key: cord-0903843-88k7pan1 authors: Memish, Ziad A.; Ebrahim, Shahul H.; Kattan, Rana F.; Alharthy, Abdulrahman; Alqahtani, Saleh A.; Karakitsos, Dimitrios title: Leadership to prevent COVID-19: is it the most important mitigation factor? date: 2020-11-20 journal: Travel Med Infect Dis DOI: 10.1016/j.tmaid.2020.101925 sha: be0a50b7d435e04dae09fb5dcd29b47600ed74bb doc_id: 903843 cord_uid: 88k7pan1 nan The word pandemic has an ancient heritage coming from the root "pan" (all) and "demos" (people) meaning that it affects us all. Underscored in this adage is both a responsibility and imperative for nations and leaders to synchronize their capacities to fight a common enemy to all of world's citizens. Recently, concerns were raised about the blurred political leadership responding to the novel SARS-CoV-2 disease that was observed in multiple countries both in developed and developing countries [1] . COVID-19 has created significant challenges for leaders at all levels across the world to address the two overarching priorities; respect and promote scientific advisories aimed at mitigating the pandemic, maintaining societal and economic functions [2] [3] [4] . A third priority also emerged in developed economies about upholding individual freedom of and consequently individuals being charged to make informed and socially beneficial decisions about individual contribution to disease control, irrespective of an individual being directly affected by the crisis [2] [3] . It is possible that the notion of individual liberties as overriding collective societal responsivities may have been corralled by the advocates of economic security over health security. From a disease control perspective, leaders that make policy errors by prioritizing economic progress and personal gain over pandemic mitigation has been the major limitation to global pandemic mitigation [5] . As outlined in the first comprehensive recommendations on pandemic mitigation and succeeding scientific discourse assert that pandemic mitigation is a combination of simultaneous synchronized approaches [6] [7] [8] . It is a combination of imperfect individual J o u r n a l P r e -p r o o f interventions, and combination makes them more effective. Focus on one approach or action by one country would not be sufficient. The failure of pandemic mitigation has dire consequences to the economy, national security, political security and by extension for future health security because we are facing a novel pathogen with a lot of unknowns [9] . Maintaining jobs and economic output are equally important as pandemic mitigation, but we know how to do this better than how to manage a pandemic derived from a novel pathogen. We know how to revive the economy and create jobs. Despite the unequal development trajectory of our nations, as was done by the Marshall Plan after the World War, collectively we do have the resources to achieve a vibrant economy and development. But, mortality and psychological impact of COVID-19 on individuals are irreversible. By ignoring science and the threat posed by the pandemic, we endanger the very platform we can use to rebuild our economies, leading to further exacerbation of the socioeconomic disparities between nations. The multifactorial blow of the COVID-19 outbreak on global health and economy remains to be fully elucidated. Moreover, the socio-economic and psychological impact of travel restrictions and lockdowns, which were imposed to reduce cross-border viral transmission, cannot be underestimated. A recent study projected that by the end of 2020 the impact of aviation losses might negatively reduce the World Gross Domestic Product up to 1.6%, while job losses may rise up to the value of 25-30 millions [10] . In retrospect, the data flow commotion between the Chinese government and the World Health Organization (WHO), at the beginning of the pandemic, might have been partially responsible for the delayed governmental responses in several Western countries. The WHO characterized the COVID-19 pandemic as a Public Health Emergency of International Concern with a purpose so as to accelerate a response, and showed decisive leadership by enhancing international partnerships through its Solidarity Fund/Trial, and the COVID-19 Supply Chain System [11] . The Solidarity trial facilitated recent developments such as the beneficial effect of low-dose dexamethasone therapy in critically ill patients with COVID-19 [12] . The WHO initiatives upgraded data and expertise sharing and boosted partnerships with countries and private foundations including financial support programs, and medical supply donations. However, gradually, it became apparent that the production of effective therapies against COVID-19, and the development of robust protective strategies (i.e., vaccines) would require governmental collaboration to overcome funding, and technical difficulties. Building up new platforms for molecular processing and developing standardized