# COVID-19 and beyond: a call for action and audacious solidarity to all the citizens and nations, it is humanity's fight

Charles Auffray, Rudi Balling, Niklas Blomberg, Myrna Bonaldo, Bertrand Boutron, Samir Brahmachari, Christian Bréchot, Alfredo Cesario, Sai-Juan Chen, Karine Clément, et al.

► To cite this version:

Charles Auffray, Rudi Balling, Niklas Blomberg, Myrna Bonaldo, Bertrand Boutron, et al. COVID-19 and beyond: a call for action and audacious solidarity to all the citizens and nations, it is humanity's fight. F1000Research, 2020, 9, pp.1130. 10.12688/F1000RESEARCH.26098.1. pasteur-04098143

HAL Id: pasteur-04098143

https://pasteur.hal.science/pasteur-04098143

Submitted on 15 May 2023

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>
<figure><img src="image_2.png" /></figure>

Check for updates

OPINION ARTICLE

# COVID-19 and beyond: a call for action and audacious solidarity to all the citizens and nations, it is humanity's fight [version 1; peer review: 3 approved with reservations]

Charles Auffray ID<fnref n="1" />, Rudi Balling<fnref n="2" />, Niklas Blomberg<fnref n="3" />, Myrna C. Bonaldo<fnref n="4" />,
Bertrand Boutron ID<fnref n="1" />, Samir Brahmachari<fnref n="5" />, Christian Bréchot<fnref n="6" />, Alfredo Cesario<fnref n="7" />, <fnref n="8" />,
Sai-Juan Chen<fnref n="9" />, Karine Clément<fnref n="10" />, Daria Danilenko<fnref n="11" />, Alberto Di Meglio<fnref n="12" />,
Andrea Gelemanović<fnref n="13" />, Carole Goble<fnref n="14" />, Takashi Gojobori<fnref n="15" />, <fnref n="16" />, Jason D. Goldman<fnref n="17" />,
Michel Goldman¹⁸, Yi-Ke Guo¹⁹, ²⁰, James Heath²¹, Leroy Hood²¹, ²²,
Peter Hunter²³, Li Jin²⁴, Hiroaki Kitano²⁵, ²⁶, Bartha Knoppers ID²⁷, Doron Lancet²⁸,
Catherine Larue²⁹, Mark Lathrop³⁰, Martine Laville³¹, Ariel B. Lindner³²,
Antoine Magnan³³, Andres Metspalu³⁴, Edgar Morin³⁵, Lisa F.P. Ng³⁶,
Laurent Nicod³⁷, Denis Noble³⁸, Laurent Nottale³⁹, Helga Nowotny⁴⁰,
Theresa Ochoa⁴¹, Iruka N. Okeke⁴², Tolu Oni⁴³, ⁴⁴, Peter Openshaw ID⁴⁵,
Mehmet Oztürk⁴⁶, Susanna Palkonen⁴⁷, Janusz T. Paweska⁴⁸, Christophe Pison⁴⁹,
Mihael H. Polymeropoulos⁵⁰, Christian Pristipino<fnref n="8" />, ⁵¹, Ulrike Protzer⁵²,
Josep Roca⁵³, Damjana Rozman⁵⁴, Marc Santolini ID³², Ferran Sanz ID⁵⁵,
Giovanni Scambia<fnref n="7" />, Eran Segal⁵⁶, Ismail Serageldin⁵⁷, Marcelo Bento Soares⁵⁸,
Peter Sterk⁵⁹, Sumio Sugano⁶⁰, ⁶¹, Giulio Superti-Furga⁶², David Supple⁶³,
Jesper Tegner⁶⁴, ⁶⁵, Mathias Uhlen⁶⁶, Andrea Urbani<fnref n="7" />, Alfonso Valencia⁶⁷,
Vincenzo Valentini ID<fnref n="7" />, Sylvie van der Werf ID⁶⁸, Manlio Vinciguerra⁶⁹,
Olaf Wolkenhauer⁷⁰, Emiel Wouters⁷¹, ⁷²

<footnote n="1">¹European Institute for Systems Biology & Medicine, EISBM, Vourles, 69390, France</footnote>

