AHI COVID-19 Information

Being vaccinated does not mean that we can throw caution to the wind and put ourselves and others at risk, particularly because vaccinated people can be infected and transmit COVID-19 to others. Research is still ongoing into how much vaccines protect people against disease severity and death.

Recommended reading: Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

Rule of five:

What we know about COVID-19

It is a very serious systemic disease with potential long term impact on general health. COVID-19 is a multi-system disease, meaning that it can trigger a huge range of health problems [1]. (Learn more)

We are still learning about immunity to COVID-19. Most people who have been infected with COVID-19 have develop an immune response within the first few weeks.

We don’t know how strong or lasting the immune response is, or how it differs from one person to another. Apparently, the level of antibodies that can destroy the virus peaked about three weeks after the onset of symptoms, then swiftly declined.

There have been reports of people vaccinated or infected with COVID-19 to have been infected for a second time.

Watch for symptoms of COVID-19 and self-isolate.

If you have a continuous cough, fever, loss of taste and smell, fatigue, headaches, muscle pains, diarrhoea, confusion, loss of appetite and shortness of breath, which are among the wide range of symptoms of COVID-19, or if you have tested positive for COVID-19, you should self-isolate. Self-isolation means when you do not leave your home.

This helps stop the virus spreading to other people.

Recommended teaching approach

Currently, school children are major driving of COVI-19 infection.

Making wearing mask at school compulsory would have a significant impact in controlling the spread of COVID-19.

e.learning

In countries where schools are closed, AHI CIO advocates the delivery of education through local radio stations and television channels because in many localities children do no have access to internet and nearly everyone in the world has a radio or television at home. (Learn more)

What should be considered when deciding to close or reopen schools?

Deciding to close, partially close or reopen schools should be guided by a risk-based approach to maximise the educational and health benefit for students, teachers, staff and the wider community, while helping to prevent a new outbreak of COVID-19 in the community. Elements to consider in a general health-risk assessment include epidemiological factors, health-system and public-health capacities, community engagement, and government capacity to sustain social and economic support for the most vulnerable. (Learn more)

Recommended measures for school reopening

The AHI Health-Promoting School (HPS) model includes several approaches recommended by the WHO to address the COVID-19 pandemic. These can facilitate a risk-based approach at the local level by offering standard operating procedures and checklists for schools, based on scientific evidence and social conditions. The following strategies and adaptations should be in place wherever possible: (Learn more)

Continuation of Dental Services

The COVID-19 pandemic has unnecessarily affected the delivery of dental health services across the world. The World Health Organisation (WHO) declared the COVID-19 outbreak to be a global pandemic on 11th March 2020, prompting the closure of dental services worldwide.

A major reason for this was the infection risk associated with Aerosol Generating Procedures (AGP), such as the use of high-speed drills.

Minimum Intervention Dentistry (MID), the modern biological approach to the control of dental caries, offers a cost-effective solution to the delivery of dental services during and after the COVID-19 pandemic. (Learn more)

Affordable Health Initiative

COVID-19 is a social-psychological behaviour disease: brief comments on the approach to controlling the COVID-19 pandemic.

Professor Wagner Marcenes 

The biological pathway for controlling the pandemic is unlikely to be more effective than the pathway of social-psychological behaviour.

March 2020 [amends in italic]

COVID-19 is a very serious multi-system disease, meaning that it can trigger a huge range of health problems (Noris, Benigni, & Remuzzi, 2020). COVID-19 disease originates in the lungs causing severe shortness of breath, coughing and fatigue (Varga et al., 2020). This is a result of the severe inflammatory host immune response that affects the lungs, diminishing oxygen uptake which results in endotheliitis and thrombotic events and intravascular coagulation (Noris, Benigni, & Remuzzi, 2020). Additionally, endothelial cell involvement was identified across the vascular system of different organs in a series of patients with COVID-19 (Varga et al., 2020), which may explain the multiorgan damage (Noris, Benigni, & Remuzzi, 2020). COVID-19 affects the biological functioning of vital organs by causing cardiac, acute kidney and brain injuries (Noris, Benigni, & Remuzzi, 2020; Varga et al., 2020; Yachou et al., 2020). The latter can cause long-term psychosis, delirium, anxiety and confusion (Zhang et al. 2020; Heneka et al. 2020; Serrano-Castro et al., 2020). Symptoms may be permanent as these biological changes are irreversible (Noris, Benigni, & Remuzzi, 2020). As the number of COVID-19 survivors increases, it is becoming evident that in addition to respiratory disease, COVID-19 has long-term consequences threatening other organs.