technologies for manufacturing novel medications requires effort, time, and multifaceted collaborations between active privateers and governments. Currently, the diversification in the development of vaccinations by pharmaceutical companies including launching "national vaccination products" cannot be excluded but may facilitate public's confusion and produce questionable scientific results. Therefore, combining projects and collecting our resources in a global effort to overcome the COVID-19 threat should have been a political priority. While the current pandemic is not a political issue per se, unfortunately, its death toll reflects war time statistics; hence inspirational and serious political leadership is required. Furthermore, as shown by countries such as Taiwan and New Zealand, the fact that the majority of COVID-19 J o u r n a l P r e -p r o o f deaths are preventable makes a powerful tool for inspiration and to unite the population. The fight against the pandemic is not solely a matter of scientific development but it is first and foremost about saving lives and protecting the less privileged members of our global community. The world today has the science, wealth, and communication infrastructure to address the Given the interconnectedness of our economy, less COVID-19 anywhere is less COVID-19 everywhere. By increasing compliance with available mitigation tools such as the use of face coverings, our preparedness for a vaccine introduction can be greatly enhanced. Despite evidence for face coverings, our face covering compliance rates vary between single digits to near total [13] . Face covering has become a perfect indicator to measure the existence of promitigation leadership [14] . For leadership to be globally effective, they should be effective locally. To achieve this, leaders should tactically address the short and long -term socio-economic and public health burden that a pandemic can impose. Second, leaders should develop a framework for recovery of economic and societal functions not just for one country but for all. Finally, COVID-19 management experience should be put to use to inform a framework for global collaboration to contain or respond to emergencies, climate disasters and disease threats. influenzas pandemic and with COVID-19 and portrayed as 'a tale of two cities or countries', is directly linked to leadership inertia, delayed action, and travesty of science. • Countries that succeeded in pandemic mitigation had forward thinking agile leadership who rallied behind science, with swift and synchronized implementation of mitigation measures. • Countries with proactive leadership that implemented early mitigation and corralled their population towards compliance do not have a protracted and destabilizing wave of COVID-19 outbreaks. New findings: • Success of both political leadership and pandemic mitigation are intertwined. Leadership will fall with failure of mitigation-sooner or later. • Ignoring opportunities is not leadership. • Pathogens can be elusive, but smart leadership will prevail. • Given SARS-COV-2 transmission dynamics, any successful local leadership has immense global implications. • Reliance on science, communicating with the community, leading by example, fostering collaboration, and learn as we go are key leadership skills that can help manage repeat COVID-19 waves and mitigation fatigue. Impact on clinical practice: • As we are still in a pre-vaccine stage, strong and proactive leadership will help reimplement adaptive pandemic mitigation measures to avert the stress on health care system. • The concept of 'learn as we go' enables health care system to be forward leaning and preparedness oriented rather than reactive. Through collaboration and a all-hand on deck approach, leadership should be able to fill the gaps in needed surge capacity. • Good leadership principles will help boost the morale of both the community and health care system to face future waves of COVID-19 more sustainably. Innovation for Pandemics Reopening Economies during the COVID-19 Pandemic: Reasoning about Value Tradeoffs Economic, social and political issues raised by the COVID-19 pandemic. Economic analysis and policy Presidential powers and response to COVID-19 Dying in a Leadership Vacuum Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic Covid-19 and community mitigation strategies in a pandemic All hands on deck: a synchronized whole-of-world approach for COVID-19 mitigation If the world fails to protect the economy, COVID-19 will damage health not just now but also in the future Estimating and Projecting Air Passenger Traffic during the COVID-19 Coronavirus Outbreak and its Socio-Economic Impact Solidarity" clinical trial for COVID-19 treatments The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report NEJM 2021436 Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis Estimating the COVID-Related Deaths Attributable to President Trump's Early Pronouncements About Masks