<footnote n="2">²Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, L-4362, Luxembourg</footnote>

<footnote n="3">³ELIXIR, Wellcome Genome Campus, Hinxton, CB10 1SD, UK</footnote>

<footnote n="4">⁴Oswaldo Cruz Foundation, Manguinhos, Rio de Janeiro, RJ 21040-360, Brazil</footnote>

<footnote n="5">⁵Institute of Genomics and Integrative Biology, CSIR, Delhi, 110 007, India</footnote>

<footnote n="6">⁶Global Virus Network, University of South Florida, Tampa, FL, 33612, USA</footnote>

<footnote n="7">⁷Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Rome, 00168, Italy</footnote>

<footnote n="8">⁸Italian Association for Systems Medicine and Healthcare - ASSIMSS, Rome, Italy</footnote>

<footnote n="9">⁹National Research Center for Translational Medicine, Jiao Tong University School of Medicine, Shanghai, 200025, China</footnote>

<footnote n="10">¹⁰Nutriomique Research Unit, F-CRIN/FORCE network, Pitié-Salpêtrière Hospital, Paris-Sorbonne University, Paris, 75013, France</footnote>

<footnote n="11">¹¹Smorodintsev Research Institute of Influenza, Saint-Petersburg, 197376, Russian Federation</footnote>

<footnote n="12">¹²CERN, Meyrin, 1217, Switzerland</footnote>

<footnote n="13">¹³Mediterranean Institute for Life Sciences, Split, 21000, Croatia</footnote>

<footnote n="14">¹⁴Department of Computer Science, University of Manchester, Manchester, M13 9PL, UK</footnote>

<footnote n="15">¹⁵Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, 4700, Saudi Arabia</footnote>

<footnote n="16">¹⁶National Institute of Genetics, Mishima, 411-8540, Japan</footnote>

<footnote n="17">¹⁷Infectious Diseases and Organ Transplant, Swedish Medical Group, Providence St Joseph Health, Seattle, WA, 98104, USA</footnote>

<footnote>18</footnote>
Institute for Interdisciplinary Innovation in Healthcare, Université Libre de Bruxelles, Brussels, 1050, Belgium

¹⁹Data Science Institute, Imperial College London, London, SW7 2AZ, UK

²⁰President Office, Hong Kong Baptist University, Kowloon, Hong Kong

²¹Institute for Systems Biology, Seattle, WA, 98109, USA

²²Providence St Joseph Health, Seattle, WA, 98104, USA

²³Auckland Bioengineering Institute, The University of Auckland, Auckland, 1142, New Zealand

²⁴Human Phenome Institute, Fudan University, Shanghai, 201203, China

²⁵Systems Biology Institute, Tokyo, 141-0022, Japan

²⁶Okinawa Institute of Science and Technology Graduate University, Okinawa, 904-0495, Japan

²⁷Centre of Genomics and Policy, Faculty of Medicine, Human Genetics, McGill University, Montréal, Québec, H3A 0G4, Canada

²⁸Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 7610010, Israel

²⁹Integrated Biobank of Luxembourg, Luxembourg Institute of Health, Dudelange, L-3555, Luxembourg

³⁰McGill Genome Centre, McGill University, Montréal, Québec, H3A 0G1, Canada

³¹Lyon-Sud University Hospital, Pierre-Bénite, 69310, France

³²Center for Research and Interdisciplinarity, Université de Paris, Paris, 75004, France

³³L'institut Du Thorax, Faculté de Médecine, Université de Nantes, Nantes, 44007, France

³⁴Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia

³⁵Association pour la Pensée Complexe, Montpellier, 34000, France

³⁶Singapore Immunology Network, A*STAR, Singapore, 139648, Singapore

³⁷Service de Pulmonologie, Centre Hospitalier Universitaire Vaudois, Lausanne, 1011, Switzerland

³⁸Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3P, UK

³⁹Paris-Meudon Observatory, Meudon, 92190, France

⁴⁰Vienna Science and Technology Fund, Wien, 1090, Austria

⁴¹Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru

⁴²Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria

⁴³Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SL, UK

⁴⁴School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa

⁴⁵Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, SW3 6LY, UK

⁴⁶Izmir Biomedicine and Genome Center, Dokuz Eylül University Health Campus, Izmir, 35340, Turkey

