Pre-2020 Pandemic Plans
1 Examples of Pre-2020 Plans
Pre-2020 pandemic procedures weren't followed: "Worldwide, we are currently in an unprecedented situation with regard to the SARS-Cov-2 epidemic, where countries are using isolation and lock-down measures to control the spread of infection. This is a scenario generally not much anticipated by previous theory, and in particular, there has been little attention paid to the question of extinction as a means to eradicate the virus; the prevailing view appears to be that this is unfeasible without a vaccine."
2020 Aug 20: Stochastic extinction of epidemics: how long would it take for SARS-Cov-2 to die out without herd immunity?
https://www.medrxiv.org/content/10.1101/2020.08.10.20171454v3
"The COVID-19 pandemic has forced the global population to adopt several public health measures, including social distancing, environmental disinfection and use of personal protective equipment (PPE), which are still widely recommended although several vaccines are currently available."
2022 Jan 19: Facial masks vestibulitis: the risk of mismanagement in the COVID-19 pandemic
https://pubmed.ncbi.nlm.nih.gov/35075074/
"The Untold Story of the Birth of Social Distancing"
https://www.nytimes.com/2020/04/22/us/politics/social-distancing-coronavirus.html
China did not follow pre-2020 pandemic plans:
400 Studies About Mask Ineffectiveness, Mask Mandates, Mask Harms, Lockdowns, and School Closures, courtesy of Paul Elias Alexander of the Brownstone Institute
Joint plan between the United States, Canada, and Mexico:
"Centers for Disease Control and Prevention (CDC) . . . performed confirmatory testing and rapidly produced a strain-specific laboratory test. Test kits and protocols were quickly distributed to international virology laboratories for use in identifying cases. Although laboratory testing capabilities were rapidly developed, low sensitivity field testing methods and changing case definitions led to uncertainty and potential misdiagnosis in the early days of the pandemic."
"During Pandemic (H1N1) 2009, mitigation measures employed for residents of border and non-border communities included keeping people educated, asking sick people to exercise voluntary personal preventive measures when attending large events or traveling, and to stay home when possible. Although these measures did not contain the pandemic, they may have mitigated its impact. The quick decision of Canada, Mexico, and the United States to keep the borders open and minimize travel restrictions limited disruptions of travel and trade, avoided panic, and saved resources."
-Only mention of masks, social distancing, quarantine is in regarding to countries sharing their plans for implement personal protective equipment
-No mention of border closure, travel restrictions, entry/exit testing
2013 North American Plan For Animal and Pandemic Influenza
https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/nml-pndmc-nflnz/index-en.aspx
https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/nml-pndmc-nflnz/nml-pndmc-nflnz-eng.pdf
"Good practice for strategic planning: There is a legal framework for the deployment of pandemic response measures, e.g. regulatory approval and procurement of pandemic vaccines and other pharmaceutical countermeasures, social distancing measures, emergency release of budget.
"Pandemic plans that take into account ethical aspects, such as prioritisation of clinical treatment or vaccine, provision of pandemic vaccine to healthcare workers, handling of conflicts of interest, possible infringement of basic human rights in pandemic response, extent of medical professionals’ duty of care."
"Non-pharmaceutical interventions (NPIs) may help reduce transmission of the pandemic virus and may be especially important in the first months of a pandemic when there is no pandemic vaccine available . . . the measures implemented should . . coordinated under the provisions of Decision No 1082/2013/EU, whether they pertain to international travel and trade, personal protection or social distancing. It should be noted that the evidence-base for the effectiveness of many NPIs is weak. This, as well as acceptability, feasibility and legal framework for implementation differs between countries and should be taken into account in national planning."
-No mention of masks, travel restrictions, border closures, quarantines, lockdowns, entry/exit testing
Guide to revision of national pandemic influenza preparedness plans Lessons learned from the 2009 A(H1N1) pandemic, European Center for Disease Prevention and Control, World Health Organization Regional Office for Europe
https://www.ecdc.europa.eu/sites/default/files/documents/Guide-to-pandemic-preparedness-revised.pdf
1.1 2019 WHO Global Influenza Programme
"The human rights of free movement should be considered, as should the adverse economic effects"
"governments are entitled to implement public health measures to protect the health of their populations during public health events respecting three golden rules, which are that such measures must be based on scientific principles, respect human rights, and not be more onerous or intrusive than reasonably available alternatives.
