The current COVID-19 test mess

Guidelines on COVID-19 in vitro diagnostic tests and their performance

If you receive a document with the title Guidelines on COVID-19 in vitro diagnostic tests and their performance you may expect to read about Guidelines and Performance. Unfortunately, you'll not find them in such document. After 2 months and a half, and an absolute market and regulatory chaos, the European Union releases a document that says that in the future they will provide some analysis of the situation. Meanwhile the regulation is the one enacted in 1998, that it was updated in 2017, but it will not be applied until 2022!!!
It could seem a joke if we were not talking about issues of life and death. The health and the economy is affected by his situation and unless we are able to asses the current extent of pandemics and immunity, we will not succeed from the current lockdown. Live and livelihood deserve better european policy makers.

Carlos Díaz

The viruses to come

Crisis in the Red Zone. THE STORY OF THE DEADLIEST EBOLA OUTBREAK IN HISTORY, AND OF THE VIRUSES TO COME

If you want to read a story of ebola outbreak and its implications beyond it, this is the book you have to read. It may be translated into a screenplay of a film.

At the end it says:

A family of viruses called the morbilliviruses is regarded by some experts as a leading candidate for the emergence of a previously unknown Level 4 monster that travels in the air. If there was no vaccine or drug for it, and if it was highly infectious, and if it floated out of peoples mouths, the virus could go around the world in a few weeks, traveling inside people who are flying on airplanes and walking through airport terminals, breathing. 

Glups!

A pandemic is not a war

Deadliest Enemy. Our War Against Killer Germs

Key messages from the book:

To review, our greatest threats are:
1. Pathogens of pandemic potential, which essentially means influenza and the downstream effects of antimicrobial resistance.
2. Pathogens of critical regional importance, which include Ebola, coronaviruses like SARS and MERS, other viruses such as Lassa and Nipah, and Aedes-transmitted diseases such as dengue, yellow fever, and Zika.
3. Bioterrorism and dual-use research of concern (DURC), and gain-of-function research of concern (GOFRC).
4. Endemic diseases that continue to have a major impact on the world’s health, particularly among emerging nations, including malaria, tuberculosis, AIDS, viral hepatitis, childhood diarrheal diseases, and bacterial pneumonia.

Priority 1: Create a Manhattan Project–like program to secure a game-changing influenza vaccine and vaccinate the world.
Priority 2: Establish an international organization to urgently address all aspects of antimicrobial resistance.
Priority 3: Support and substantially expand the mission and scope of the Coalition for Epidemic Preparedness and Innovations (CEPI) to fast-track comprehensive public-private vaccine research, development, manufacturing, and distribution for diseases of current or potential critical regional importance.
Priority 4: Launch the Global Alliance for Control of Aedes-Transmitted Diseases (GAAD) and coordinate with the Bill & Melinda Gates Foundation’s malaria strategy, “Accelerate to Zero.
Priority 5: Fully implement the recommendations of the bipartisan report of the Blue Ribbon Study Panel on Biodefense.
Priority 6: Establish an international organization similar to the National Scientific Advisory Board for Biosecurity (NSABB) to minimize the use of DURC and GOFRC to transmit pathogens of pandemic potential
Priority 7: Recognize that TB, HIV/AIDS, malaria, and other life-threatening infectious diseases remain major global health problems
Priority 8: Anticipate climate-change effects
Priority 9: Adopt a One Health approach to human and animal diseases throughout the world.

Health supplies as strategic asset

China Rx
EXPOSING THE RISKS OF AMERICA'S DEPENDENCE ON CHINA FOR MEDICINE

Key messages from Chapter 14:

China has been one of America's bankers, buying US Treasury bonds, and is now America's drugmaker. The centralization of the global supply of key ingredients for America's medicines in a single country poses enormous risks that must be mitigated.
Free market advocates may contend that the United States is better off outsourcing medicine making to China and allowing Americans to keep more of their money to spend on other goods. But medicines are essential for life. A country needs them to function. Prescription drugs are made by private corporations, but many serve a public purpose. 

