strategy 2021 to defeat SARS-CoV-2

THE PATH to virus extinction

On January 11, 2021 we had offered a suggestion as to how to fight the pandemic. https://www.sajo-innovation.de/blog/call-to-action-asap/

Now we see that on January 21 a group of authors from ten European countries has published a similar proposition in The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00150-1/fulltext

We are happy that others are joining the choir, the more, the merrier.

We wish to thank all those who picked up our previous suggestions for their response. We are convinced this strategy is the ONE to work, if correctly applied in a disciplined way. This means to stick to the strategy for a while to get to a better 2022.

We are encouraging everyone interested to get into contact with us. Let yourselves be consulted.

MOMENTARY SITUATION:

Today, globally we are counting more than 100 million infected and a whopping 2.2 million deaths. The US report 26 million infected and more than 430,000 deaths. The UK is counting 3.8 million infected and more than 100,000 deaths. Germany is reporting more than 2.2 million infected with 55,000 casualties. These numbers are stunning, the pandemic is raging on. There is no end in sight. New emerging mutants will contribute to this.

These are the currently reported case numbers for Germany. Since there had been reporting errors in the past, actual numbers may be higher. Case numbers are depending on the number of tests and immediate reporting.

It is obvious that the so-called “lockdown” is not sufficient to significantly decrease infection numbers in a fast way. There are too many exceptions, the economy is running as usual (without any proper risk mitigation). Roads are packed, most people are mobile as ever. The public transportation, one more driver of the pandemic, is being ignored in the current measures.

In our post on January 11, we had explained that a half-hearted approach will lead to the virus obtaining more mutations that might take hold. Viruses are masters of adaptation and escape. Our politicians are playing with fire.

Fighting a pandemic is only possible in a global way, with a lot of effort. This is starting in individual countries, extending to a continent, and finally worldwide. There is some hard work waiting for the president of the United States Joe Biden and his vice president Kamala Harris in this pandemic. Hope and expectations are high. We are crossing our fingers. With much relief we see the reentry of the US into the WHO and the Paris Climate Agreement. We are looking forward to a science-based action against the pandemic. Tony Fauci and many other US colleagues are being listened to, finally.

To repeat again: The situation is very serious, the strategy needs to be adjusted. There is no more time for games, for compromises, for sales talk, for manipulation. No more time for negotiations.

THE CENTRAL QUESTION IS: How can the pandemic be fought successfully in Germany and Europe?

This requires mid- and long-term strategic planning. People are tired of the short-term tactics of the 16 state governors. Without a cooperation of the populace, the pandemic cannot be defeated.

Now, in the year 2021, we have got this one chance!

Why? The viral evolution and the resulting emergence of new mutants is breathing into our necks. This is the driving force. Should we fail to reduce case numbers drastically in a given time frame, we shall lose the race against this virus. What would be the consequences? New mutants will spread almost at the same time on most continents. These will include mutants that are better at spreading in aerosols, that might be more aggressive or more deadly, and our arsenal of weapons is stretched very thin. An adjustment of vaccines and their production will take months again. Thus, it is imperative to act preventively.

Three possible scenarios may be envisioned for 2021 and 2022:

1. The governors will continue their tactics and react in a two-week schedule with halfhearted measures. The result will be seen in case numbers and deaths. With such tactics the virus will continue to rage.
2. Measures are being prolonged or tightened gradually. As soon as an arbitrarily chosen incidence number is reached (i.e. 50) measures are being lifted. Immediately, case numbers will soar again. Such a strategy is leading into a yo-yo effect which is damaging economy and society alike.
3. A country-wide shutdown of all non-essential areas is imposed. Thus, within several weeks, case numbers will decline drastically. In order to then reach a goal of ZERO incidence, there need to be two more components: First, a nationwide vaccine campaign covering all age groups. Second, making use of warmer temperatures in spring and summer, while keeping up all the mitigation measures. The latter one was missed in summer 2020, with all the known consequences.

The goal for 2021 must be a massive reduction of case numbers, if possible, down to an incidence rate of ZERO. Only with a ZERO incidence rate, all the measures may be lifted. Once the incidence rate is higher than zero, the yo-yo effect will ensue since the virus is not gone.

This is feasible, if everybody is cooperating on all levels with strict discipline. To that end, we do have three tools at hand. Vaccine campaigns, emergency care, and nonpharmacological interventions. The first two are in the hands of medics and hospitals. The third one is in the hands of politicians and the people. This third tool is the sharpest of all three. But even the sharpest knife needs to be applied in the right manner.

THE 18 – STEP PLAN FOR 2021:

1. The vaccine campaign needs to be applied nationwide and across Europe as efficiently as possible. Stick to the EMA vaccine recommendations. Note: It is to be expected with a newly developed vaccine to see a rocky start. It was important to wait for a regular approval, who would like to get a non-tested vaccine?
2. An efficient shutdown, including most of the economy, will drastically reduce infection numbers. It puzzles us, how in a pandemic the economy is expected to grow.
3. Home office needs to be followed more rigorously. Childcare centers are still being occupied by 90%.
4. Schools and childcare facilities need to stay closed, since each place of encounters is giving the virus an opportunity to spread. Children may learn from home for a while. The state of Bremen has shown that it is possible to provide kids with tablets. Ask the manufacturers for some donations. Unfortunately, schools, teachers, and public authorities are exhibiting a depressingly low amount of inspiration and commitment.
5. Travel, for whatever reasons, in times of a pandemic is just a foolish idea. Stay at home! Note: In 2020 every 4th travel took place. There were a mere 10 % less traffic accidents, this means people kept 90 % of their mobility. This is not a lockdown!
6. Public transportation is one of the biggest and closest areas of interaction. Thus, it is necessary to close it in a real shutdown period, until the goal is reached.
7. Protective measures, such as N95 masks, 6 ft. distance, heightened hygiene need to be applied everywhere, all the time. Violations need to be sanctioned, there are no exceptions.
8. Quarantine rules need to be adhered to. In case of a quarantine, the complete household is under quarantine, not just one person. Should this one person be infected, all members may get infected, and thus the virus may spread to other households as well. Anything else is just useless for a real quarantine.
9. We would even suggest random checks of the quarantine and measures. Violations need to be severely penalized since they are putting public health at risk.
10. Tests and monitoring need to be ramped up. This includes home tests as well as medical tests. Regular tests of personnel in all institutions, companies, who need presence is a must. Daily tests of all personnel and visitors in hospitals and nursing homes we consider a prerequisite already now. Everything else is just careless.
11. Every positive medical test needs to be sequenced. Denmark is leading the way here. Thus, a spread of emerging mutants may be identified early. This needs to be communicated at once to be able to react locally, nationwide, and if needed at the borders.
12. This is enabling a dense monitoring. Only this way, we are able to react quickly to new viral variants, and only so in a European effort with fast communication. A spread of new variants may only be fought by prevention.
13. This strategy may work, if in the coming spring and summer seasons restrictions stay in place to reduce contacts. Consequently, in spring and summer, N95 masks need to be worn in closed spaces, where a safe distance is not possible. This includes offices, factories, public transportation, shops, schools, childcare centers, every place of people gathering. This, in combination with a wide-spread vaccination campaign and the warmer temperatures may help us to reduce the incidence rate to ZERO. However, ALL of us need to stick to the mitigation measures and rules.
14. Measures need to be coherent to be understood. At the moment, nobody is having a clue as to what rules apply in what area. This is chaotic. Some of the measures are nonsense.
15. Communication needs to improve. Politicians, authorities, and the media need to make a better job. Education campaigns about properly dealing with the situation would help. We advice involving prominent people. Where are our “stars”?
16. There will be no early re-opening after a ZERO incidence is reached. Only after two weeks of constant ZERO, a controlled, nationwide relief of the measures may be envisioned.
17. There is a desperate need for the development of new antiviral drugs. Without new and efficient drugs, an enduring long-term treatment of infections is not possible.
18. Finally: It is important that EVERYONE is sticking to ALL the points made here. Do your best! There should be ample motivation to do so.

We NEED to use all tools at hand to prevent the virus from escaping again with new mutations.

Thus, infection numbers need to go down massively. Each infection is giving the virus an opportunity to change. Therefore, the measures must not be lifted too early again. A complete lifting of restrictions can only happen with ZERO incidence. That is the goal for 2021.

WHAT THEN?

If we keep the foot on the brakes for two weeks after reaching ZERO incidence, slowly re-opening all areas, we will still experience local outbreaks – but at a low rate. Where there is no virus, there is no outbreak.

HOWEVER: You should be aware that there is no going back to (carefree, self-indulgent) life as before the pandemic. The virus is here to stay. It is a question of how we want to live with it. In a constant threat of new variants? In a constant yo-yo in society and economy? Or with sporadic local outbreaks that are brought under control quickly using a monitoring system and early warnings.

In Europe we finally learned the lesson to wear face masks during the “cold-season” in the future.

From 2022 on we expect annually adjusted coronavirus vaccinations, for the virus will continue to circulate. Should we succeed to push back the virus in 2021, this will work as for the annual Influenza shots.

We are aware that only a fraction of the population will take a vaccine. Thus, there will be outbreaks with many infected and numerous deaths. Here, a broad arsenal of antiviral drugs may help to avoid unnecessary suffering.

For questions we are available.

One further comment: We are not inhumane, as it might seem to lay people reading this post. We are just as normal as you are, but we are dealing with this virus for a year now, using all our decades long accumulated know-how to find a way to defeat this virus. The measures we are suggesting are hitting us as well personally, our friends and families. But we are aware of the fact that this virus is using every opportunity to let the situation escalate. This virus is bringing with it two features: It is mutating quickly, becoming more dangerous, and escaping any monotherapy. And it is capable of repeated infections. There is no way around, we need to use all our tools to get rid of this virus as best we can. That is the only way to return to a “normal” life, with seasonal protective measures.

Yours, Sabine and Jörg

SAJO is consulting all around infectious diseases. We are applying our know-how, that we have acquired in more than 20 years. We do what we can to fight this pandemic.

SAJO – for a healthy world and better future!

CALL: We are all in desperate need of new antiviral drugs to defeat SARS-CoV-2 with all its future mutants. SAJO offers THE key technology to enable this timely. Should you seek an opportunity to invest, please feel free to do so, in order for us to develop antivirals and to make progress at a faster pace.

This post is No. 150. To our delight our blog is receiving a lot of acceptance, we love to share our knowledge. Single posts and contents are being adopted by others, also in media. We have learned how to correctly make a citation; this we would wish from others in return as well. Please feel free to share the link – it is an informative tool to fight this pandemic.

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