"face masks have, at best, a small effect on influenza transmission"
"Not recommended in any circumstances: Quarantine of exposed individuals, contract tracing, border closure, internal travel restrictions, entry and exit screening"
Source: 2019 WHO Global Influenza Programme: Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza
https://apps.who.int/iris/bitstream/handle/10665/329438/9789241516839-eng.pdf?ua=1
1.2 2019 Johns Hopkins Center for Health Security Preparedness
"Once a candidate drug or vaccine has been developed, it must then go through clinical trials to test for safety and efficacy. However, as was demonstrated in the 2014 2016 Ebola epidemic in West Africa, trials in the midst of an outbreak will be logistically and ethically challenging. Moreover, many countries maintain their own paradigm for pharmaceutical regulation and have not put in place policies for emergency use of medical countermeasures that may not have full regulatory approval. These complexities could slow international MCM deployment, which could impede efforts to control a severe disease outbreak."
"NPIs often require addressing additional considerations or challenges to implement. For example, quarantine requires strict adherence to be effective, so it works best when government has a trusting relationship with the public. Quarantine and other movement restrictions also involve legal and ethical considerations and should be supported by available evidence to prevent undue burden on affected individuals."
"Widespread use of masks and respirators by the public would be complicated by the challenges of proper fit, the costs, and the inability of the supply chain to provide masks at that scale."
"The implementation of border closures and travel bans may give governments more credibility among their own citizens for attempting to stop the outbreak, but historical evidence and modeling and public health experts would argue such measures would be unlikely to substantially add to disease control efforts."
"For high-impact respiratory pathogens, contact tracing would quickly become infeasible."
"In the context of a high-impact respiratory pathogen, quarantine may be the least likely NPI to be effective in controlling the spread due to high transmissibility."
"Quarantine measures will be least effective for pathogens that are highly transmissible, have short incubation periods, and spread through true airborne mechanisms, as opposed to droplets."
"travel restrictions have also been employed by countries as a political or social measure to abate fear rather than a necessary public health measure."
-No mention of entry or exit screening
Source: 2019 Johns Hopkins Center for Health Security Preparedness for a High-Impact Respiratory Pathogen Pandemic
https://apps.who.int/gpmb/assets/thematic_papers/tr-6.pdf
1.3 2019 Australian Health Management Plan for Pandemic Influenza
The Australian pandemic response plan begins with an "ethical framework" which considers people's liberty, "ensuring that rights of the individual are upheld as much as possible,” as well as people's privacy and confidentiality, saying it's “important and should be protected.”
Face Masks
-Face mask effectiveness: “No evidence. Very few studies have been undertaken about the effectiveness of PPE in reducing infection in the community.”
-No mention of mask wearing by healthy individuals
-"Mask wearing by symptomatic individuals in the community," a measure with criteria that "[t]his measure may be considered by individuals when the disease has a high clinical severity."
-Masking risk "increased indirect transmission through constant touching and adjusting of wet masks"
-"Poor compliance is likely. It is particularly difficult to keep masks on young children."
-"There is a case for wider use of masks early in the pandemic, when the clinical severity of the disease may not be well known."
Closures, Distancing, and Quarantines
-School closures: “Not recommended”
-Proactive school closures: "Not generally recommended"
-Reactive school closures: "Not recommended"
-Workplace closures: “Not generally recommended”
-Canceling mass gatherings: “Not generally recommended”
-Internal travel restrictions: "Not recommended in general as benefits are likely to be minor"
-Working from home: "This measure should be considered for pandemics with a moderate to high clinical severity, and where home working can be reasonably accommodated. Home working may not be practical for many workplaces
-Social distancing: "the available evidence is weak" . . . "The evidence concerning the overall effectiveness of isolating cases is moderate. It is limited to a small number of modelling studies that tried to measure the impact of isolation of affected cases at home." "Compliance and benefits with social distancing measures are likely to be highest when disease is clinically severe."