⁴⁷Patient Access Partnership, Brussels, 1040, Belgium

⁴⁸Centre for Emerging Zoonotic and Parasitic Diseases, National Institute of Communicable Diseases, National Health Laboratory Service, Gauteng, South Africa

⁴⁹Grenoble-Alps University Albert Michallon Hospital, La Tronche, 38700, France

⁵⁰Vanda Pharmaceuticals, Washington, DC, 20037, USA

⁵¹San Filippo Neri Hospital, Roma, 00135, Italy

⁵²Institute of Virology, Technical University of Munich / Helmholtz Zentrum München, Munich, 81675, Germany

⁵³Thorax Clinical Institute, Hospital Clinic, Barcelona, Spain

⁵⁴Faculty of Medicine, University of Ljubljana, Ljubljana, 1000, Slovenia

⁵⁵Research Programme on Biomedical Informatics, Institut Hospital de Mar de Investigaciones Médiques, Universitat Pompeu Fabra, Barcelona, E-08003, Spain

⁵⁶Weizmann Institute of Science, Rehovot, Israel

⁵⁷Library of Alexandria, Alexandria, 21526, Egypt

⁵⁸University of Illinois College of Medicine, Peoria, IL, 61605, USA

⁵⁹Department of Pulmonary diseases, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands

⁶⁰Laboratory of Functional Genomics, Department of Medical Genome Sciences, University of Tokyo, Tokyo, 108-8639, Japan

⁶¹University of Chiba, Chiba, 277-8562, Japan

⁶²Research Center for Molecular Medicine, Medical University of Vienna, Wien, Austria

⁶³Asthma-UK, London, E1 8AA, UK

⁶⁴Living Systems Laboratory, King Abdullah University of Science and Technology, Thuwal, 4700, Saudi Arabia

⁶⁵Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, 17176, Sweden

⁶⁶Science for Life Laboratory, Royal Institute of Technology, Stockholm, SE-100 44, Sweden

⁶⁷Barcelona Supercomputing Center, Barcelona, 08034, Spain

⁶⁸Department of Virology, Institut Pasteur, Paris, 75015, France

⁶⁹International Clinical Research Center, St. Anne's University Hospital, Brno, 656 91, Czech Republic
Department of Systems Biology & Bioinformatics, University of Rostock, Rostock, 18057, Germany

⁷¹Department of Respiratory Medicine, University of Maastricht, Maastricht, 6200 MD, The Netherlands

⁷²Ludwig Boltzmann Institute for Lung Health, Vienna, A-1140, Austria

**V1** First published: 14 Sep 2020, **9:1130**
https://doi.org/10.12688/f1000research.26098.1

Latest published: 14 Sep 2020, **9:1130**
https://doi.org/10.12688/f1000research.26098.1

## Abstract

**Background:** Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belongs to a subgroup of coronaviruses rampant in bats for centuries. It caused the coronavirus disease 2019 (COVID-19) pandemic. Most patients recover, but a minority of severe cases experience acute respiratory distress or an inflammatory storm devastating many organs that can lead to patient death. The spread of SARS-CoV-2 was facilitated by the increasing intensity of air travel, urban congestion and human contact during the past decades. Until therapies and vaccines are available, tests for virus exposure, confinement and distancing measures have helped curb the pandemic.

**Vision:** The COVID-19 pandemic calls for safeguards and remediation measures through a systemic response. Self-organizing initiatives by scientists and citizens are developing an advanced collective intelligence response to the coronavirus crisis. Their integration forms Olympiads of Solidarity and Health. Their ability to optimize our response to COVID-19 could serve as a model to trigger a global metamorphosis of our societies with far-reaching consequences for attacking fundamental challenges facing humanity in the 21st century.

