key: cord-0940007-7h1txusy authors: Sani, Immanuel; Chedid, Youssef; Amalendran, Jubilent; Hamza, Yaser title: Learning from recent events – A commentary on: “Health Policy and Leadership Models During the COVID-19 Pandemic - Review Article” date: 2020-08-28 journal: Int J Surg DOI: 10.1016/j.ijsu.2020.08.025 sha: 92f9a6b73b990492f6c8de86a30829c86ba218e3 doc_id: 940007 cord_uid: 7h1txusy nan Dear editor, The insightful article by Nicola et al discussed exemplary national leadership models, postulated several de-escalation strategies on current restrictions, and most importantly, reflected on the lessons learned from countries that have effectively contained the COVID-19 pandemic. 1 As the reverberation from the initial easing of the lockdown protocol is imminent and even proceeding in some areas, we endeavour to further explore our collective understanding of the first COVID-19 pandemic wave and strategies that may alleviate the severity of a second wave. We understand that some herd immunity exists in several regions. The exact degree of herd immunity is currently indeterminate; however, it is clear that a significant proportion of the population has contracted the SARS-Cov-2 virus both during and before the initiation of lockdown measures. It has been theorised that immunity may be short-lived within individuals exposed to SARS-Cov-2. The recent study by Doores et al demonstrated that whilst 60% of individuals exhibited a significant antibody response at peak viral load, only 17% retained the same magnitude of the antibody response three months post-onset of symptoms. 2 Therefore, based on these findings, it is strongly recommended that government officials refrain from over-reliance on the attainment of herd immunity as firstly, this may not be achieved until an effective vaccine has been approved for mass production. Secondly, local healthcare systems may become overwhelmed if a considerable number of symptomatic individuals require hospital admission within a short period. Widespread workplace absenteeism due to a sudden increase in COVID-19 cases may further exacerbate the decreased consumption, demand and utilisation of products and services, and thus negatively impact the global economy as described by Nicola et al. 3 The immunocompetent cohort amongst the general population should take caution when interacting with others as current societal behaviour may shape the world's recovery from the pandemic. There has also been a noticeable improvement in national governments' responsiveness to the evolving situation. In the United Kingdom, we have witnessed the recent implementation of local lockdowns in some regions for example, Leicestershire. Decentralisation of lockdown decision-making from the central government to local councils may be beneficial as a selective and regional approach instead of a nationwide lockdown, that encompasses regions with an acceptable COVID-19 reproduction number, will prevent unnecessary decline of the economy. Normal social and operational activities should be gradually restored judiciously. The group of individuals susceptible to COVID-19 has been clearly defined. If any of these individuals succumb to COVID-19, the majority will experience mild ailment but for those who may not, there is now a variety of therapies that significantly improve health outcomes which includes Dexamethasone, Beta Interferon, Remdesivir and the use of anticoagulant agents, all of which illustrates the advancement in the J o u r n a l P r e -p r o o f management of COVID-19. The symptomatology of COVID-19 is now better understood as anosmia and ageusia were not widely recognised as common symptoms during the early phase of quarantine. With this knowledge, individuals that develop such symptoms will be able to withdraw from public circulation promptly and self-isolate for 10 days rather than the previous recommendation of 7 days. Diet modification has an integral role in protection from COVID-19 which should comprise adequate intake of Vitamins B, C, D, E, zinc, and protein. 4 Interestingly, there has been a suggestion that countries such as Romania and Latvia, who consume a high quantity of green vegetables, have experienced a significant reduction in COVID-19related deaths. Fonseca et al showed that a national increase in consumption of green vegetables resulted in a 13.6% decrease in the mortality risk for COVID-19. 5 Although, it is unclear whether the change associated with vegetable consumption was causal or correlational. Despite this, the adoption of a balanced diet in amalgamation with other immune-protective measures is warranted in the general public to attenuate the impact of a second COVID-19 wave. As we face a potential second wave, it is vital to critically reflect on recent events during the peak of the pandemic to improve our preparedness for the future. We hope to provide an encouraging outlook on the future and draw attention to recent simple, yet valuable interventions that when employed consistently and in combination with existing strategies, may constrain the impact of a second wave. Health Policy and Leadership Models During the COVID-19 Pandemic-Review Article Longitudinal evaluation and decline of antibody responses in SARS-CoV-2 infection The socio-economic implications of the coronavirus pandemic (COVID-19): A review Immune response in COVID-19: A review Association between consumption of vegetables and COVID-19 mortality at a country level in Europe Ethical approval: Not required The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories, then this should be stated. None to declare None to declare Please enter the name of the registry, the hyperlink to the registration and the unique identifying number of the study. You can register your research at http://www.researchregistry.com to obtain your UIN if you have not already registered your study. This is mandatory for human studies only.1. Name of the registry: N/A 2. Unique Identifying number or registration ID: N/A 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): N/A Please specify the contribution of each author to the paper, e.g. study design, data collections, data analysis, writing. Others, who have contributed in other ways should be listed as contributors.Yaser Hamza -Writing Jubilent Amalendran -Writing Immanuel Sani -Writing Youssef Chedid-Writing The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Please note that providing a guarantor is compulsory. J o u r n a l P r e -p r o o f No primary research or confidential patient data was obtained due to the nature of this article. No data sets were generated or analysed.