Статья

Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

K. Farsalinos, K. Poulas, D. Kouretas, A. Vantarakis, M. Leotsinidis, D. Kouvelas, A. Docea, R. Kostoff, G. Gerotziafas, M. Antoniou, R. Polosa, A. Barbouni, V. Yiakoumaki, T. Giannouchos, P. Bagos, G. Lazopoulos, B. Izotov, V. Tutelyan, M. Aschner, T. Hartung, H. Wallace, F. Carvalho, J. Domingo, A. Tsatsakis,
2021

COVID-19 pandemic mitigation strategies are mainly based on social distancing measures and healthcare system reinforcement. However, many countries in Europe and elsewhere implemented strict, horizontal lockdowns because of extensive viral spread in the community which challenges the capacity of the healthcare systems. However, strict lockdowns have various untintended adverse social, economic and health effects, which have yet to be fully elucidated, and have not been considered in models examining the effects of various mitigation measures. Unlike commonly suggested, the dilemma is not about health vs wealth because the economic devastation of long-lasting lockdowns will definitely have adverse health effects in the population. Furthermore, they cannot provide a lasting solution in pandemic containment, potentially resulting in a vicious cycle of consecutive lockdowns with in-between breaks. Hospital preparedness has been the main strategy used by governments. However, a major characteristic of the COVID-19 pandemic is the rapid viral transmission in populations with no immunity. Thus, even the best hospital system could not cope with the demand. Primary, community and home care are the only viable strategies that could achieve the goal of pandemic mitigation. We present the case example of Greece, a country which followed a strategy focused on hospital preparedness but failed to reinforce primary and community care. This, along with strategic mistakes in epidemiological surveillance, resulted in Greece implementing a second strict, horizontal lockdown and having one of the highest COVID-19 death rates in Europe during the second wave. We provide recommendations for measures that will reinstate primary and community care at the forefront in managing the current public health crisis by protecting hospitals from unnecessary admissions, providing primary and secondary prevention services in relation to COVID-19 and maintaining population health through treatment of non−COVID-19 conditions. This, together with more selective social distancing measures (instead of horizontal lockdowns), represents the only viable and realistic long-term strategy for COVID-19 pandemic mitigation. © 2020 The Authors

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  • 1. Version of Record от 2021-04-27

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Об авторах
  • K. Farsalinos
    Laboratory of Molecular Biology and Immunology, Department of Pharmacy, University of Patras, Panepistimiopolis, 26500, Greece
  • K. Poulas
    School of Public Health, University of West Attica, L Alexandras 196A, Athens, 11521, Greece
  • D. Kouretas
    Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, 41500, Greece
  • A. Vantarakis
    School of Medicine, University of Patras, Panepistimiopolis, 26500, Greece
  • M. Leotsinidis
    Lab. of Public Health, Medical School, University of Patras, University Campus26504, Greece
  • D. Kouvelas
    Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
  • A. Docea
    Department of Toxicology, University of Medicine and Pharmacy of Craiova, Craiova, 200349, Romania
  • R. Kostoff
    School of Public Policy, Georgia Institute of Technology, Gainesville, VA 20155, United States
  • G. Gerotziafas
    Sorbonne Université, INSERM, UMR_S 938, Group de recherche « Cancer-Hemostasis-Angiogenesis », Centre de recherche Saint-Antoine, CRSA, Centre de Thrombose, Tenon-Saint Antoine, University Hospitals, Assistance publique Hôpitaux de Paris, France
  • M. Antoniou
    Gene Expression and Therapy Group, King's College London, Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, 8th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
  • R. Polosa
    Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, Catania, 97 95131, Italy
  • A. Barbouni
    Centro Prevenzione Cura Tabagismo, Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, 95123, Italy
  • V. Yiakoumaki
    Department of History, Archaeology and Social Anthropology, University of Thessaly, Volos, 38221, Greece
  • T. Giannouchos
    Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
  • P. Bagos
    Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, 35100, Greece
  • G. Lazopoulos
    Department of Cardiac Surgery, University Hospital of Heraklion, Crete, Greece
  • B. Izotov
    Department of Analytical Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, Moscow, 119991, Russian Federation
  • V. Tutelyan
    Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation
  • M. Aschner
    Department of Molecular Pharmacology, Albert Eisntein College of Medicine, 1300 Morris Park Avenue BronxNY 10461, United States
  • T. Hartung
    Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
  • H. Wallace
    Department of Pharmacology and Toxicology, University of Konstanz, Konstanz, 78464, Germany
  • F. Carvalho
    Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
  • J. Domingo
    UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, 4050-313, Portugal
  • A. Tsatsakis
    Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
Название журнала
  • Toxicology Reports
Том
  • 8
Страницы
  • 1-9
Ключевые слова
  • Article; community care; comorbidity; coronavirus disease 2019; disease surveillance; epidemic; health care system; home care; hospital admission; hospitalization; human; infection prevention; mortality rate; pandemic; patient satisfaction; primary medical care; priority journal; quarantine; seroprevalence; social distancing; virus transmission
Издатель
  • Elsevier Inc.
Тип документа
  • journal article
Тип лицензии Creative Commons
  • CC
Правовой статус документа
  • Свободная лицензия
Источник
  • scopus