**Mission:** For COVID-19 and these other challenges, there is no alternative but action. Meeting in Paris in 2003, we set out to "rethink research to understand life and improve health." We have formed an international coalition of academia and industry ecosystems taking a systems medicine approach to understanding COVID-19 by thoroughly characterizing viruses, patients and populations during the pandemic, using openly shared tools. All results will be publicly available with no initial claims for intellectual property rights. This World Alliance for Health and Wellbeing will catalyze the creation of medical and health products such as diagnostic tests, drugs and vaccines that become common goods accessible to all, while seeking further alliances with civil society to bridge with socio-ecological and technological approaches that characterise urban systems, for a collective response to future health emergencies.

## Keywords

COVID-19, Pandemic, Coalition, Coronavirus, SARS-CoV-2, Solidarity, Systemic crisis, Systemic response

## Open Peer Review

### Approval Status

<figure><img src="image_3.png" /></figure>

1

2

3

### version 1

14 Sep 2020

<figure><img src="image_4.png" /></figure>

view

<figure><img src="image_5.png" /></figure>

view

<figure><img src="image_6.png" /></figure>

view

1. **Ruth Chadwick**, Cardiff University, Cardiff, UK

2. **Hossein Khalili**, University of Wisconsin-Madison, Madison, USA
Western University, Ontario, Canada

3. **Tommaso Mazza** ID, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy

Any reports and responses or comments on the article can be found at the end of the article.
<figure><img src="image_7.png" /></figure>

This article is included in the **Emerging Diseases and Outbreaks** gateway.

<figure><img src="image_8.png" /></figure>

This article is included in the **Coronavirus collection.**
**Corresponding author:** Charles Auffray (cauffray@eisbm.org)

**Author roles:** Auffray C: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing; Balling R: Writing – Review & Editing; Blomberg N: Writing – Review & Editing; Bonaldo MC: Writing – Review & Editing; Boutron B: Writing – Review & Editing; Brahmachari S: Writing – Review & Editing; Bréchot C: Writing – Review & Editing; Cesario A: Writing – Review & Editing; Chen SJ: Writing – Review & Editing; Clément K: Writing – Review & Editing; Danilenko D: Writing – Review & Editing; Di Meglio A: Writing – Review & Editing; Gelemanović A: Writing – Review & Editing; Goble C: Writing – Review & Editing; Gojobori T: Writing – Review & Editing; Goldman JD: Writing – Review & Editing; Goldman M: Writing – Review & Editing; Guo YK: Writing – Review & Editing; Heath J: Writing – Review & Editing; Hood L: Writing – Review & Editing; Hunter P: Writing – Review & Editing; Jin L: Writing – Review & Editing; Kitano H: Writing – Review & Editing; Knoppers B: Writing – Review & Editing; Lancet D: Writing – Review & Editing; Larue C: Writing – Review & Editing; Lathrop M: Writing – Review & Editing; Laville M: Writing – Review & Editing; Lindner AB: Writing – Review & Editing; Magnan A: Writing – Review & Editing; Metspalu A: Writing – Review & Editing; Morin E: Writing – Review & Editing; Ng LFP: Writing – Review & Editing; Nicod L: Writing – Review & Editing; Noble D: Writing – Review & Editing; Nottale L: Writing – Review & Editing; Nowotny H: Writing – Review & Editing; Ochoa T: Writing – Review & Editing; Okeke IN: Writing – Review & Editing; Oni T: Writing – Review & Editing; Openshaw P: Writing – Review & Editing; Oztürk M: Writing – Review & Editing; Palkonen S: Writing – Review & Editing; Paweska JT: Writing – Review & Editing; Pison C: Writing – Review & Editing; Polymeropoulos MH: Writing – Review & Editing; Pristipino C: Writing – Review & Editing; Protzer U: Writing – Review & Editing; Roca J: Writing – Review & Editing; Rozman D: Writing – Review & Editing; Santolini M: Writing – Review & Editing; Sanz F: Writing – Review & Editing; Scambia G: Writing – Review & Editing; Segal E: Writing – Review & Editing; Serageldin I: Writing – Review & Editing; Soares MB: Writing – Review & Editing; Sterk P: Writing – Review & Editing; Sugano S: Writing – Review & Editing; Superti-Furga G: Writing – Review & Editing; Supple D: Writing – Review & Editing; Tegner J: Writing – Review & Editing; Uhlen M: Writing – Review & Editing; Urbani A: Writing – Review & Editing; Valencia A: Writing – Review & Editing; Valentini V: Writing – Review & Editing; van der Werf S: Writing – Review & Editing; Vinciguerra M: Writing – Review & Editing; Wolkenhauer O: Writing – Review & Editing; Wouters E: Writing – Review & Editing