Testing
-Entry screening: "As screening methods are not effective in detecting cases, border nurses will not have a significant impact on preventing transmission from imported cases."
-Exit screening: "Not recommended as effectiveness is likely to be low and costs are likely to be high"
-Thermal scanners: "Not recommended as effectiveness is likely to be low"
Vaccination
-"The public’s perceived risk-benefit profile for vaccination is likely to be dynamic, becoming less favourable over the course of a pandemic response."
-"Acceptability will depend on public perception of the impact of the pandemic and candidate vaccine safety."
1.4 2018 Pan-Canadian Planning Guidance for the Health Sector
"Ethical decision-making – ethical principles and societal values should be explicit and embedded in all decision-making, including the processes used to reach decisions. It is especially important to ensure that all actions respect ethical guidelines tailored to the concerns of public health, while respecting the rights of individuals as much as possible."
"Some measures, like hand hygiene and respiratory etiquette, are applicable in all pandemics. Other measures (e.g., proactive school closures and travel restrictions) might be used only in moderate- to high-impact situations, as they can be associated with significant societal and economic costs."
"Border and travel measures—These interventions include provision of travel health advice, screening of travellers and travel restrictions. Evidence for their effectiveness is limited and their implementation would depend on the risk assessment and resultant risk/benefit analysis of the actions being considered."
"exercising powers under the Quarantine Act to protect public health by taking comprehensive measures to help prevent the introduction and spread of communicable diseases in Canada. Such measures may include, but are not limited to, the screening, examining and detaining of arriving and departing international travellers"
"The overall impact of the pandemic vaccine strategy will depend on vaccine efficacy and uptake, as well as the timing of vaccine availability in relation to pandemic activity."
"the novel virus could be resistant to antiviral medications and/or pandemic vaccine production could be delayed or unsuccessful. The extent of vaccine uptake and adoption of public health measures is also unknown. Furthermore, interventions could have unintended consequences."
"Because of their potential societal impact, social distancing measures are most applicable in pandemics of moderate to high impact."
"Levels of public awareness and understanding and risk perception, along with level of trust in health authorities, could affect degree of adoption (and therefore potential effectiveness) of preventive behaviours such as infection prevention behaviours, social distancing, and uptake of vaccine and antiviral medications."
-No mention of masks
2018 Planning Guidance for the Health Sector, Pan-Canadian Public Health Network
1.5 2017 CDC Community Mitigation Guidelines
"Personal protective measures reserved for pandemics include voluntary home quarantine of exposed household members and use of face masks in community settings when ill."
"However, little evidence supports the use of face masks by well persons in community settings"
"CDC might recommend the use of face masks by ill persons as a source control measure during severe, very severe, or extreme influenza pandemics when crowded community settings cannot be avoided"
"CDC does not routinely recommend the use of face masks by well persons"
"Carefully considering and justifying any restrictions on individual freedom needed to implement voluntary home quarantine"
"CDC generally does not recommend voluntary home quarantine of exposed household members"
"CDC generally does not recommend use of face masks by ill persons"
"CDC generally does not recommend social distancing measures"
"CDC generally does not recommend modifications, postponements, or cancellations of mass gatherings"
"the evidence base for the effectiveness of [social distancing] measures is limited"
"The updated 2017 planning guidelines do not address pandemic vaccine development and distribution, use of respirators in community or health care settings during a pandemic, or travel restrictions during a pandemic."
-No mention of border closure
-No mention of contact tracing
-No mention of human rights
Source: 2017 CDC Community Mitigation Guidelines to Prevent Pandemic Influenza in the United States
https://www.cdc.gov/mmwr/volumes/66/rr/pdfs/rr6601.pdf
1.6 2011 UK Influenza Pandemic Preparedness
"Although there is a perception that the wearing of facemasks by the public in the community and household setting may be beneficial, there is in fact very little evidence of widespread benefit from their use in this setting."
