Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

doi:10.1016/j.toxrep.2020.12.001

. 2021:8:1-9.

doi: 10.1016/j.toxrep.2020.12.001. Epub 2020 Dec 3.

Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

Konstantinos Farsalinos^{1

2}, Konstantinos Poulas¹, Dimitrios Kouretas³, Apostolos Vantarakis⁴, Michalis Leotsinidis⁵, Dimitrios Kouvelas⁶, Anca Oana Docea⁷, Ronald Kostoff⁸, Grigorios T Gerotziafas⁹, Michael N Antoniou¹⁰, Riccardo Polosa^{11

12}, Anastastia Barbouni², Vassiliki Yiakoumaki¹³, Theodoros V Giannouchos¹⁴, Pantelis G Bagos¹⁵, George Lazopoulos¹⁶, Boris N Izotov¹⁷, Victor A Tutelyan¹⁸, Michael Aschner¹⁹, Thomas Hartung^{20

21}, Heather M Wallace²², Félix Carvalho²³, Jose L Domingo²⁴, Aristides Tsatsakis^{17

25}

Affiliations

¹ Laboratory of Molecular Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece.
² School of Public Health, University of West Attica, L Alexandras 196A, Athens, 11521, Greece.
³ Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, 41500, Greece.
⁴ School of Medicine, University of Patras, Panepistimiopolis, 26500, Greece.
⁵ Lab. of Public Health, Medical School, University of Patras, University Campus, 26504, Greece.
⁶ Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
⁷ Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
⁸ School of Public Policy, Georgia Institute of Technology, Gainesville, VA, 20155, USA.
⁹ Sorbonne Université, INSERM, UMR_S 938, Group de recherche « Cancer-Hemostasis-Angiogenesis », Centre de recherche Saint-Antoine, CRSA, Centre de Thrombose, Tenon-Saint Antoine, University Hospitals, Assistance publique Hôpitaux de Paris, France.
¹⁰ Gene Expression and Therapy Group, King's College London, Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, 8th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
¹¹ Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, 97 95131, Catania, Italy.
¹² Centro Prevenzione Cura Tabagismo, Center of Excellence for the Acceleration of Harm Reduction, University of Catania, 95123, Catania, Italy.
¹³ Department of History, Archaeology and Social Anthropology, University of Thessaly, 38221, Volos, Greece.
¹⁴ Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
¹⁵ Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, 35100, Greece.
¹⁶ Department of Cardiac Surgery, University Hospital of Heraklion, Crete, Greece.
¹⁷ Department of Analytical Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, 119991, Moscow, Russia.
¹⁸ Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation.
¹⁹ Department of Molecular Pharmacology, Albert Eisntein College of Medicine, 1300 Morris Park Avenue Bronx, NY, 10461, USA.
²⁰ Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
²¹ Department of Pharmacology and Toxicology, University of Konstanz, 78464, Konstanz, Germany.
²² Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
²³ UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
²⁴ Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain.
²⁵ Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece.

PMID: 33294384
PMCID: PMC7713637
DOI: 10.1016/j.toxrep.2020.12.001

Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

Konstantinos Farsalinos et al. Toxicol Rep. 2021.

. 2021:8:1-9.

doi: 10.1016/j.toxrep.2020.12.001. Epub 2020 Dec 3.

