Learning from recent events – A commentary on: “Health policy and leadership models during the COVID-19 pandemic – Review article”

Dear editor,

The insightful article by Nicola et al. discussed exemplary national leadership models, postulated several de-escalation strategies on current restrictions, and most importantly, reflected on the lessons learned from countries that have effectively contained the COVID-19 pandemic [1]. As the reverberation from the initial easing of the lockdown protocol is imminent and even proceeding in some areas, we endeavour to further explore our collective understanding of the first COVID-19 pandemic wave and strategies that may alleviate the severity of a second wave.

We understand that some herd immunity exists in several regions. The exact degree of herd immunity is currently indeterminate; however, it is clear that a significant proportion of the population has contracted the SARS-Cov-2 virus both during and before the initiation of lockdown measures. It has been theorised that immunity may be short-lived within individuals exposed to SARS-Cov-2. The recent study by Doores et al. demonstrated that whilst 60% of individuals exhibited a significant antibody response at peak viral load, only 17% retained the same magnitude of the antibody response three months post-onset of symptoms [2]. Therefore, based on these findings, it is strongly recommended that government officials refrain from over-reliance on the attainment of herd immunity as firstly, this may not be achieved until an effective vaccine has been approved for mass production. Secondly, local healthcare systems may become overwhelmed if a considerable number of symptomatic individuals require hospital admission within a short period. Widespread workplace absenteeism due to a sudden increase in COVID-19 cases may further exacerbate the decreased consumption, demand and utilisation of products and services, and thus negatively impact the global economy as described by Nicola et al. [3] The immunocompetent cohort amongst the general population should take caution when interacting with others as current societal behaviour may shape the world's recovery from the pandemic.

There has also been a noticeable improvement in national governments’ responsiveness to the evolving situation. In the United Kingdom, we have witnessed the recent implementation of local lockdowns in some regions for example, Leicestershire. Decentralisation of lockdown decision-making from the central government to local councils may be beneficial as a selective and regional approach instead of a nationwide lockdown, that encompasses regions with an acceptable COVID-19 reproduction number, will prevent unnecessary decline of the economy. Normal social and operational activities should be gradually restored judiciously.

The group of individuals susceptible to COVID-19 has been clearly defined. If any of these individuals succumb to COVID-19, the majority will experience mild ailment but for those who may not, there is now a variety of therapies that significantly improve health outcomes which includes Dexamethasone, Beta Interferon, Remdesivir and the use of anticoagulant agents, all of which illustrates the advancement in the management of COVID-19. The symptomatology of COVID-19 is now better understood as anosmia and ageusia were not widely recognised as common symptoms during the early phase of quarantine. With this knowledge, individuals that develop such symptoms will be able to withdraw from public circulation promptly and self-isolate for 10 days rather than the previous recommendation of 7 days. Diet modification has an integral role in protection from COVID-19 which should comprise adequate intake of Vitamins B, C, D, E, zinc, and protein [4]. Interestingly, there has been a suggestion that countries such as Romania and Latvia, who consume a high quantity of green vegetables, have experienced a significant reduction in COVID-19-related deaths. Fonseca et al. showed that a national increase in consumption of green vegetables resulted in a 13.6% decrease in the mortality risk for COVID-19 [5]. Although, it is unclear whether the change associated with vegetable consumption was causal or correlational. Despite this, the adoption of a balanced diet in amalgamation with other immune-protective measures is warranted in the general public to attenuate the impact of a second COVID-19 wave.

As we face a potential second wave, it is vital to critically reflect on recent events during the peak of the pandemic to improve our preparedness for the future. We hope to provide an encouraging outlook on the future and draw attention to recent simple, yet valuable interventions that when employed consistently and in combination with existing strategies, may constrain the impact of a second wave.

Ethical approval

No ethical approval necessary.

Sources of funding

None to declare.

Author contribution

Yaser Hamza – Writing.

Jubilent Amalendran – Writing.

Immanuel Sani – Writing.

Youssef Chedid– Writing.

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Guarantor

Immanuel Sani.

Data statement

No primary research or confidential patient data was obtained due to the nature of this article. No data sets were generated or analysed.

Provenance and peer review commentary

Internally reviewed.

Declaration of competing interest

None to declare.