**Competing interests:** RB reports being a founder/shareholder of ITTM S.A. and Megeno S.A., outside the submitted work, he is co-inventor and holder of two issued patents; JH reports personal fees and other from PACT Pharma, outside the submitted work; HK reports grants from Minister of Health, Welfare, and Labor of Japanese Government, grants from Okinawa Prefecture Government, outside the submitted work; DL reports personal fees from Weizmann Institute of Science and LifeMap Science Inc., outside the submitted work; CL reports personal fees from Genfit, outside the submitted work; PO reports personal fees for consultancy work with Janssen, J&J and Sanofi, grants from MRC, European Union, NIHR Biomedical Research Centre, and a collaborative grant with GSK, outside the submitted work; SP reports grants from Aimmune, Astra Zeneca, Boehringer Ingelheim, Chiesi, DBV Technologies, GSK, Leo Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, outside the submitted work, is employed by the EFA who receives unrestricted grants from corporate entities as above, represents EFA in the following advisory groups of these entities: Astra Zeneca COPD Advisory Committee, GSK Health Advisory Board and Novartis European Patient Advisory Group, receives no personal gain, honoraria, when applicable expenses are payed to her organization, is in a voluntary function the Chair of the Patient Access Partnership PACT who receives unrestricted grants from EFPIA, MedTech Europe, EUCOPE and Medicines for Europe for core operations, and project grants from individual companies, outside the submitted work; CP reports personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, GSK, Novartis, outside the submitted work; MP reports other from Vanda Pharmaceuticals, outside the submitted work; UP reports grants from VIR Biotechnology, grants and non-financial support from Roche, grants from Alios-J&J, personal fees from Abbvie, Arbutus, Dicerna, Gilead, GSK, MSD, Vaccitech, personal fees from University Hospital Cologne, grants and other from SCG Cell Therapy, outside the submitted work; PS reports other from Breathomix BV, outside the submitted work; GSF reports being a shareholder of Proxygen GmbH, Haplogen GmbH and Alcyte GmbH, outside the submitted work; VV reports personal fees from Merck Serono, Betaglue, outside the submitted work; SvdW reports funding from Sanofi Pasteur, outside the submitted work; she is the holder of four issued patents. The other authors have declared no conflict of interest.

**Grant information:** This work was supported during its preparation phases by the State Key Laboratory of Medical Genomics, Overseas Expertise Introduction Project for Discipline Innovation [111 Project, B17029] to SJC, LH, CA; European Union grants CASyM [FP7-n°305033] to CA, RB, JR, DR, DS, JT, OW; eTRIKS (IMI-1-n°115446) to CA, RB, YG; PREPARE [FP7-n°602525] to CA, PO, SV; and initial funds in support of the deep phenotyping clinical study from philanthropic donors, Gilead, Merck and Novartis to JG, JH, LH; the Ricerca Corrente Program by the Italian Ministry of Health to AC, CPr, GS, AU, VV; the National Megaprojects of China for Infectious Diseases [2017ZX10103009-001, 2018ZX10305409-001-005], Double First-class projects from the Ministry of Education to the National Research Center for Translational Medicine Shanghai to SJC; Shanghai Municipal Science and Technology Major Project [2017SHZDZX01] to LJ. *The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.*

**Copyright:** © 2020 Auffray C et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**How to cite this article:** Auffray C, Balling R, Blomberg N et al. COVID-19 and beyond: a call for action and audacious solidarity to all the citizens and nations, it is humanity's fight [version 1; peer review: 3 approved with reservations] F1000Research 2020, 9:1130 https://doi.org/10.12688/f1000research.26098.1

**First published:** 14 Sep 2020, 9:1130 https://doi.org/10.12688/f1000research.26098.1
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19)