"The economic, political, and social consequences of border closures would also be very substantial, including risks to the secure supply of food, pharmaceuticals, and other supplies."
"Given the two to three day incubation period for pandemic influenza, there is no evidence of any public health benefit to be gained from meeting planes from affected countries or similar pro-active measures such as thermal scanning or other screening methods. Such measures are largely ineffective, impractical to implement, and highly resource intensive."
"The development of a new pandemic-specific vaccine can only begin once the new pandemic influenza viral strain has been identified and isolated."
"it is not realistic to expect that vaccination with a pandemic-specific vaccine will have an impact during the first wave of an influenza pandemic"
"The primary aim of vaccination is to protect the individual who receives the vaccine."
Source: 2011 UK Influenza Pandemic Preparedness Strategy
2007 Responding to pandemic influenza: The ethical framework for policy and planning
"1. Respect. This principle means that:
- people should be kept as informed as possible
- people should have the chance to express their views on matters that affect
them
- people’s personal choices about their treatment and care should be respected as
much as possible"
"2. Minimising the harm that a pandemic could cause. During a pandemic, some harm is likely to be unavoidable. This principle means that there is a need to:
- minimise the disruption to society caused by a pandemic."
"6. Keeping things in proportion. This principle means that:
- those responsible for providing information will neither exaggerate or minimise
the situation and will give people the most accurate information that they can
- decisions on actions that may affect people’s daily lives, which are taken to
protect the public from harm, will be proportionate to the relevant risk and to the benefits that can be gained from the proposed action."
"7. Flexibility. This principle means that:
- plans will be adapted to take into account new information and changing
circumstances
- people will have as much chance as possible to express concerns about or
disagreement with decisions that affect them."
"8. Good decision-making. ii. Inclusiveness. This means that those making decisions will:
- take into account all relevant views expressed
- take into account any disproportionate impact of the decision on particular
groups of people.
iii. Accountability. This means that those responsible for making decisions are answerable for the decisions they do or do not take."
"iv. Reasonableness. This means that decisions should be:
- based on appropriate evidence
- practical – what is decided should have a reasonable chance of working."
2007: Responding to pandemic influenza The ethical framework for policy and planning
1.7 2007 WHO Ethical Considerations in Pandemic Responses
Ethical considerations in developing a public health response to pandemic influenza, World Health Organization, 2007 WHO released guidance on ethical considerations during pandemics in 2007:
"Many critical ethical questions arise in pandemic influenza planning, preparedness and response. How can surveillance, isolation, quarantine and social-distancing measures be undertaken in a way that respects ethical norms?"
"efforts to protect individual rights should be part of any policy. Measures that limit individual rights and civil liberties must be necessary, reasonable, proportional, equitable, non discriminatory, and in full compliance with national and international laws"
"Public health measures that involve significant costs and/or burdens should be reserved for situations where they can be reasonably expected to make a difference to the consequences of a pandemic."
"Countries have an obligation to minimize the burden of disease on individuals and communities, but they must do so in a way that is respectful of individual rights and liberties. The need to balance the interests of the community and the rights of the individual is of particular importance in the implementation of public health measures such as isolation, quarantine, social distancing and border control. While all of these measures can legitimately be attempted in order to delay the spread or mitigate the impact of an influenza pandemic, the burden they place on individual liberties requires that their use be carefully circumscribed and limited to circumstances where they are reasonably expected to provide an important public health benefit."
"governments should establish coherent and transparent communication policies that articulate how such international efforts are grounded in ethics and human rights."
