Italy fired the European warning shot, yet few countries took heed. International travel, ski trips and Fashion Week events were some of the vectors that allowed the virus to propagate to a global level by April 2020. Two figures stand out from my 26 February 2020 account: 300, the number of Italian citizens infected with the virus, and 12, the national death toll at the time. Two figures that in February gave the rest of the world a false sense of security as they looked on at the “Italian problem.” It was the tip of the iceberg. Within weeks countries followed suit toppling like dominoes, superseding Italy in fatalities.
To date the global number of covid-19 positive cases is 112m, with 2.49m deaths, of which Italy has had a total of 96,348 deaths. A year on, we are all in the same boat: all equal in the face of illness yet some more privileged than others when it comes to accessing care. The age-old tale of global health inequality we have yet to mend.
After a year of resilience, countries in the developed world possess the main weapons to tackle this virus. The question remains open regarding vaccine distribution to those less fortunate. At the start of 2020 it was evident that the world was unprepared for a pandemic of this scale; now that we have the tools, what is the WHO’s plan on a global level given that we have had a year to prepare for this moment?
Tremor before the earthquake
In Luxembourg, (most) citizens have finally accepted the efficacy of medical grade masks in reducing transmission, and our government has made mask wearing mandatory. Moreover, teleworking has become less demonised, and vaccines have marked the advent of 2021. We have made progress, albeit the fact that covid-safe behaviour only surfaced in Luxembourg in the second half of 2020. We--and certain other cities--have, by and large, been very sluggish to adapt to the pandemic, despite experiencing some of the lightest covid restrictions in Europe.
After a year of “extraordinary” press briefings, most of us will have developed an internal barometer for when the government is due to announce tighter covid-measures. In countries where the scientific rationale is clear, press briefings become ominous at the first spike in cases, after which there is the inevitable clamp-down to avoid the dramatic surge in cases that would otherwise ensue. Italy has demonstrated this reasoning time and time again in its year-long battle with the virus. In Luxembourg on the other hand, the correlation between the evidence, neighbouring country case spikes and local restrictions has been less clear.
Italy owes its later success in controlling cases to its iron-fisted approach. Following the exponential rise in cases in the first months of 2020, it underwent one of the most stringent lockdowns in Europe. Borders were heavily secured until May, and solely supermarkets for basic needs remained open. By late April certain regions had begun testing rigorously for covid-19 well before their European counterparts. The country now operates under a regionalised 3-tier colour-system (yellow, orange and red). The ICU capacity and Rt number of each respective region/town then dictate the area’s colour. In the strictest of these, the red zones ("zona rossa"), it is forbidden to socialise beyond one’s own household, coffee shops are shut after 6pm and gyms are completely closed. In schools, children who test positive must provide a negative test before returning to school. Vaccinations meanwhile are in line with the European norm, with those aged over 65, teachers and healthcare staff all fully vaccinated. Additionally, the government opted to extend the ban on movement (due to expire today) between regions until 27 March 2021.
Movement restriction
Why tighten travel bans when vaccinating is progressing so well? The Italian strategy follows a specific logic. Scientists have predicted that certain regions could see another spike in cases in the next three weeks. Why? A vaccine rollout needs to be as homogenous as possible, therefore it is paramount to avoid huge discrepancies between vaccination rates both within countries and between countries in the world. Failing to do so will only promote an increase in the number of viral mutations (variants). Restricting movement at this point in the pandemic does not remove personal freedom--rather it protects it and is crucial for the longer term.
We are facing the Herculean task of vaccinating entire countries as fast as possible. There is no race, but this virus will not be eradicated if the whole world is not treated. While the launch of the vaccines fills us with a sense of optimism that covid is at long last subsiding (and Luxair is urging you to escape), this is misleading. The B117 variant is still rife, highly transmissible and continues to spread at alarming rates. In the US some states prematurely rolled back mask mandates and welcomed potential indoor super spreader events. What we do now to stop viral spread determines whether it takes over and fills hospitals again in 2 months. We have yet to see the effects from the Carnival holiday exodus, and Easter remains to be another eventful period for hospitals and schools alike.
Speed
The UK along with the US, have been the quickest to deploy their vaccine campaign. Both are picking up speed, demonstrating promising results whilst doing so. Boris Johnson’s bold rhetoric could well mean that this year citizens could enjoy a great British summer--providing vaccinations go as planned, and travel is carefully controlled. With the UK a few steps ahead of Europe, their data will speak for itself in the coming weeks and could provide European leaders a canvas to follow. If results are favourable, we could see the advent of further country roadmaps with similar target dates highlighted.
Meanwhile, in Israel, Netanyahu states that 38% of the 9m citizens have received at least one vaccine dose to date. The “vaccination nation” plans on easing restrictions next month by opening shops, libraries and museums to the general public. Gyms and hotels will be allowed entry subject to covid vaccine status (vaccinated or Covid recovered). This strategy seems audacious, yet the results bolster the argument. Could this be where Europe will be headed in due course?
Coordination
Granted the poor attempt for a streamlined European vaccine roll-out was far from enviable. This said, some countries seem to have managed to muddle through better than others in the process--so much so that the German press has hailed these as an example of well-organised vaccinating.
Aptly entitled “Operation Freedom”, the Greek vaccine campaign is entirely digital and centrally run in real-time. Citizens are notified when their vaccine appointment is scheduled via SMS or email and so far, the country’s vaccination rate is 6.5% percent. The target is to fully vaccinate 80% or more of those aged 18 and over by September 2021. France allows its citizens to register online or via a telephone hotline, after which a centralised platform facilitates the vaccine appointments digitally. Over 1m citizens have completed their full vaccine course to date. The enablers of this slow success are that both countries prioritised the use of a digital platform early on and both invested in robust planning for the expected vaccine campaign. Any delays are due to vaccine shortages not to poor planning.
A healthy tourist is a safe tourist
Vaccine passports have been lingering in discussions regarding the summer period both in the UK and the US. Strong advocates for these include Cyprus and Greece, whose economies depend on tourism and 2021 will be no exception. Both countries have been vaccinating their over-65 cohorts with great success--yet governments remain ambivalent on the matter. Questions surrounding the legality and privacy of issuing such documents have been raised.
Epidemic of misinformation
Whilst inside hospitals medical staff battled the virus, another epidemic flourished within homes. With screen time rising, the tsunami of misinformation accessible to all is one of the biggest hurdles we have yet to overcome. Not only is it a detrimental force to the quality of scientific evidence being produced for the general public, but social media provides a dangerous platform that can easily propagate false and misleading information at the risk of the general population’s own health. This pandemic has demonstrated that medical professionals and scientists are no longer recognised or trusted as a source for valid information in health crises. We are at a stage where citizens would rather accept public health advice endorsed by an influencer than by a professional in the field.
People are fatigued, frustrated with mask-wear, aching to return to a normal life and with this comes complacency. The easiest solution becomes the most favourable and sitting in isolation has tested people’s limits. Those luckier, escape to sunnier destinations and succeed in spreading the virus further afield or manage to bring home something new. For these few that dare--many are tirelessly waiting and abiding at home. The virus is not done with us, nor does it tire. How we act now determines how soon we collectively get over this.
Dr Lilani Abeywickrama is a trained ophthalmologist. Her main interest is advocating for health, technology and medical affairs. She currently works in the field of health and medical management in Luxembourg.