Chapter 1 16 Public health response and medical interventions In the absence of vaccines and therapeutic tools during the first months of the pandemic, non-pharmaceutical interventions (NPIs) were the primary way to reduce the impact of SARS-CoV-2 in 2020[32]. Public health policy aimed to use NPIs for both containment (diagnosing and interrupting transmission through isolation of cases and quarantine of contacts) and mitigation (implementing population-wide contact restrictions and bolstering healthcare and essential services to reduce hospitalisation and case fatality rates) of the pathogen. Coupling such interventions with clear and timely communication of essential information was crucial for explaining the need for radical disease control measures[33, 34] and thus help achieve high compliance. Public health measures were soon aided by evidence – developed at record speed – to support the use of therapeutics, adding to our toolkit to reduce the impact of COVID-19. Ground-breaking clinical trials such as the RECOVERY Trial investigated the effect of existing licensed drugs on adverse outcomes of COVID-19. Dexamethasone (an affordable, off-licence medicine also available in low- and middle-income countries [LMICS]) was shown to reduce 28-day mortality among hospitalised patients requiring respiratory support[35]. Other therapies such as interleukin (IL)-6 receptor antagonists[36], janus kinase (JAK) inhibitors[37] and anti-viral agents[38], also improved clinical outcomes of patients hospitalised with COVID-19. The rapid development of this knowledge was a fantastic example of interdisciplinary efforts between virologists, clinicians and epidemiologists, and had direct impact on reducing serious consequences of infection. Whilst these medical breakthroughs reduced COVID-associated morbidity and mortality among those admitted to hospital for COVID-19, it was the development of numerous effective vaccines that helped to prevent severe disease and thereby lessen pressures on tertiary care. Three vaccines had been approved by the European Medicines Agency (EMA) by early 2021: BNT162b2 (developed by BioNTech and Pfizer)[39], ChAdOx1 (developed by AstraZeneca)[40] and mRNA-1273 (developed by Moderna)[41]. In the first year of vaccine roll-out alone, it is estimated that tens of millions of deaths were prevented by vaccination[42]. Nonetheless, the potential impact of vaccination has not been fully realised, owing to both reduced access to vaccination in low-income settings and persistent vaccine scepticism worldwide[43]. Whilst the COVID-19 landscape in 2023 is vastly different from 2020, these enduring challenges continue to undermine our ability to prevent all adverse outcomes of COVID-19.
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