Ethical considerations in developing a public health response to pandemic influenza, World Health Organization, 2007
https://www.who.int/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2c.pdf
2 Sweden Followed Pre-2020 Plans with Success
"Sweden: Despite Variants, No Lockdowns, No Daily Covid Deaths"
https://www.aier.org/article/sweden-despite-variants-no-lockdowns-no-daily-covid-deaths/
"Sweden’s no lockdown covid response is often called an “experiment.” This is utterly false, and it’s easy to prove."
https://threadreaderapp.com/thread/1406736935687753730.html
"Children are generally considered less likely to develop severe COVID‐19 disease and represent a low proportion of diagnosed cases."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242453/
"In total, 68 Swedish hospitals reported 10 991 pediatric surgical or diagnostic procedures in the selected period of 2020 compared to 18 006 in the matched weeks of 2019. This amounts to 7015 fewer procedures during the pandemic and, therefore, a reduction in the total number of 39.0%. The reduction in elective cases was 53.7% (6819 fewer cases, p < .001)."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242453/
"From the onset of the COVID-19 pandemic, the Public Health Agency, Folkhälsomyndigheten (FHM), embarked on a de-facto herd immunity approach, allowing community transmission to occur relatively unchecked.4 No mandatory measures were taken to limit crowds on public transport, in shopping malls, or in other crowded places, while recommending a limit of 50 people for gatherings5 as of March 29, 2020. Coronavirus testing, contact tracing, source identification, and reporting, as recommended by WHO,6 were limited and remain inadequate.7 In our view, there is still not sufficient recognition in the national strategy of the importance of presymptomatic and asymptomatic transmission, aerosol transmission,8, 9 and use of face masks."
COVID-19 and the Swedish enigma, December 22, 2020
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32750-1/fulltext
"It has downplayed the roles of asymptomatic spread, aerosol transmission, children as potential source of infection, and the use of face masks. It has maintained an approach that mainly builds on recommendations to take voluntary actions, guided (in our view) more by public opinion than by sound public health policy. The media has played a crucial role in this pandemic response, mostly lacking in investigative journalism and failing to question or hold the public health agency accountable, with some exceptions.2 Dagens Nyheter, a major newspaper, recently exposed3 Sweden's large inequities in COVID-19 deaths across income, education, and origin of birth—data that should have informed the national strategy from its inception."
The Swedish COVID-19 strategy revisited, April 19, 2021 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00885-0/fulltext
"Italy had installed a national lockdown, minimised outdoor activities, and imposed restrictions on international travel and public gatherings. In contrast, Sweden had adopted a less restrictive strategy, permitting outside activities to take place, and allowing gatherings of up to 50 persons, while restricting international and non-essential travel (Habib, 2020). South Korea was able to bring the transmission of COVID-19 under control through more targeted measures, avoiding a national lockdown and instead increasing the deployment of COVID-19 testing and contact tracing(COVID-19 and the Long Road to Herd Immunity | Hub, n.d.)(Ritchie et al., 2020a)."
"There is no size fits all in the analysis of the COVID-19 response. Italy had to impose a restrictive measure to ensure that the healthcare system had resources and time to combat the outbreak. Italy has an increasingly elderly population with comorbidities who were vulnerable to the virus and had attributed to the increased death toll. On the other hand, Sweden had placed the responsibility back onto the individual and were able to secure public health compliance. It is apparent that Sweden was able to adopt the strategy which may not be appropriate to replicate in other EU member states. South Korea was able to afford lessened restrictions due to the high-volume testing. With low contact high volume tracing, cases could be isolated and there was less reliance on other measures making the restrictions more sustainable."
"the death toll for Italy is significantly higher when compared to Sweden and South Korea."
December 2021: Health Ineqalities Cast Studies, COVID-19 Response: Comparative Case Study Between Italy, Sweden, and South Korea, European Public Health Alliance
https://epha.org/wp-content/uploads/2021/12/hi-casestudy-covid19response.pdf
"Sweden's controversial non-lockdown COVID-19 policy appears to be paying off as positive cases hit a new low. While infection rates in other European cases are surging, Sweden recorded a rolling seven-day average of 108 yesterday - its lowest since March. Sweden has reported 5843 pandemic deaths - one of the world's highest due to a big spike at the start of the pandemic."
