An interesting correspondence by Hernandez published October 22, 2020 in The Lancet looks at the answers to this perplexing question. 

One of the most striking facts about the COVID-19 pandemic is the notable difference in approach, attitude, control measures, case incidents and mortality rates between Eastern and Western hemispheres. 

Results of a recent analysis show lessons to be learned from the experiences of these countries and regions.  The differences in approach and mortality could be explained, at least partially, if not totally by the misclassification of the infectious agent risk. 

WHO classifies microorganisms into four risk levels. 

Group four includes new or known agents for which there is no vaccine or treatment and which can spread at community level.  Ebola virus and variola virus are categorised as group four agents. 

Group three includes dangerous microorganisms such as mycobacterium tuberculosis but do have available antibiotic therapies and other well-known control measures. 

When SARS-CoV-2 appeared in Wuhan, China and other Asian countries, Australia, New Zealand put in place contingency plans against an infectious agent of the highest risk, not only in occupational health but also to protect the general population. 

Given the uncertainty about the nature and real risk of the threat, governments of these countries decided to take the strictest measures – the same measures that would have been used in the case of smallpox or plague.  For this reason, protective equipment similar to that used against Ebola was used.  The streets were disinfected with chlorine.  Patients with COVID-19 were separated from other patients in monographic centres.  Mandatory individual quarantines were ordered.  Collective quarantines in the form of lockdowns were implemented. 

By contrast, the Western approach, according to a supposed risk classification of group two or three, initially considered COVID-19 a new kind of influenza and determined that the general management of cases and contacts would be made in general hospitals in outpatient wards, without any type of mandatory quarantine or isolation in monographic hospitals.

The EEC debated in June 2020 the classification of SARS-CoV-2, categorising it as a group three agent.  This decision was strongly protested by members of the European Parliament, who disagreed and called for it to be a group four classification.  

Hernandez argues that if Europe and other countries in the Western hemisphere want to achieve an epidemiological trend similar to Asian countries, then SARS-CoV-2 should be considered an agent of maximum risk in all technical approaches, clinical settings and social levels. 

The London General Practice is happy to consult with patients who do not have COVID symptoms face to face.  The practice adheres to strict hygiene measures and all practitioners wear full PPE. 

For those with COVID-19 symptoms, the practice is happy to offer home testing and provide medical advice by video consultation.

Dr Paul Ettlinger
The London General Practice

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