The long and painful learning curve about COVID-19

Abstract

“Salud!” “God bless you!”. The wish that we usually exchange after a sneeze was born almost seven centuries ago, in 1348. In that year a sneeze could represent a banal physiological act, or the first symptom of the Black Plague that would have killed the victim in a few days. Even today we are experiencing the after-effects of that pandemic: in the same way also the after-effects of Covid-19 will heavily affect our lives in future years, starting from the frustrating experience of having to learn how to fight a completely unknown virus, in a slow and painful learning curve. Italy was the first country to be affected by the virus outside China: as early as February 2020 our teaching hospital identified male sex, respiratory frequency> 22, cancer as comorbidity, thrombocytopenia and arterial partial pressure of oxygen / fractional inspired oxygen ratio <260 as significantly associated with higher odds for severe disease¹. The study of support therapies started, among which the most promising was the use of hyperimmune plasma, extensively studied at our hospital and with proven efficacy ², as long as used in the early stages of viral replication, as well as dexamethasone and monoclonal antibodies, and completely useless during the subsequent cytokine storm marking the most serious cases. The global picture has radically changed in just one year: on the one hand the advent of vaccines, on the other of viral variants, show us how we still have to learn a lot, in a disheartening learning curve tha the 357,316 cases registered in a day in India make particularly painful³. As far as vaccine production is concerned, in March the total production was around 413 million doses, but by the end of this year the forecast is for 9,5 billion doses available⁴ ; their used turned out to be safe also for people with severe allergies to foods, oral medications, latex, bee venom ⁵. While aiming to vaccinate as many people as possible, we are still in the learning curve if vaccination really protects against infection: according to ISARIC4C⁶, 3.842 (7.3 %) of the 99.445 patients hospitalized for  COVID-19 had previously been vaccinated, with 40 % developing symptoms 0-7 days after vaccination, 19 % 8-14 days after vaccination: given that the median incubation period for SARS-CoV-2 is approximately five days, it is likely that many of these patients were infected before immunity developed. This data justifies the need to persevere in the use of personal protective equipment, even if we are not yet sure if these should be worn always, even outdoors⁷, also after vaccination; on the other hand, it has been showed that a single dose of the COVID-19 m-RNA vaccine cuts a person’s risk of transmitting SARS-CoV-2 to their closest contacts by as much as half, according to an analysis of more than 365,000 households in the United Kingdom⁸.

The need to accelerate vaccinations to stop the spread of variants - with increased transmissibility compared to the original strain is confirmed by the increase in cases in the younger sections of the population.
The learning curve still returns to the initial evels as regards the most common variants in 7 European countries, including Italy: the English one (B.1.1.7), the South African (B.1.351) and the Brazilian (P. 1). The English variant is the most widespread, also in young population (19.4 % 0-19 years, 31.3 % 20-29 years, 32.0 % 40-59 years). It would entail a hospitalization risk triple for the 20-39 age group and a 2.3 times greater for the 40 - 59 age group, doubling the risk of intensive care for the 40-59 group⁹.
The research continues, and the papers ndexed in Medline under the keyword “COVID-19” have reached the incredible number of 130,504. While research products are the common assets of humanity, the same
cannot be said of vaccines, which are still protected by patents: in the words of Jeffrey Sachs, patron of the Sustainable Develop ment Network System, “…The benefits of mRNA vaccines… should be made available globally without further delay, and the knowhow should be shared as rapidly and widely as possible. We have the capabilities to scale worldwide immunization, in order to save lives, prevent the emergence of new variants, and end the pandemic. Intellectual property must serve the global good, rather than humanity serving the interests of a few private companies”¹⁰. In a globalized world, where the virus does not care about borders, it is not possible to think of ending the pandemic only in one country, or in a single continent, forgetting the others. As Pope Francis said on the sad evening of March 27, 2020, in his blessing Urbi et Orbi under a pouring rain in a deserted Piazza San Pietro: “We can only be saved together”.