Sweden's relaxed pandemic policy 'vindicated' as cases hit new low, September 16, 2020
3 Unprepared Africa Beats COVID
2018 study evaluated the pandemic response plans of 47 African countries which were made in response to the WHO's calls for new pandemic plans after the 2009 H1N1 outbreak.
"Of the 47 countries in the WHO African region, a total of 35 national pandemic plans were evaluated. The composite score for the completeness of the pandemic plans across the 35 countries was 36%. Country-specific scores on each of the thematic indicators for pandemic plan completeness varied, ranging from 5% in Côte d’Ivoire to 79% in South Africa. On average, preparation and risk communication scored 48%, respectively, while coordination and partnership scored the highest with an aggregate score of 49%. Surveillance and monitoring scored 34%, while prevention and containment scored 35%. Case investigation and treatment scored 25%, and ethical consideration scored the lowest of 14% across 35 countries. Overall, our assessment shows that pandemic preparedness plans across the WHO African region are inadequate."
"Most importantly, although often forgotten in the majority of the preparedness plans is the need for ethical considerations. Our study indicates that, with the exception of one plan (South Africa), no other plans reported having an ethical framework in place. There is an expectation that during a pandemic influenza outbreak, ethical issues will arise due to conflicting interests between civil liberties (i.e. violation of human rights) and population health (i.e. greatest good for the greatest number) [20]. In the absence of an ethical plan, it is difficult to respond appropriately to ethical dilemmas and this can constitute a threat to preparedness and response. We propose that all countries develop an ethical framework that can be used to address ethical problems such as these of rationing limited vaccines or failure by health care-workers to work on the bedside during the pandemic."
November 2018: Pandemic influenza preparedness in the WHO African region: are we ready yet?
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3466-1
South Africa's Feb. 2020 preparedness and response plan did not include guidelines for mask wearing by non-healthcare workers, social distancing, border closures, travel restrictions, entry/exit testing, quarantines, lockdowns, or herd immunity via vaccination.
2020 Republic of South Africa Pandemic Response Plan https://www.westerncape.gov.za/assets/departments/health/FP/national_preparedness_plan_covid-19_draft.24.02.2020.pdf
Nigeria's 2013 response plan does not mention use of face masks by non-healthcare workers, border closures being effective, internal entry/exit testing, quarantines for asymptomatic, lockdowns.
Nigeria National Pandemic Influenza Preparedness and Response Plan September 2013
https://ncdc.gov.ng/themes/common/docs/protocols/16_1490369515.pdf
"The morbidity and mortality were statistically significantly less in the 31 countries using CDTI [community-directed treatment with ivermectin]. The recovery and fatality rates were not statistically significant difference. The average life expectancy was statistically significantly higher in the non-endemic countries."
Why COVID-19 is not so spread in Africa: How does Ivermectin affect it?
https://europepmc.org/article/PPR/PPR303143
No mention of hydroxychloroquine or HIV antivirals: "Africa has attracted tremendous attention, due to predictions of catastrophic impacts that have not yet materialized. Early in the pandemic, the seemingly low African case count was largely attributed to low testing and case reporting. However, there is reason to consider that many African countries attenuated the spread and impacts early on. Factors explaining low spread include early government community-wide actions, population distribution, social contacts, and ecology of human habitation."
"The phenomenon of trained immunity may be tempering the COVID-19 burden in the continent."
"Relatively low severity and death due to COVID-19 in Africa presents somewhat of a paradox [41,42,187]. Despite early ‘doomsday’ predictions for Africa, the continent succeeded in stemming the first wave of SARS-CoV-2 spread [188], although the second wave was more severe [21]."
"It is likely that SARS-CoV-2 has already been widely disseminated through Africa, yet evidently without having had the severe consequences of COVID-19 burden, such as the significant uptick in hospitalizations and deaths that many other regions have experienced [25]. If so, widespread infection is likely to also result in widespread natural immunity [197]."
"Now, as the pandemic evolves, the vaccine rollout needs to be especially accelerated to reach more people, as the continent lags with less than 5% of its population having received at least one shot as of August 2021 [201]."