Not unlike the manufacture of other consumer products, business decisions about manufacturing essential drugs and their therapeutic ingredients have been left to the invisible hand of the market. Financial and human capital have migrated to countries with the lowest cost of doing business. Corporate executives and their boards have determined that for them, the benefits of dependence on China outweigh the risks.
These decisions are too important to leave to the invisible hand. As China rapidly pursues a determined strategy to become a pharmaceutical power, US dependence on a single country will rise dramatically.

Key prescriptions to consider:

1. CONSIDER MEDICINES A STRATEGIC ASSET, NOT A COMMODITY TO BE BOUGHT AT THE LOWEST PRICE
2. TRACK AND FORECAST VULNERABILITIES IN THE SUPPLY OF AMERICA'S MEDICINES
3. PRIORITIZE A LIST OF MEDICINES FOR WHICH A SUPPLY INTERRUPTION POSES AN IMMEDIATE DANGER TO PUBLIC HEALTH
4. INVESTIGATE CHINESE DRUG CARTELS TO FIND OUT IF THEY CAUSE DRUG SHORTAGES IN THE UNITED STATES
5. PROVIDE INCENTIVES TO BRING DRUG MANUFACTURING HOME
6. ENSURE THE US MILITARY DOES NOT DEPEND ON CHINA FOR ESSENTIAL MEDICINES
7. STRENGTHEN, DON'T WEAKEN GOVERNMENT OVERSIGHT OF DRUG MANUFACTURERS
8. DON'T CEDE US REGULATORY OVERSIGHT OF DRUG MANUFACTURING TO CHINA
9. INCREASE FDA TESTING OF MEDICINES                                                            10. LUCK IS NOT A STRATEGY: IDENTIFY PROBLEM PRODUCTS RAPIDLY

Given the current health crisis, you can change medicines by tests and it fits perfectly. You can apply it to your country.

Stories from spanish flu epidemic

THE SPANISH FLU EPIDEMIC AND ITS INFLUENCE ON HISTORY.  Stories from the 1918–1920 global flu pandemic

From Chapter 11:

Perhaps the most lasting legacy of Spanish flu is that it barely left a legacy at all. While it has continued to be studied and analysed in niche virology circles, the collective memory seemed to stub it out and hurry to move on. Were it not thanks to a handful of dedicated historians such as Geoff Rice and Richard Collier, who collected personal accounts of the tragedy through the 1970s and 1980s, many first-person testimonies may have been lost. There are a few explanations of this mass memory loss and one of them related to honour. Perhaps in order to dull the painful reality of the loss of a treasured father, husband, brother or son, much pomp was  conveyed onto the memory of those who died in battle. Dying from flu, however, did not convey the same sense of honour. In fact, in a world where eugenics had played a strong role so far, it made otherwise brave men appear weak and flawed.

 Time is a healer, though, and there are lots of good reasons to be interested in Spanish flu now, a hundred years on from the pandemic; to honour the dead, to analyse the medical response, to measure the impact of the virus on the health of the population through the relatively new discipline of
epigenetics … but perhaps the most pressing reason for us to remember the outbreaks from a virology, epidemiology, sociology and historical point of view, is because of the high possibility it could happen again.

 The outbreak of Spanish flu at the start of the twentieth century is considered to be one of the deadliest infections in the history of humanity, affecting a minimum of 30 per cent of the global population, and killing around 5 per cent.

In a previous post you may find additional details.

How pandemics shaped our world

Germs, Genes, & Civilization. How Epidemics Shaped Who We Are Today

From Chapter 11:

In his futuristic work The Shape of Things to Come, published in 1933, H. G. Wells relies on a novel plague to eliminate half the population of Earth in 1955–1956 and usher in a new era. Although this epidemic was largely modeled on the Black Death, Wells had his “maculated fever” waft around the world on the wind instead of spread by fleas. His fictitious disease emerged from captive baboons in the London Zoological Gardens. The Shape of Things to Come was written as a prediction of the future in an age when most scientists foresaw only the eventual eradication of infectious disease, not its resurgence.
So what should we predict? First, let’s consider the global situation. The British Empire was the last great civilization. Improved hygiene, originating from the industrialized West, led to worldwide decreased infant mortality. That, in turn, created a population boom that undermined the profitability of the European colonial empires. Despite poor hygiene and rampant disease relative to the industrial nations, the birth rate still outstrips infant mortality in Third World countries. The ongoing population explosion is the single most important biological trend in today’s world.
Denser populations, coupled with poverty, are promoting the spread of disease. Although tuberculosis is in the lead right now, most of those infected do not fall ill. As the remaining sensitive humans are weeded out, the incidence of TB in the Third World will begin to decline naturally, just as it did in Europe a century ago.
In the advanced nations, AIDS will affect homosexuals and intravenous drug users but have marginal impact on the mainstream. Its major effect, especially in the United States, will be to increase the cost of health care in the inner cities. This will help enlarge the growing gap between rich and poor. In Africa and, to a lesser extent, other third world regions, AIDS will thin out the promiscuous and malnourished, and favor the spread of religious puritanism, particularly, Islamic sects.
Still more serious, in my opinion, are malaria and other insect-borne infections that are spreading in the tropics. Rising world temperatures promote the spread of insects that transmit many tropical or subtropical diseases. Human construction and irrigation projects are helping, as is the steady increase in insecticide resistance among the insect carriers. An ugly long-term threat is the possible adaptation of tropical viruses to be carried by insects that survive in colder climates

PS. Further reading

Fascinating classics written long ago that are still good reading:
Defoe, Daniel. Journal of the Plague Year. New York: New American Library, 1960. (Original edition 1723.)
Although a work of fiction, the author lived in times when the bubonic plague was still around.
Nightingale, Florence. Notes on Nursing: What It Is and What It Is Not. New York: Dover Publications, 1969. (Original edition 1859.)
For a nice little old lady, Florence Nightingale was amazingly blunt and opinionated. She made generals tremble in their shoes. She would have made Hillary Clinton wilt!
Most important modern works:
Ewald, Paul W. Evolution of Infectious Disease. Oxford: Oxford University Press, 1994.
Seminal work on the evolution of infectious disease from the modern genetic and evolutionary viewpoint. Rather academic.
Herlihy, David. The Black Death and the Transformation of the West. Cambridge, MA: Harvard University Press, 1997.
Expounds the idea that the Black Death was responsible for the emergence of Western democracy.
McNeill, W. H. Plagues and Peoples. Garden City, NY: Anchor Press, 1976.
The most important single source that summarizes and explains the idea that epidemics affected human history.
Zinsser, Hans. Rats, Lice & History. Boston: Little, Brown and Company, 1934. (Reprinted quite frequently.)
Classic on typhus fever and history from the viewpoint of a microbiologist.
Narrow in focus, yet fascinating:
Cantor, Norman F. In the Wake of the Plague. New York: Free Press, 2001.
How the Black Death remodeled European society.
Cockburn, Aidan, and Eve Cockburn. Mummies, Disease and Ancient Cultures. Cambridge, U.K.: Cambridge University Press, 1980.
Grmek, Mirko D. Diseases in the Ancient Greek World. Baltimore: Johns Hopkins University Press, 1989.
A selection of other interesting books:
Cartwright, Frederick F., and Michael D. Biddiss. Disease and History. New York: Dorset Press, 1972.
Crawford, Dorothy H. Deadly Companions. Oxford: Oxford University Press, 2007.
Diamond, Jared. Guns, Germs and Steel. New York: W. W. Norton, 1998.
Garrett, Laurie. The Coming Plague. New York: Penguin Books, 1995.
Oldstone, Michael B. A. Viruses, Plagues, and History. New York: Oxford University Press, 1998.
Preston, Richard. The Hot Zone. New York: Random House, 1994.
Wills, Christopher. Yellow Fever, Black Goddess: The Coevolution of People and Plagues. Reading, MA: Addison-Wesley, 1996. (First published in the United Kingdom by HarperCollins as Plagues: Their Origins, History and Future.)

PS. The exit of the lockdown

Contagion

Now is the time to watch this great film:

And you'll get convinced that unless we have a vaccine soon, all things will be very dificult to manage...