In just a few short months, the new coronavirus SARS-CoV-2 causing COVID-19 has shaken planet Earth and its inhabitants in a chain of events starting in the megacity of Wuhan in China's Hubei Province whose speed and severity seem to have taken citizens and political and economic leaders by surprise. The COVID-19 epidemic turned into a pandemic affecting almost all of the 197 states recognized by the United Nations and their associated territories. The number of individuals affected, which is probably largely underestimated because of the large number of asymptomatic forms that are potentially contagious, exceeds 24 million and caused the death of more than 820,000 persons as of August 28¹⁻⁸. The pandemic shows no sign of slowing down globally, entering the range of casualties of the most severe influenza pandemics of the past 50 years. It has already provoked important secondary increases in chronic and psychiatric health conditions. This has locally saturated the health-care systems of the most affected countries, such as Italy, Spain, France, then Great Britain and the United States of America, from which the political leaders thought they were safe, and which were in turn severely impacted. This is particularly true in areas where major outbreaks of contagion have caused explosive spread of the SARS-CoV-2 coronavirus⁹⁻¹⁶. This phenomenon has started to reach into areas with poorly developed health infrastructures, with the risk of decimating entire populations, particularly in Africa, South America and South-East Asia. Most African countries, with their experience of recent epidemics such as Ebola, have been quick to take strict containment measures, and have been much less affected so far because of the youthfulness of their populations¹⁷. On the contrary, Mexico, Brazil and many other countries in South America are experiencing an epidemic outbreak, as is the case also in South Africa, the Middle-East, India and South-East Asia¹,².

In many of the structures where elderly, dependent people are cared for, such as the Établissement d'hébergement pour personnes âgées dépendantes (EHPADs; Accommodation facility for dependent elderly people) in France, the SARS-CoV-2 virus has caused large numbers of COVID-19 casualties. It is only recently that the victims who died in these facilities have been listed and included in a daily check-up that is constantly increasing, and we will only know the number of those who died undetected at home by comparing this year's mortality with that of previous years, as was the case during the 2003 heat wave in Western Europe. These various factors, combined with the very rapid worsening of the disease - which in its severe forms leads to the serial failure of different organs¹⁸⁻²⁰, most often starting with the lungs and producing respiratory distress - have led to an underestimation of the severity and extent of the pandemic. In order to understand how the current health emergency came about, to imagine solutions to overcome this crisis, to prevent it from continuing and worsening in successive waves due to failure to comply with containment rules, or from reoccurring with other emerging pathogens, it is essential to re-examine with the necessary hindsight the conditions that have allowed the dazzling upheavals we are witnessing.

Among the factors that have accelerated the spread of SARS-CoV-2 and transformed the initial focus of the COVID-19 epidemic into a pandemic are the considerable increase in air and land transport or the swift expansion of megacities that have become unbreathable over the last two decades due to air pollution, as has been pointed out by many commentators. As the pandemic continues to develop, it is still difficult to identify its future course. It could resemble that of the previous flu epidemics with one or several additional waves of similar or increased intensity occurring after the current one due to insufficient immunity of the population, especially given the unequal distribution of COVID-19 within regions and countries¹,². Transfers of people from one region to another could lead to the emergence of new clusters of propagation, following one another with a temporary time lag. The pandemic may radiate to all the destinations permitted by passenger transport, and therefore unpredictably, without being subject to the physical constraints of atmospheric flows that we have gradually learned to model using massive data from measuring stations and satellite observations to feed our weather forecasts.

The SARS-CoV-1 epidemic in 2002–2003 was largely confined to China by the drastic measures taken by the Ministry of Health, affecting just over 8,000 people, 774 of whom died, mainly in the Canton region, but also in some 30 countries such as Canada, where it was carried by travellers²¹. The MERS-CoV epidemic mainly affected Saudi Arabia and Middle Eastern countries such as Jordan, before being spread to South Korea by a single traveller, causing an outbreak of contagion and the death of 186 people, then affecting some 30 countries. Between 2002 and 2005, this highly pathogenic virus caused the death of nearly 500 people among the 1,400 or so infected people who could be identified²².

Like all these coronaviruses and viruses in general, SARS-CoV-2 is not a self-propagating unidentified flying object. It is an inert, newly identified viral object, which is only activated when it comes into contact with animal or human cells, from which it diverts its functions in order to multiply and transmit itself through contact first between animals and humans, and then similarly between humans. SARS-CoV-2 was identified and characterized as early as the beginning of 2020, which made it possible to rapidly develop tests to detect it.

