Nordic Life Science 1
shows that similar global outbreaks have occurred
with a certain degree of regularity; the polio epidemic, the Asian and the Hong Kong flu outbreaks, to name but a few. How did this year’s coronavirus pandemic come to be so different and reported so widely in the mass media? Does it have characteristics that we didn’t know about before? It has become obvious that we cannot compare information from different countries, which is why excess mortality has been examined to show how different strategies have worked. Whether we have had a significant excess mortality in Sweden, or if it has been predominantly severely ill elderly people who have died prematurely remains to be seen. The annual figures are needed to ultimately answer this question. Something that has been special about this coronavirus pandemic has been the variation in how ill people have become. The same virus has caused little or mild symptoms in just over 80 percent of those infected, but in other cases has resulted in pronounced symptoms and sometimes long-lasting suffering. It is interesting that the most prevalent mutated variant of the coronavirus seems to be nine-times more infectious than the original version, but does not cause such severe disease progression. We can therefore hope for a successive mutation towards a more normal, mild cold virus, although only time will tell. In Sweden just over half of those who have died from, or as a result of, SARSCoV-2-infection have been over the age of 85-years, 90 percent have been 70-years or over, and only one percent has been younger than 50-years old. At the same time a strong correlation has been seen with other pre-existing illnesses and risk factors. Those risk factors that have been cited most often are high blood pressure, heart disease, lung disease and most recently the significance of being overweight or obese has been noted. The race to a vaccine is storming ahead, with AstraZeneca, Moderna and Pfizer in the lead. Registration already during the autumn or by the middle of next year is being talked about, but it remains to be seen if a number of hurdles can be cleared. One such hurdle is the large phase III study of 30 000 individuals that is required for approval. The Russian vaccine that was registered following trials on the minimum number of test subjects (n=78) cannot currently be critically evaluated, but many of the experts outside of Russia have their doubts. Approved vaccines need to demonstrate not only an immunological IgG antibody response, but also a T-cell response and a resulting immunity that lasts for more than a few months. If it is necessary to have several injections and renew the doses every year, we will have a problem from a global perspective. We must also be aware of the fact that a number of vaccines are being developed using methods that have not proven successful in the past and that the use of viral vectors increases the risk of generating antibodies against the treatment. An incredibly large number of studies have been carried out during the spring on new medications, but primarily also on existing drugs, to test if they have effects against COVID-19. We have been able to follow the rise and fall of hydroxychloroquine, the hard to interpret effects of remdesivir and a number of questionable results about administration of strong anti-inflammatory treatments. Publications describing plasma treatment and antibody treatments have also not demonstrated entirely unambiguous results. The product that seems to be most promising and that is used today in Swedish coronavirus healthcare is dexamethasone. We must cross our fingers and hope that more treatments demonstrate an effect. They will be needed. Most of the interest and attention in the mass media has been about the Swedish strategy, if Sweden has chosen the right way to go with its recommendations to wash your hands, keep your distance and generally stay away from larger gatherings of people. Would a more severe general lockdown and mandatory wearing of face masks have been better? We will not know the answer until around six months from now. At the present time the developments in Sweden look promising, with progressively decreasing numbers of infections and deaths. Countries that chose to impose more stringent measures from the beginning have in many instances just as many infected in their populations and are today witnessing a new wave of infection spread. At the present time, 70 countries are reporting a continuing increase in the number of infections, including Denmark and Norway. It will be fascinating to follow how the situation develops during the autumn. NLS NORDIC LIFE SCIENCE 35