In most countries, there has been virtually no marked change in
mortality rates, some increase in mortality in the USA (from 5.1 to
5.86%), Germany (from 3.07 to 4.69%), Norway (from 1.31 to 2.8%), was
statistically unreliable (OR: 0.833 (95% CI, 0.262-2.642), p=0.756;
0.600 (96% CI, 0.147-2.433), p=0.475; and 0.33 (95% CI, 0.35-3.150),
p=0.337) respectively.
The persistence of a stable level of lethality in coronavirus disease
seems to be due to the difficulties of etiopathogenetic treatment of
this viral infection. The existing methods of medical treatment are
extremely variable, the drugs used were mostly recommended by the
principle of ”repositioning” drugs and imply the search for drugs for
the treatment of a new disease among the substances already studied in
clinical trials or used in clinical practice [9]. Almost to this
day, there are no drugs whose effectiveness has been proven by the
results of randomized controlled trials and meta-analyses. An example is
the recent WHO recommendations not to use chloroquine/hydroxychloroquine
that are not based on strong evidence in the treatment of coronavirus
disease. 96,032 patients with COVID-19 from 20.12.2019 to 14.04.2020
were analyzed for the effectiveness of treatment in 671 hospitals on 6
continents [10].
10,698 (11.1%) of them died in hospitals, 14,888 patients formed 4
groups: within 48 hours after diagnosis, they began receiving
chloroquine (1,868), chloroquine with macrolides (3,783),
hydroxychloroquine (3,016) and hydroxychloroquine with macrolides (6,221
patients). 81,144 patients did not receive treatment for any of the
schemes made up the control group. In the control group, the mortality
rate was 9.3%, in the group receiving hydroxychloroquine - 18%,
hydroxychloroquine with macrolides - 23.8%, chloroquine - 16.4%, and
chloroquine with macrolides - 22.2%.
Scientists from South Korea have screened about 3,000 approved drugs and
found substances potentially effective against SARS-CoV-2 and considered
niclosamide and cyclosonide the most promising [9]. The genomes of
SARS-CoV and SARS-CoV-2 viruses coincide by 79.5% , and therefore the
authors suggested that drugs that suppress SARS-CoV may also be
effective against SARS-CoV-2 [57].
Out of 3,000 molecules, 35 were identified that inhibit SARS-CoV-2. In
the course of the experiment Vero cell culture (normal kidney cells of
African green monkey) was treated with the drug, and then infected with
SARS-CoV-2. 24 hours after the infection the immunofluorescent cell
analysis was carried out with antibody that recognized SARS-CoV-2
nucleo-capsid protein - it was identified as the most significant 2
medications. Niklozamide, an antihelminthic drug used in tapeworm
infestation, was very active against SARS-CoV-2 (IC50 semi-maximum
inhibition concentration - 0.28 µM) and was effective against a wide
range of viruses, including SARS-CoV and MERS-CoV. Ciclesonide, an
inhaled corticosteroid, is used to treat bronchial asthma and allergic
rhinitis, although its activity was significantly lower against
SARS-CoV-2 (IC50 - 4.33 µM).
Possible reasons for the lack of reduction in mortality can be a gradual
reduction in the resources of medical organizations, health care in
general, the growing shortage of medical personnel due to their
morbidity, mortality, physical, moral and psychological fatigue, lack of
proper material and moral support.
In April, the unemployment rate in Sweden reached 7.9%, excluding
seasonal factors - 8.2%. Bloomberg analyst Johanna Jeneson forecasts
that unemployment will rise to 17%. Thus, the Swedish economy, which
refused to impose a strict quarantine, did not help.
Analysts of the Financial Times, comparing the mortality during the
pandemic in 13 countries in March-April 2020 with the average for the
same period in 2015-2019, noted an increase of 49% in 2020: in France
34%, Italy 90%, the Netherlands 40%, Spain 51%, Belgium 60%, Sweden
only 18%.
But according to countrymeters.info, in January-March 1,580 people per
day died, in 2019 - 1,586 people per day. In USA in the first three
months of 2020, 4,477 people died per day, and in 2019 - 7,458 people
died per day. Spain - 1,098 and 1,105, Germany - 2,400 and 2,410, Russia
- 5,538 people per day (including from COVID-19 - 450 people) in 2020
and 5,563 people per day in 2019.
The infection rate in the Russian Federation in the middle of March was
at the level of 3, 15 May - 0.9, for a full economic life 0.5 is
required. As of May 15, 2020 in 28 regions the coefficient was
<1, in 9 - about 3.
Hospitalized on May 20, 2020 in Russia - 109 thousand people, 2,500 - in
the ICU. By severity: heavy - 4.2%, medium - 34.9%, light - 60.9%. Of
the specialized 165,290 beds, 110 thousand (66%) are used, 92% of the
beds with ventilators are not occupied. Thus, 2.29% of patients with
COVID-19 were hospitalized for intensive care and resuscitation. On the
one hand, the high percentage of unused, especially expensive beds is a
serious, additional burden on health care, which certainly contributes
to growth, ”accumulation” of patients waiting for planned, especially
surgical treatment. But on the other hand, the complexity and
unpredictability of the epidemiological process, the emergence of new
outbreaks, justifies the over-deployment of infectious beds, at least
until the infection rate < 1.0, after the ”plateau” of
morbidity has been completed and the decline began.
