SARS-CoV-2 risk misclassification explains poor COVID-19 management

One of the most striking facts about the COVID-19 pandemic is the notable difference in approach, attitude, control measures, case incidence, and mortality rates between eastern and western hemispheres. Results of a recent analysis¹ show lessons to be learnt from the experiences of these countries and regions. The differences in approach and mortality could be explained, at least partially, if not totally, by the misclassification of the infectious agent risk.

WHO classifies microorganisms into four risk levels according to its biosafety manual.² National legislation, in accordance with this classification, regulates prevention measures and biosecurity, mainly to protect occupational health.³ Group 4 includes new or known agents for which there is no vaccine or treatment and which can be spread at community level. Ebola virus and variola virus are categorised as group 4 agents. Group 3, however, includes dangerous microorganisms such as Mycobacterium tuberculosis that have available antibiotic therapy and other well known control measures.

When severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China, other Asian countries, Australia, and New Zealand put in place contingency plans against an infectious agent of the highest risk, not only in occupational health but also to protect the general population. Given the uncertainty about the nature and real risk of the threat, governments of these countries decided to take the strictest measures—the same measures that would have been used in a case of smallpox or plague. For this reason, protective equipment similar to that used against Ebola was used, the streets were disinfected with chlorine, patients with COVID-19 were separated from the rest of the patients in monographic centres, and mandatory individual quarantines were ordered. Then collective quarantines in the form of lockdown were implemented.

By contrast, the western approach, according to a supposed risk classification of group 2 or 3, initially considered COVID-19 a new kind of influenza and determined that the general management of cases and contacts would be made in general hospitals and outpatients wards, without any type of mandatory quarantine or isolation in monographic hospitals. The European Commission debated in June, 2020, the classification of SARS-CoV-2, categorising it as a group 3 agent. This decision was strongly protested by members of the European Parliament, who disagreed and called for a group 4 categorisation.4, 5

If Europe and other countries in the western hemisphere want to achieve an epidemiological trend similar to Asian countries, then SARS-CoV-2 should be considered an agent of maximum risk in all technical approaches, clinical settings, and social levels.