Comparison of strains isolated from different affected regions and countries showed that SARS-CoV-2 is a distant cousin of SARS-CoV-1, their common ancestor dating back to the 13th century. These studies strongly suggest that SARS-CoV-2 originates from a reservoir of coronaviruses that have been prevalent in bats for at least 40–70 years, from which new coronaviruses may in turn emerge²³. SARS-CoV-2 was detected initially in Wuhan. However, since the three different clads that are prevalent in Italy are distinct from the one that predominates in France, it is well possible that several closely-related variants have come to infect humans during the recent months and years, and burgeoned simultaneously in several locations, from which it irradiated to other close or distant places through infected travellers. Indeed, retrospective
exploration of health records have identified early cases during
the third trimester of 2019 that remained undetected or
asymptomatic²⁴.

This reversal of perspective allows us to understand that it is
the organization of our economic and social life, as it has devel-
oped over the past few decades, that is at the root of the spread
of these epidemics and the current pandemic. It affects a much
larger number of people because of the higher contagious-
ness of SARS-CoV-2, but it causes proportionally fewer deaths
in the population, because it is fortunately much less virulent
than SARS-CoV-1 or SARS-MERS. A notable commonality
between the development of these three epidemics of corona-
virus disease is that their spread from the initial outbreak has
occurred locally and remotely through human contact and has
spread to other countries mostly through air and land travel.
Epidemiological studies will help identify what other factors
may have contributed to the high contagiousness of SARS-
CoV-2, such as air pollution with fine particles, the simple
diffusion of droplets produced by speech into ambient air,
or even of the viral particles themselves²⁵,²⁶. Availability of
population-based health status information provided by indi-
viduals in the field on real time through secure channels²⁷,²⁸,
and platforms to provide access to virus and serocover-
sion testing²⁹,³⁰ will be essential for identifying local and
regional outbreaks of SARS-CoV-2 and avoid further spread
of COVID-19. Fast-prototyping and open-source approaches
complement these actions by providing innovative, low-cost
solutions that can be of particular interest for affected low-
income countries.

The COVID-19 pandemic calls for safeguards
and remediation measures through a systemic
response

The COVID-19 pandemic due to the outbreak of SARS-CoV-2 thus impacts on biological, social, economic and human relations. It challenges the concepts of individuality and temporality, which are entangled at all scales. It forces us to change our relationship with nature, the built environment, education, health and death. It challenges our working habits and way of life, our understanding of living organisms and their relationships to the environment, as well as our political, social, economic, production and health organizations.

Over the centuries brilliant human minds have explored the
formation, organization and evolution of matter at the smallest
scales, of galaxies at the largest scales, and of living sys-
tems at intermediate scales. In biology and medicine, we have
not yet learnt sufficiently from the experience of astronomers
and physicists who understood early on that complex sys-
tems require the generation of enormous amounts of data to
deconvolute complexity, open science international collabo-
rations supported by common infrastructures and open data
sharing to enable diverse types of analyses and multiscale
modeling. The web developed by the European Organization
for Nuclear Research (CERN) to empower multiple centres
to generate, access and analyze big data and exchange results,
together with complementary efforts developing communication

standards, enabled democratization of Internet. We need to organ-
ize similarly to understand complex and dynamic microbes-
host-environment interactions, and resolve the pandemic
threatening humanity³¹,³².

The complexity of SARS-CoV-2 and COVID-19 calls for a global, systemic approach. The coronavirus crisis, strikingly illustrates, as complexity theory proposes, that when a complex system is increasingly fragmented it eventually disintegrates³³. But with proper integrative and analytical techniques the pieces can be assembled, to a certain extent, into a comprehensive and understandable whole. The current health crisis can thus be understood and resolved only by a systemic approach placing the analytical method in the context of each individual dynamic and longitudinal big data cloud³⁴ to unveil dysfunctions and propose actionable solutions. The systemic approach links the complexities that interact within the same person in relation to her/his environment. This way of thinking transcends the barriers between different scientific and medical disciplines and the humanities.