What Could Explain the Lower COVID-19 Burden in Africa despite Considerable Circulation of the SARS-CoV-2 Virus?
https://www.mdpi.com/1660-4601/18/16/8638/htm
No mention of hydroxychloroquine, ivermectin, or HIV antivirals: "Recent data estimates that the African continent has accounted for just 4.1% of the total of 4.3 million deaths due to COVID-19. Earlier on in the pandemic, scientists had predicted a COVID-19 catastrophe in Africa, which is much more severe than what has actually been observed across the continent. South Africa is an exception and accounts for 35% of the confirmed cases and 42% of total deaths reported in 55 countries of the African continent."
"The extensive spread and high disease burden were predicted based on transmission dynamics of the virus, socioeconomic deprivation, unsanitary living conditions, and poor healthcare systems throughout the African continent. Several small studies have been conducted in different parts of Africa, but these results were not validated in an Africa-specific context. Cross-reactivity with other micro-organisms and hypergammaglobulinemia due to malaria exposure may affect the sensitivity/specificity of these tests. This could further lead to underestimation or overestimation of seroprevalence."
"Some studies have argued that factors like the demographic profile and early actions (e.g., lockdowns) are responsible for the lower COVID-19 burden, but there are still many questions unanswered."
"Why is the COVID-19 transmission rate low in Africa? Many governments in Africa acted early to contain the pandemic, and on 22nd April 2020, the World Health Organization highlighted examples of how Africa was leading the global response. Measures such as early border closures, less international connectivity, and lockdowns helped lower the caseload."
"healthcare facilities are quite poor in the continent, and a third wave or the emergence of more infectious variants may severely challenge public health in this region. Vaccination remains a challenge, and less than 5% of the African people have received at least one vaccine dose. This is undoubtedly the area that needs immediate attention and improvement."
No mention of hydroxychloroquine nor HIV antivirals: "In the capital as in much of Zimbabwe, the coronavirus is quickly being relegated to the past, as political rallies, concerts and home gatherings have returned. “COVID-19 is gone. When did you last hear of anyone who has died of COVID-19?” Ndou said. “The mask is to protect my pocket,” he added. “The police demand bribes, so I lose money if I don’t move around with a mask.”"
Scientists are mystified, and wary, as Africa avoids COVID-19 disaster
Africa followed China's response, and no mention of hydroxychloroquine, ivermectin, nor HIV antivirals: "In response to the COVID-19 pandemic these countries closed their borders and airports, implemented screening for SARS-CoV-2 at port of entry, and introduced a mandatory 14-day quarantine for returning travellers. These SSA countries issued national guidelines on recommended safety measures, initiated immediate contact tracing, prevented mass gatherings, instituted national lockdown and curfew, closed schools and urged the private sector and the government personnel to work from home."
Addressing Africa’s pandemic puzzle: Perspectives on COVID-19 transmission and mortality in sub-Saharan Africa
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499400/
"Instead of rising during the pandemic to slow the spread of COVID-19, new CCP research finds that handwashing rates actually fell in parts of sub-Saharan Africa."
"“People are exhausted and perhaps not as likely to be as assiduous with prevention measures as they were at the beginning of the pandemic,” she says. “It’s imperative that we need to find ways to cut through that and remind people how important it still is to wash their hands, wear face masks and physical distance from one another.”"
November 15, 2021: In Midst of COVID-19 Pandemic, Handwashing Rates in Africa Fell
https://ccp.jhu.edu/2021/11/15/handwashing-rates-africa-pandemic-covid/
No mention of hydroxychloroquine, ivermectin, nor HIV antivirals:
"COVID Vax Rates in Africa Are Low But Region Avoids Worst, Leaving Scientists Baffled"
No mention of hydroxychloroquine, ivermectin, nor HIV antivirals:
"Scientists mystified, wary, as Africa avoids COVID disaster"
No mention of hydroxychloroquine, ivermectin, nor HIV antivirals: "AFRICA HAS SUFFERED FEWER COVID-19 DEATHS THAN PREDICTED. RICHARD WAMAI KNOWS WHY."
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