The COVID-19 pandemic seems to be out of control in many countries as surveillance systems which are used to monitor the Coronavirus Disease 2019 (COVID-19) pandemic shows. Indeed, there is an urgent need of a more effective global strategy to control the COVID-19 pandemic.

The biological pathway for controlling the pandemic is unlikely to be more effective than the pathway of social-psychological behaviour. As with the HIV/AIDS epidemic, many people at risk of contracting COVID-19 will not have access either to a vaccine, or to the drugs required for prevention and treatment – the biological pathway for controlling the pandemic. If success was achieved in the fight against HIV (UNAIDS, 2010; Halperin et al. (2004), this was thanks only to prevention efforts; although antiretroviral medications are now available in many developing countries, providing medication to millions of people would have been an overwhelming drain on government health resources (UNAIDS, 2010). Zimbabwe’s approach to preventing HIV transmission succeeded only because of its focus on behavioural change (Halperin et al. 2011), a situation mirrored in Uganda (Stoneburner & Low-Beer, 2004; Hallett et al., 2006), urban Kenya (Hallett et al., 2006), urban Haiti (Hallett et al., 2006), Dominican Republic (Halperin et al., 2009) and Thailand (Nelson et al., 1996). If HIV is now contained, this has had nothing to do with a vaccine, for which we are all still waiting. Instead, it was achieved thanks to a shift in sexual behaviour (Halperin et al., 2004), underpinned by massive campaigns in favour of protected sex. Convincing people to wear masks in public places and keep a two-metre physical distance to slow the spread of COVID-19 should be a far easier task than convincing people to wear condoms for sex. Promoting COVID-19-safe behaviour is feasible, if we take lessons from successful approaches to address other epidemics.

Even if a vaccine is produced [now developed], it is unlikely to be manufactured in sufficient quantity to immunise the world’s population. Furthermore, in countries where the vaccine will be available to all, people still need to agree to take it. Anti-vaccine groups are well mobilised against a vaccine that has the potential to save millions of lives, while anti-science groups dismiss all scientific information out of hand. Self-styled ‘freedom-lovers’ forget that liberty must be balanced against fair play, and that the concept of freedom does not stretch to jeopardising others’ lives. It is a fact that countries whose leaders disregard the behavioural factors associated with the COVID-19 pandemic are leading the world in numbers of deaths. In such nations, where levels of social inequalities are also pronounced, death has become commonplace. People in the poorest neighbourhoods in affluent countries are up to four times more likely to be killed by the virus compared with those in the richest areas (Office for National Statistics, England).

The major challenge in containing the pandemic and prevent it from becoming a disease of the less affluent citizens is, therefore, the choice of a global approach in promoting population-wide behavioural change. The behavioural pathway for controlling the pandemic must not discount the well-demonstrated theory that social conditions are the fundamental cause of health inequalities. This enduring association stems from the fact that higher socio-economic position embodies an array of resources, such as money, knowledge, prestige, power and beneficial social connections, that protect health no matter what mechanisms are relevant at any given time; it takes resources to avoid risk (materialistic pathway) and adopt protective health behaviour (Phelan, Link & Tehranifar, 2010). Social psychological theories and research on intergroup relations, including prejudice, discrimination, stereotyping, stigma, and threats to social identity, contribute another explanation for the presence and persistence of health inequities (Major, Mendes, & Dovidio, 2013).

