The COVID-19 pandemic: key considerations for the epidemic and its control
The COVID-19 pandemic: key considerations for the epidemic and its control
复制标题
DOI：
10.1111/apm.13141
复制
发表时间：
2021-07-01
期刊：
影响因子：
2.8
通讯作者：
Simonsen, Lone
中科院分区：
文献类型：
--
作者：
Orskov, Soren;Nielsen, Bjarke Frost;Simonsen, Lone
对持续的COVID-19大流行的反应以严厉的措施和太多的重要未知数为特征，例如真正的死亡风险、儿童作为传播者的角色以及人口免疫力的发展和持续时间。疫情爆发一年多来，我们已经学到了很多东西，对这种新型流行病的见解和控制方案正在形成。使用历史透镜，我们回顾我们所知道的和仍然不知道的关于正在进行的COVID-19大流行。由冠状病毒家族成员引起的大流行是继世纪多的甲型流感大流行之后出现的新情况。然而，最近的大流行威胁，如2003年爆发的相关和新型致命冠状病毒SARS和2012年以来爆发的MERS，已将冠状病毒列入世卫组织的优先疾病蓝图清单。与大流行性流感一样，SARS-CoV-2具有高度传播性（R-0类似于2.5）。此外，它可以在雷达下飞行，由于广泛的临床谱，其中无症状和症状前感染者也传播病毒，包括儿童。COVID-19比季节性流感致命得多;来自中国的初步数据显示，病死率为2.3%--与1918年致命的西班牙流感相当。但是，尽管西班牙流感杀死了年轻人，否则健康的成年人，但老年人死于COVID-19的风险极高。我们回顾了现有的感染率血清流行病学证据，并计算了丹麦（0.5%）、西班牙（0.85%）和冰岛（0.3%）的感染死亡率（IFR）。我们还推断，人口年龄结构是关键。SARS-CoV-2的特征是超级传播，因此，大约10%的感染个体产生80%的新感染。这种现象被证明是病毒的致命弱点，这可能解释了我们迄今为止有效缓解疫情的能力。这场大流行将如何结束？由于非药物干预措施的强烈缓解，欧洲尚未实现群体免疫;例如，在第1波和第2波中，只有约8%的丹麦人感染。幸运的是，我们现在有几种安全有效的疫苗。全球疫苗对大流行病的控制在很大程度上取决于我们是否有能力跟上病毒当前和未来的免疫逃逸变体。因此，我们应该为疫苗更新和病毒突变之间的竞赛做好准备。社会的永久重新开放在很大程度上取决于赢得这场比赛。
The response to the ongoing COVID-19 pandemic has been characterized by draconian measures and far too many important unknowns, such as the true mortality risk, the role of children as transmitters and the development and duration of immunity in the population. More than a year into the pandemic much has been learned and insights into this novel type of pandemic and options for control are shaping up. Using a historical lens, we review what we know and still do not know about the ongoing COVID-19 pandemic. A pandemic caused by a member of the coronavirus family is a new situation following more than a century of influenza A pandemics. However, recent pandemic threats such as outbreaks of the related and novel deadly coronavirus SARS in 2003 and of MERS since 2012 had put coronaviruses on WHOs blueprint list of priority diseases. Like pandemic influenza, SARS-CoV-2 is highly transmissible (R-0 similar to 2.5). Furthermore, it can fly under the radar due to a broad clinical spectrum where asymptomatic and pre-symptomatic infected persons also transmit the virus-including children. COVID-19 is far more deadly than seasonal influenza; initial data from China suggested a case fatality rate of 2.3%-which would have been on par with the deadly 1918 Spanish influenza. But, while the Spanish influenza killed young, otherwise healthy adults, it is the elderly who are at extreme risk of dying of COVID-19. We review available seroepidemiological evidence of infection rates and compute infection fatality rates (IFR) for Denmark (0.5%), Spain (0.85%), and Iceland (0.3%). We also deduce that population age structure is key. SARS-CoV-2 is characterized by superspreading, so that similar to 10% of infected individuals yield 80% of new infections. This phenomenon turns out to be an Achilles heel of the virus that may explain our ability to effectively mitigate outbreaks so far. How will this pandemic come to an end? Herd immunity has not been achieved in Europe due to intense mitigation by non-pharmaceutical interventions; for example, only similar to 8% of Danes were infected across the 1(st) and 2(nd) wave. Luckily, we now have several safe and effective vaccines. Global vaccine control of the pandemic depends in great measure on our ability to keep up with current and future immune escape variants of the virus. We should thus be prepared for a race between vaccine updates and mutations of the virus. A permanent reopening of society highly depends on winning that race.