By 25 May 2020, 3,807 people had died from COVID-19 in Russia, which
would have been about 14.64% of all deaths in 2019 in Russia due to
pneumonia (26,000).
In 2019, the total mortality rate in the Russian Federation from all
diseases was 1.2%, and from coronavirus during the pandemic period was
0.98-1.05%. Thus, in the structure of total lethality, deaths from
coronavirus may be 0.21% (3,807 deaths from COVID-19 as of 26.05.2020
for a total of 1,800,000 deaths in 2019).
Concomitant diseases and infections lead to an increase in the severity
of respiratory viral infections and mortality [11]. Most deaths
during the 1918 influenza epidemic were caused by subsequent bacterial
infection, especially Streptococcus pneumonia [11].
Poor outcomes of the 2009 H1N1 flu pandemic were also associated with
subsequent bacterial infections [12].
In the current COVID-19 pandemic, 50% of patients who died had
secondary bacterial infections [13], with both bacterial and fungal
infections reported [14].
Patients with COVID-19 are on an invasive ventilator for a long time (on
average, 9.1 days), which increases the likelihood of developing
hospital- and ventilator-associated infections.
It is important to prevent the second wave of the epidemic, which is
predicted by many virologists in autumn-winter 2020.
In Berlin, scientists suggest tightening the quarantine at 30 newly
infected per week, then the extreme color of the epidemiological
”traffic light” turns on, at 20 per 100,000 - warning yellow. The second
factor - the coefficient - is the so-called coronovirus reproduction
index, i.e. the number of people infected by one infected person. Only
when this coefficient is < 1.0 can the epidemic be kept under
control. If for 3 days in a row 1 infected person will infect 1.1
healthy - the color of yellow is turned on, at a factor of 1.2 - red
”traffic light”, the third criterion - the number of beds for heavy
patients with COVID-19 in the intensive care and intensive care units in
the clinics. In the ”quiet period” 9% of the beds are occupied, if this
indicator reaches 15% - yellow will light up, at 25% - red color of
the epidemiological ”traffic light”
(http://p.dw.com/p/3cAza).
With two yellow signals at 3 ”traffic lights”, the Berlin (Senate)
management begins a thorough analysis of the situation, and with two red
signals, it decides whether to introduce quarantine restrictions again,
if yes, which ones.
Obviously, apart from these figures, it is important to monitor the
dynamics of the epidemiological process.
German scientists have summed up the first results of the fight against
COVID-19 in the country (DW-Breaking World News, 20.05.2020) and among
the key factors to contain the coronavirus epidemic in Germany, they
call the decisive actions of the authorities, on the one hand, and the
loyalty of the population to the decisions of the authorities, on the
other. Now, after the easing of restrictive measures, in places of mass
appearance of people, such measures as thermometry in front of the
entrance to shops, mandatory hand disinfection, issuing masks to all
visitors and inside the building, social distance is maintained.
According to German scientists (prof. Karl Gustav Karus University
hospital Michael Albrecht) the new coronavirus has nothing to do with
ARVI or flu. COVID-19 in the worst case affects not only the lungs, but
also other internal organs, causes severe immunological reactions in
them, affects the central nervous system. Scientists believe that the
widely discussed problem of lack of ventilators is just one aspect of
the treatment of patients with COVID-19. Thanks to the cancellation of
public events and the prohibition of human contact, the spread of
infection in Germany was stopped
(http://p.dw.com/p/3cAza).
Similar experiences in the fight against the pandemic in Austria, the
Czech Republic, China, Russia have also shown the effectiveness of such
restrictive measures (morbidity, mortality, etc.).
According to various virologists from England and Germany, the pandemic
may last for another one to two years. It is believed that COVID-19, on
the one hand, will not disappear, and on the other, will not become an
obstacle to the normalization of life, which will occur due to
vaccination or the acquisition of immunity by the population naturally
[7].
According to computer simulations of the pandemic from Johns Hopkins
University, which were developed under the condition that antiepidemic
measures were maintained or introduced, quarantine measures could be
withdrawn in most countries no earlier than August-September 2020.
The emergence of the experimental vaccine and its application to the
vaccination of medical personnel is predicted in November 2020, and mass
vaccination in spring 2021 [8].
One of the most common models for predicting the development of
epidemics is SIR, which was developed in the late 1920s (an acronym
formed from the first letters of the words ”susceptible”, ”infected” and
”recovered”) [15].
The essence of the SIR model is that the entire population is divided
into the susceptible – those who may be infected, those who are
actually infected and recovered.
Several variations of the models have been developed to date, including
SEIR, where E means exposed, i.e. infected with the virus during the
incubation period (contact). These people have already been infected,
but the symptoms of the disease are not yet apparent. According to the
SEIR model, susceptible people first become infected, then the
incubation period lasts for some time, after which they develop symptoms
and eventually recover or die. In the case of COVID-19, infected people
can infect others before symptoms appear, which makes the virus
particularly contagious (the incubation period of the coronavirus is on
average 5-6 days) [16].
The infectivity (pathogenicity) of the virus is measured using the index
(coefficient) of basic reproduction – RO, if it is equal to 1.0, then
each person infects another person, and that person then passes the
virus to another person, and so on.