
"SARS – Severe acute respiratory syndrome - was unheard of before 2003. But it affected more than 8,000 people, killing about one in ten of them, causing fear and panic across the world, and inflicting enormous economic damage, especially in Asian countries.
In 2009, a novel influenza virus, H1N1, started to spread, creating the first influenza pandemic of the 21st century. But – and this is a reason for cautious hope - it was not as severe as expected thanks to recent preparedness efforts. The importance of these efforts is a core issue in this handbook.
In 2012-2013, a new virus surfaced in the Middle East, causing an epidemic of what became MERS – Middle East respiratory syndrome – that spreads fatally into many countries beyond that region.
The Ebola epidemic in West Africa (Guinea, Liberia, and Sierra Leone) in 2014 was unlike the previous 24 localized outbreaks observed since 1976. Instead of being restricted geographically, this one seriously affected three African countries and spread to six other countries in three continents, and sparked alarm worldwide.
In 2015, the Zika virus, transmitted by the Aedes Aegypti mosquito, triggered a wave of microcephaly in Brazil. This disease causes dreadful damage in the brains of unborn babies. Almost 70 countries, one after another, then experienced their own Zika epidemic. There are probably many more to come, because most of the global intertropical zone has a high density of Aedes Aegypti that transports the disease.
And so a clear pattern continues to take shape. Old diseases – Cholera, Plague, Yellow fever among them – often return, and new ones invariably arrive to join them. About 40 outbreaks of cholera alone are reported to WHO every year.”
Also, according to the same report, this pattern has another worrisome aspect - Epidemics are spreading faster and further. Just as fast, in fact, as an intercontinental aircraft can fly.
Based on that new reality, global health organizations have put in place monitoring and R&D programs, with international collaborations. These are aimed at identifying a pathogen resurgence or mutation that may trigger an outbreak.
When that first line of defense does not work - like in all cases listed above and many more in the previous centuries, we have to deal with an actual outbreak or series of outbreaks, and try to mitigate those before they become uncontrolled and global - before they become a pandemic.
Back to today: we have all witnessed the unprecedented global impact brought by Covid-19. Countries around the world have been scrambling to find the best possible way to respond to the devastating effects with uneven success. Across the world, as of November 2020, over 1.3M people have lost their lives, with more than 50M affected. Shutdowns, restrictions, physical distancing, remote work, disappearance of all activities that people enjoy in normal times all have a tremendous impact on the economy, businesses, employees, and people all over the world.
Every part of the global economy is affected: brands in entertainment, retail, dining, hospitality, travel, sports and conferences, corporate campuses, education, healthcare and government to name a few. Bankruptcies are also accelerating, with unprecedented job losses, and financial stress on populations around the world. The mental health impact is also taking a toll that will be with us for years to come.
Everyone starts talking about the “New Normal” as if we must resign ourselves to being overcome by the disease, with limited ways to fight back. This is not sustainable. We must and should do better.
So, what can we do? What should we do? The key to tackling this pandemic successfully is a well coordinated combination of prevention behaviors, immunization via vaccines, knowledge via testing and data management to know who’s healthy or not, and therapeutics via a range of existing or soon to come solutions.
1 Prevention behaviors
We’ve all heard this - masks and “social” distancing are the first line of defense. National mandates are key. And it works best when there’s a consequence - such as a fine - for the ones who do not comply. This is a critical tool that should be the foundation of any plan.
As of November, according to a New York Times Coronavirus Vaccine Tracker, there are 54 vaccines in clinical trials on humans, and at least 87 preclinical vaccines are under investigation in animals. Out of the 54, 12 are in "phase 3" (large scale efficacy testing) and 6 in “limited” approval.
As of November, also according to a New York Times Coronavirus Drug and Treatment Tracker. Solutions include Antivirals (to stop the virus from hijacking our cells), Solutions to mimick the Immune System (convalescent plasma, monoclonal antibodies, Interferons), to reducing Immune System Response (Corticosteroids, Cytokine Inhibitors, Blood Filtration Systems, Stem Cells) and other treatments.
Visibility of the state of the pandemic and outbreaks in real time - The reason for large scale shutdowns and stay at home orders is the lack or absence of visibility on the disease progression across populations or groups in real time. This drives authorities to force entire populations or groups (100%) into life changing rules while only 1 to 10% of those individuals are sick are any given time.
Testing alone is not the solution. And even that has failed us since the beginning of the pandemic. Key reasons: lack of availability, price too high for recurring testing, long turn-around time, inconsistent accuracy and inconvenient sample type - nasal swab. Better testing solutions are urgently needed. Tests that are saliva based, easy to take by everyone, affordable (less than $10), highly accurate and with quick time to answer.
But testing once in a while is pretty much worthless. Reason why after 9 months in and significantly higher tests availability, the pandemic is still accelerating in the northern hemisphere. A weekly testing schedule should be the norm. This will enable reliable contact tracing and minimization of contamination.
The only practical way to move forward to a weekly testing program is to allow consumers to test from the comfort of home. For that, the FDA will need to accelerate approval for Over-The-Counter (OTC) label for a wide range of tests that fit the bill on the above listed requirements. Watch Dr Anthony Fauci's November 19 interview with Chris Cuomo where he explains the value of rapid, broadly available home testing.
Testing weekly at population scale would enable visibility of the progress of the pandemic and impact of population health programs in real-time. To do that, results must be automatically captured and stored through a mobile application.
All that data should then be centralized into an enterprise app (de-identified), and in full HIPAA and security compliance. With real-time models showing pandemic evolution to assess the results of health initiatives to fight it. This is the necessary tool for key “destination” organizations listed above to have the necessary actionable information to put an end to this pandemic, quickly.
There are countless test manufacturers from around the world rushing to grab a piece of this multi-billions dollar opportunity globally. But there are few Platform Solutions that can be effective at complementing Prevention behavior, Immunization and Therapeutics as a the “eyes” of the master plan.
Let's urge governments (national, regional and local), corporations, health care, education and brands to seek such comprehensive solutions and implement them quickly, to will help mitigate and end this pandemic, and be ready for the next ones. Together is the only way out of this. And the only way to not let future pathogen catch us by surprise, and turn our lives, health and economies upside down. Let's get to work.
By Gaëtan Fraikin / CEO / Addictive Health / www.addictive.health / + 1 760 580 3908 / firstname.lastname@example.org