The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper

Abstract

Background: One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis.

Management: Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic.

Current issues: The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a second and even third generation of vaccines has already been acknowledged by the WHO and governments.

Perspectives: There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA).

Conclusion: The "PDA strategy" integrated into state policy for the support and expansion of health systems and introduction of digital organizations (i.e., telemedicine, e-Health, artificial intelligence, and machine-learning technology) is of major importance for the preservation of citizens' health and life world-wide.

Fig. 1

Illustration of the PDA strategy: prevention of SARS-CoV-2 infection accelerated massive vaccination world-wide, epidemiological surveillance, masks, distancing, improvement of sanitary conditions, and setup of primary health care structures, which are capital elements for the mitigation and the control of the pandemic. PDA, prevention, detection, and anticipation.

Fig. 2

Illustration of the PDA strategy: detection of the dynamics of the virus circulation of patients with COVID-19 and prompt identification of those at risk of disease worsening are mandatory to preserve the health of citizens and society's cohesion. PDA, prevention, detection, and anticipation.

Fig. 3

Illustration of the PDA strategy: anticipation—medical treatment in patients with COVID-19 is essential for improved clinical outcome. Early identification of patients at risk of disease worsening and application of the recommended treatments at the level of the primary health care structures are related with improved clinical outcome and decreased mortality. The first 5 to 7 days after SARS-CoV-2 infection is a critical period for that requires identification of patients at risk of disease worsening and personalized therapeutic strategy. PDA, prevention, detection, and anticipation; VTE, venous thromboembolism.