The latter examples of intergroup relations lead to social exclusion (Major, Mendes, & Dovidio, 2013), which manufactures a breakdown in society. The dynamics of interaction between socio-economic barriers and intergroup relations play a major role in the transmission of COVID-19. Societies characterised by fragmentation will struggle to control the pandemic; those, in contrast, with satisfactory levels of social capital, characterised by strong interpersonal relationships and community engagement, shared trust, and high levels of reciprocity, are more likely to succeed (socio-psychological pathway). Only with concerted efforts by governmental and nongovernmental organisations and strong engagement by the population will the COVID-19 pandemic be controlled globally.

To that end, a holistic approach that foregrounds human values is urgently required. It is in human nature to adopt protective behaviours for survival and to preserve the species; therefore, it is reasonable to expect that a comprehensive approach towards promoting the adoption of safe behaviour by individuals – in order to protect themselves, their families and their communities – would be effective. Social conditions (materialistic pathway) explain, in part, variations in the distribution of diseases, yet some degree of health inequality remains even after accounting for differences in structural and economic factors (Major, Mendes, & Dovidio, 2013). It is for this reason that the psychological determinants of behaviour change (psychological pathway) must be considered.

To effectively develop public-health behavioural-change interventions to protect the world population from the COVID-19 disease, policymakers need to move beyond the outdated belief that risk-awareness programmes alone lead to behavioural change. Instead, the socio-economic barriers (materialist pathway) must be addressed as a priority, concurrently with the psychological determinants of behavioural change. Explanatory theories, particularly from psychology, must be the foundation for developing population behavioural change. Addressing the synergistic contributions of the materialist and the psychological pathways, and focussing on the processes associated with health inequities, can significantly improve the effectiveness of behavioural change approaches, thus helping to rein in the COVID-19 pandemic at population level.

Amid attempts to control the COVID-19 pandemic, nearly all research funding has been allocated to biological research, while social and behavioural sciences have been neglected. Although clinical trials are vital for developing both drugs and vaccines, it is equally important to carry out social science research in order to emphasize and further understand the socio-psychological determinants of protective-behaviour adoption – including willingness to take a vaccine. This understanding may hold the key to controlling the COVID-19 pandemic. COVID-19 is a social-psychological behaviour disease.

References

Hallett TB, Aberle-Grasse J, Bello G, Boulos LM, Cayemittes MP, et al. (2006). Declines in HIV prevalence can be associated with changing sexual behavior in Uganda, urban Kenya, Zimbabwe, and urban Haiti. Sexually Transmitted Infections, 82, 1–8.

Halperin DT, de Moya A, Perez-Then E, Pappas G, Garcia Calleja JM (2009). Understanding the HIV epidemic in the Dominican Republic: A prevention success story in the Caribbean? Journal of Acquired Immune Deficiency Syndromes, 51, 52-59.

Halperin DT, Mugurungi O, Hallett TB, et al. (2011). A surprising prevention success: why did the HIV epidemic decline in Zimbabwe? PLoS Medicine, 8(2)e1000414.

Halperin DT, Steiner MJ, Cassell MM, Green EC, Hearst N, et al. (2004). The time has come for common ground on preventing sexual transmission of HIV. Lancet, 364, 1913–1915.

Heneka MT, Golenbock D, Latz E, Morgan D, Brown R (2020). Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimer’s Research & Therapy. 12(1), 69.

Johns Hopkins University of Medicine (2020), Corona Virus Research Center. Retrieve from https://coronavirus.jhu.edu/map.html on 08.12.2020.

Major B, Mendes WB, Dovidio JF (2013). Intergroup relations and health disparities: a social psychological perspective. Health Psychology, 32(5), 514-524.

Martos B, Arrabal-Gómez C, Rodríguez de Fonseca F (2020). Impact of SARS-CoV-2 infection on neurodegenerative and neuropsychiatric diseases: a delayed pandemic? Neurologia, 35(4), 245-251.

Nelson KE, Celetano DD, Eiumtrakol S, Hoover DR, Beyrer C, et al. (1996). Changes in sexual behaviors and a decline in HIV infection among young men in Thailand. The New England Journal of Medicine, 335, 297–303.

Noris M, Benigni A, & Remuzzi G. (2020). The case of complement activation in COVID-19 multiorgan impact. Kidney International, 98(2), 314-322.

