COVID-19: Where do we come from and where are we heading?

Abstract

It will be a little over a year since the first cases of COVID-19 were described. The pandemic has affected us all, but the discussion about the real impact on people's lives is going to take decades. It is also to be expected that its effect on the way we relate to each other, the way we care for patients and the patterns of education, production and work will persist for years, in the same manner that other pandemics (such as HIV or H1N1) have changed human behavior.

Hopefully, the positive side effects of the pandemic will also have a lasting influence. Undoubtedly, the infectious diseases field has managed to reaffirm its recognition as an indispensable, current and valid branch of medicine. In most of the country's cities, our specialists have been called upon to form local emergency committees and are the referents for the organization and adaptation of care services, with the daily support of the Argentine Society of Infectious Diseases (SADI).

In addition, infectologists and SADI are one of the strongholds of communication, ensuring clear, non-alarmist and evidence-based messages. For the first time, information has been so influential in a pandemic, not so much because of its volume but because of the harmful effects of misinformation, which the World Health Organization (WHO) called “infodemic.” This year, SADI provided more than 4,500 television and radio interviews and more than 80 webinars open to the community. We train journalists to avoid sensationalism, violence-laden news and stories focused only on the exception of those who do not comply with the rules. We work to prevent rumors from being replicated in the media and networks. But if we add the responses to the demands that everyone receives on a daily basis, plus the information, promotion and prevention activities, we could count them in millions. Which infectologist has not received a message, always headed by "sorry to bother you...", "I know you are busy, but..."? Fortunately, these messages always end with "thank you very much for all you do" as one of the many signs of appreciation.

Initially, the community's support for the health team was unconditional, although over time it began to waver. Discrimination and fear of contagion gave rise to unexpected reactions against health personnel, and then polarization and politicization sprouted easily in a field fertilized by people's weariness and frustration and the community's archaic need to find culprits and scapegoats.

But it will never be enough to acknowledge the efforts of our colleagues since the beginning of the pandemic. Stress due to uninterrupted work, fear of contagion and of infecting our families, sadness and guilt when a colleague falls ill, frustration and anger when personal protection material is lacking, or when we do not have the support of our institutions, and poor salary conditions are commonplace in the infectious diseases field. In addition, like everyone else, we suffer the uncertainty of when it will end, the impossibility of sharing weddings, birthdays and even funerals, as well as the economic consequences of the pandemic. But we count on the resilience expressed in the solidarity work, the satisfaction when our advice or proposed measures have an effect, and the joy reflected in the smiles of those who are discharged after having been hospitalized for weeks in critical areas.

This crisis, then, represents an opportunity to recognize the importance of a quality, universal and free public health system based on equity. Latin America is the most unequal region in the world, with 232 million people living in poverty, with little access to adequate food and quality health services. In Argentina, the social determinants of communities, the weakness of the diagnosis and epidemiological surveillance networks, and the lack of robust contact search and detection systems have limited the response. The pandemic forces us to discuss the urgency of health reform to ensure the continuity of a strong, less fragmented health response, with better financing and integrated with other social policies.

Good decisions are based on good information, and it has been very difficult to decide under such uncertainty. In this issue, we are proud to present original and locally produced information related to COVID-19 including, for example, a review of sexual practices during quarantine, a description of the disease in people with solid tumors, the efficacy of optimized antimicrobial use programs in the pandemic, and the importance of a better understanding of reinfection.

SADI reinforces the need for evidence-based therapeutic decisions. We understood from the first months of the year that the epidemic was very dynamic, that information changes, and that the old adage "primun non nocere" was more current than ever, but that -sometimes- urgency obliges to take measures with limited information. These actions should never be taken in response to social or media pressure, or as a way to replace public health measures to control transmission, and should be subject to ongoing scrutiny and review of evidence. The epidemic will remain a challenge, and social distancing, use of masks, hand washing and self-care to reduce risk exposures will continue to be basic measures. Expanded diagnosis, intensive contact tracing and isolation, and early reimposition of aggressive, short-term restrictions in case of outbreaks are the basis for epidemic control until mass vaccination programs are in place.

While we continue to seek more information, some things are already clearer than before:

• The virus will circulate for many months or years to come.
• Public health measures are the most effective in reducing the number of people affected and the number of deaths.
• With multiple studies still underway, it seems unlikely that we will discover the "silver bullet for treatment."
• The vaccines are effective, and preliminary data show that they are safe, although we do not yet know the duration of the induced immune response or the long-term molecular evolution of SARS-CoV-2.

A sense of fairness and empathy with the most vulnerable are the basis of solidarity. Argentina has shown great solidarity since the beginning of the pandemic, as in all other crises. We need to recreate a national meaning of this feeling, so typical of the identity of Argentines, in order to stop this epidemic together.