Authors

Affiliations

¹ Laboratory of Molecular Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece.
² School of Public Health, University of West Attica, L Alexandras 196A, Athens, 11521, Greece.
³ Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, 41500, Greece.
⁴ School of Medicine, University of Patras, Panepistimiopolis, 26500, Greece.
⁵ Lab. of Public Health, Medical School, University of Patras, University Campus, 26504, Greece.
⁶ Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
⁷ Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
⁸ School of Public Policy, Georgia Institute of Technology, Gainesville, VA, 20155, USA.
⁹ Sorbonne Université, INSERM, UMR_S 938, Group de recherche « Cancer-Hemostasis-Angiogenesis », Centre de recherche Saint-Antoine, CRSA, Centre de Thrombose, Tenon-Saint Antoine, University Hospitals, Assistance publique Hôpitaux de Paris, France.
¹⁰ Gene Expression and Therapy Group, King's College London, Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, 8th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
¹¹ Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, 97 95131, Catania, Italy.
¹² Centro Prevenzione Cura Tabagismo, Center of Excellence for the Acceleration of Harm Reduction, University of Catania, 95123, Catania, Italy.
¹³ Department of History, Archaeology and Social Anthropology, University of Thessaly, 38221, Volos, Greece.
¹⁴ Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
¹⁵ Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, 35100, Greece.
¹⁶ Department of Cardiac Surgery, University Hospital of Heraklion, Crete, Greece.
¹⁷ Department of Analytical Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, 119991, Moscow, Russia.
¹⁸ Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation.
¹⁹ Department of Molecular Pharmacology, Albert Eisntein College of Medicine, 1300 Morris Park Avenue Bronx, NY, 10461, USA.
²⁰ Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
²¹ Department of Pharmacology and Toxicology, University of Konstanz, 78464, Konstanz, Germany.
²² Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
²³ UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
²⁴ Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain.
²⁵ Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece.

PMID: 33294384
PMCID: PMC7713637
DOI: 10.1016/j.toxrep.2020.12.001

Abstract

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.

Keywords: COVID-19 pandemic; Horizontal lockdowns; Hospital preparedness; Primary care.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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[1] Craxì L., Vergano M., Savulescu J., Wilkinson D. Rationing in a pandemic: lessons from Italy. Asian Bioeth Rev. 2020;16(June):1–6. doi: 10.1007/s41649-020-00127-1. - DOI - PMC - PubMed

[2] Craxì L., Vergano M., Savulescu J., Wilkinson D. Rationing in a pandemic: lessons from Italy. Asian Bioeth Rev. 2020;16(June):1–6. doi: 10.1007/s41649-020-00127-1. - DOI - PMC - PubMed

[3] Vergano M., Bertolini G., Giannini A., Gristina G., Livigni S., Mistraletti G., Riccioni L., Petrini F. SIAARTI Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments in exceptional, resource-limited circumstances. Available at: https://bit.ly/2UyQ6I3. Accessed 12 November 2020. - PubMed

[4] Vergano M., Bertolini G., Giannini A., Gristina G., Livigni S., Mistraletti G., Riccioni L., Petrini F. SIAARTI Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments in exceptional, resource-limited circumstances. Available at: https://bit.ly/2UyQ6I3. Accessed 12 November 2020. - PubMed

[5] Petrakis D., Margină D., Tsarouhas K., Tekos F., Stan M., Nikitovic D., Kouretas D., Spandidos D.A., Tsatsakis A. Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review) Mol. Med. Rep. 2020;22(July(1)):9–19. doi: 10.3892/mmr.2020.11127. - DOI - PMC - PubMed

[6] Petrakis D., Margină D., Tsarouhas K., Tekos F., Stan M., Nikitovic D., Kouretas D., Spandidos D.A., Tsatsakis A. Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review) Mol. Med. Rep. 2020;22(July(1)):9–19. doi: 10.3892/mmr.2020.11127. - DOI - PMC - PubMed

[7] Kostoff R.N., Briggs M.B., Porter A.L., Aschner M., Spandidos D.A., Tsatsakis A. [Editorial] COVID‑19: post‑lockdown guidelines. Int. J. Mol. Med. 2020;46(August(2)):463–466. doi: 10.3892/ijmm.2020.4640. - DOI - PMC - PubMed

[8] Kostoff R.N., Briggs M.B., Porter A.L., Aschner M., Spandidos D.A., Tsatsakis A. [Editorial] COVID‑19: post‑lockdown guidelines. Int. J. Mol. Med. 2020;46(August(2)):463–466. doi: 10.3892/ijmm.2020.4640. - DOI - PMC - PubMed

[9] World Health Organization (WHO). Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. Available at: https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-cov.... Accessed 12 November 2020.

[10] World Health Organization (WHO). Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. Available at: https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-cov.... Accessed 12 November 2020.

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Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

Affiliations

Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

Authors

Affiliations

Abstract

Conflict of interest statement

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