Office for National Statistics, England. Deaths involving COVID-19 by local area and socioeconomic deprivation. Retreated from https://www.gov.uk/government/statistics/deaths-involving-covid-19-by-local-area-and-socioeconomic-deprivation-may-2020

Phelan JC, Link BG, Tehranifar P (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. Journal of Health and Social Behavior, 51, S28-40.

Serrano-Castro PJ, Estivill-Torrús G, Cabezudo-García P, Reyes-Bueno JA, Ciano Petersen N, Aguilar-Castillo MJ, Suárez-Pérez J, Jiménez-Hernández MD, Moya-Molina MÁ, Oliver-

Stoneburner RL, Low-Beer D (2004). Population-level HIV declines and behavioral risk avoidance in Uganda. Science, 304, 714–718.

UNAIDS (2010) Joint United Nations Program on HIV/AIDS. AIDS epidemic update. UNAIDS/07.27E/JC1322E. Geneva: UNAIDS; Retrieve from http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2009/default.asp. 

Varga Z, Flammer AJ, Haberecker M et al. (2020) Endothelial cell infection and endotheliitis in COVID-19. Lancet, 395(10224), 1417-1418.

Yachou Y, El Idrissi A, Belapasov V, Ait Benali S (2020). Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurology Science, 41(10), 2657-2669

Zhang XY, Huang HJ, Zhuang DL, Nasser MI, Yang MH, Zhu P, Zhao MY (2020). Biological, clinical and epidemiological features of COVID-19, SARS and MERS and AutoDock simulation of ACE2. Infectious Diseases of Poverty, 9(1):99.

Population (Herd) Immunity

Population immunity against COVID-19 should be achieved by protecting people through vaccination, not by exposing them to the pathogen that causes the disease as sometimes done in animals.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General

COVID-19 is not a hoax (Learn more)

Self-styled ‘freedom-lovers’ forget that liberty must be balanced against fair play, and that the concept of freedom does not stretch to jeopardising others’ lives.

Professor Wagner Marcenes

Herd immunity' is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection. Population immunity is acquired when between 70% to 95% of the population have been vaccinated or infected, recovered and develop resistant to infection. Letting COVID-19 spread through populations to achieve herd immunity is a public health irresponsibility that led to a large number of death in the globe due to COVID-19 and an unnecessary high level of infections and suffering. Current level of vaccinated citizens is not sufficient to achieve population immunity.

Professor Wagner Marcenes

Where the government is not taking enough action against the COVID-19 pandemic, the community must organise to protect itself.

Communities should organise themselves rather than waiting for government mandates. Ideally, small communities (20-30 houses) should appoint one member to be in charge of disseminating COVID-19 information and monitoring the pandemic locally.

Every community should elect a small area “sherif” and they should carry out daily check-ups in all members for the symptoms of COVID-19, taking particular note of body temperature, with or without a history of fever or feeling feverish in the previous 24 hours.

Any person with symptoms, or who has been in contact with a person who has symptoms, should self isolate and stay in quarantine for seven days. This should be monitored locally and the community should ensure they receive the necessary support to stay home.

Local sherifs should notify national public health data system of COVID-19 cases.

Listed below are individual procedures that are highly relevant for controlling the COVID-19 pandemic. All should be adopted together:

• Get vaccinated as soon as a vaccine is available in your locality;

• Wear a properly fitted mask in public places to protect you and others;

• Use of a face-screen for personal protection, if you have briefing difficulties or medical conditions;

• Keep at least 1 metre physical distance from others - Non-contact greeting

• Frequently clean and disinfect the physical environment around you;

• Frequently wash your hands with soap and avoid touching your face;

• Use of a tissue to catch your cough or sneeze, bin it, then wash your hands with soap or disinfect them with a hand sanitiser

• Live and enjoy life safely.

Note: Individuals, communities and schools may produce masks and face-screens. Individuals may produce their own personalised masks and face-screens.

• Physical distance (minimum one meter) and lockdown is ideal but not always possible. Those who can work from home should stay home and those who cannot, should strictly follow the procedures listed above.