Scientific Perspectives

The Black Death, also known as the Pestilence or the plague, was the most devastating pandemic recorded in human history, killing an estimated 100 million people worldwide between 1347 and 1351 (1). The lack of scientific knowledge about the etiology of the plague made almost impossible to control its spread. The common idea about how humans contracted the disease was the “punishment by God” for bad behavior. Little was known in those days about microorganisms or antibiotics. It was not until the late 1800s that Louis Pasteur will propose the idea that pandemics were the result of the transmission of microscopic living organisms. 

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The plague was caused by the bacteria Yersinia pestis, carried by fleas present in infected rodents. Fleas were transmitted to human through direct contact and the flea bite injected the bacteria into the human blood stream.

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By 1918 we knew about microorganisms, but this knowledge was not sufficient to prevent the spread of the most severe pandemic in recent history, influenza (2). This disease is caused by the H1N1 virus, and even to this date continuous to be an ominous presence. It is estimated that about 500 million people or one-third of the world’s population became infected with influenza (2). The number of deaths was estimated to be at least 50 million worldwide.

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Other epidemics and pandemics will follow in modern days, such as HIV-aids, cholera, SARS, MERS and now Covid-19. The common denominator is that the disease can spread silently and fast, resulting in the infection of a large population worldwide before the first public health measures for containment are taken. 

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In an era of great technological advances: instant worldwide communications, genetic engineering, massive genome sequencing, virtual and augmented reality and much more, we remained fragile against pandemics. Sometimes it seems even powerless.

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From a fast analysis of how pandemics have evolved in human history, becomes clear that a “magic bullet” (vaccine, treatment or otherwise) may not be sufficient to contain the spread of a pandemic once it has started, something else is required. But what is that something else?

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Analyzing how the Covid-19 pandemic is spreading may give us some hints about what that something else might be. It is evident that the goal during a pandemic is containment. To prevent the uncontrolled spread of the microorganism, several actions are required.

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The first one is to identify the threat as fast as possible, before the disease becomes an epidemic. History has taught us that once the disease is a full-blown pandemic, containment is almost impossible. In order to prevent the onset of the pandemic, one need to be able to identify the infected population in order to contain them as much as possible. To do this, we need to develop rapid, sensitive and accurate point-of-care diagnostics. Our research group has been pushing this need for the last 10 years, with poor success, I must admit (3). Governments and health authorities are busy with immediate needs, health coverage, insurance, etc. They do not want to hear about future threats that may or may not become a reality.

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In the current pandemic by SARS-Cov-2 the main problem of diagnostics is the long lines of potentially infected people waiting for hours (and spreading the virus) for their turn to be diagnosed. Daily news brings photographs and videos of hundreds of people waiting for hours for nasal swabs (Figure 1). 

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This strategy for massive diagnostics is not efficient and may be counterproductive during a pandemic. We need a reliable test that everyone can take at home and apply to their family members. Ideally this test will be smart enough to convey the result to health authorities via Wi-Fi or cellular communications (Figure 2). Ideally a nationwide mapping system will collect all the results from in-home diagnostics and provide real-time information for decision making and public health containment policies.

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This information can also be useful to determine how many intensive care units will be needed in each area or city, in the case of Covid-19 how many respirators and in which areas will be required. A system like this will help optimize resources, distribution of PPE (personal protective equipment) and impact less severely the economy of a country.

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I sincerely hope we can learn from the pandemics devastating results due to poor handling and misconceptions in human history. We need to face the next pandemic (and perhaps even the current one) with new ideas and science-based decision making. We must stop reacting to pandemics like humans did in the 18th century. We are facing a new virus, this is not H1N1, but Science has taught us that all pandemics behave similarly: they spread silently infecting widely and we tend to react too little or too late. 
 

References.

 

1. Bramanti B, Dean KR, Walløe L, Chr Stenseth N. Proc Biol Sci. 2019 Apr 24;286(1901):20182429. doi: 10.1098/rspb.2018.2429.

2. Taubenberger JK, Morens DM. Cold Spring Harb. Perspect. Med. 2019 Dec 30. doi: 10.1101/cshperspect.a038695.

3. Asanov A, Zepeda A, Vaca L. A platform for combined DNA and protein microarrays based on total internal reflection fluorescence. Sensors (Basel). 2012;12(2):1800-15. doi: 10.3390/s120201800.

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