It is the conjunction of the systemic and analytic approaches
that will achieve the 17 sustainable development goals set by
the United Nations responding to the great challenges of the
21st century: “poverty, inequality, climate, environment, pros-
perity, peace and justice”³⁵ while leaving no one on the side
of the road, as “every life has similar value”³⁶. Indeed, in
accordance with article 27 of the Universal Declaration of
Human Rights of 1948: “Everyone has the right to freely par-
ticipate in the cultural life of the community, to enjoy the arts
and to participate in scientific progress and the resulting ben-
efits.” The third sustainable development goal is to “ensure
healthy lives and ensure wellbeing for all at all ages”, with
a special attention to the increasing burden of infectious and
non-communicable diseases (NCDs) in low, middle, and high-
income countries. It is clear that an infectious disease arising
in any country can affect the economies of many other coun-
tries. To attain this ambitious goal and combat the current
and future pandemics, a systemic approach to infectious dis-
eases is essential to generate the data necessary for decipher-
ing their complexity, develop global science collaborations with
openly shared data, and to undertake massive joint invest-
ments for health system development that lead to intersectoral
health interventions that are predictive, preventive, personalized
and participatory³⁷,³⁸.

COVID-19 highlights human limitations at the individual,
social and political levels. They have caused us to lose sight of
these sustainable goals and could call into question our abil-
ity to achieve them. However, measures that seemed impossi-
ble to implement within one or more generations can actually
be implemented in a very short time when inertia and bureauc-
racy are set aside for immediate action as shown by scien-
tific and therapeutic programmes on COVID-19 performed in
record time. We will no longer be able to cite as impossi-
ble the images of clear waters; animals that repopulate spaces
left free by humans; deserted, pollution-free and silent cities.
The COVID-19 crisis and the global response it triggered
demonstrate that there can be the will to address all daunting challenges with global systemic approaches and strategic partnerships. Hopefully, history will mark the coronavirus health crisis as a turning point in moving forward towards solving others of the 21st century greatest challenges.

The health crisis is causing astounding and immediate changes. The aircraft carrier Charles de Gaulle, flagship of the French Navy, was forced to return to its home port due to a COVID-19 outbreak with more than half of the sailors infected³⁹. Such is the case aboard cruise ships and in a number of nursing homes where elderly residents are among the most vulnerable to the disease and most likely to progress to death⁴⁰. All these images and initiatives contrast with the short-term views and the unpreparedness of many political and economic leaders who suddenly contradicted the positions they had previously adopted. The coronavirus struck them like an electric shock, causing a painful awakening. They were accustomed to thinking and deciding in a binary manner without perceiving the complexity and uncertainty of reality. In several countries the coronavirus crisis has become bipolarizing, e.g. by demanding whether to take precautions or to ignore the disease and move on with normal life and supposedly immediate economic recovery, writing off those who die as casualties of financial success. The billions that have not been wisely invested in health research and logistics for prevention now necessitate mobilization of trillions to face the greatest economic crisis that occurred since 1870 according to the World Bank⁴¹, without a guarantee that this will quickly succeed in addressing COVID-19 challenges.

Vocal segments of the media nourished by these events feed a self-perpetuating loop of hype for exaggerated promises or miraculous remedies promising a rapid return to the conditions existing before the start of the epidemic. The lessons learnt from previous epidemics before globalization and social media are forgotten: who remembers the million deaths caused by the second wave of flu during the winter of 1969–1970, and the two million deaths of the 1956–1958 flu pandemic? Or the multiplicity of more devastating flu pandemic waves of 1918–1920? Antibiotics and antivirals have helped diminish the burden of these diseases, although their successful use is being increasingly compromised by the development of resistant strains. The celebration of the 40th anniversary of the eradication of smallpox was paradoxically obscured by a pandemic resulting from reduced alertness that led to the unfortunate reduction in will and dismantling of logistical, scientific and medical means to deal with infectious diseases outbreaks.

## The Olympiads of Solidarity and Health: open and citizen science for collective advanced intelligence

All over the world, countless individual initiatives connect people, transcending social, cultural, religious or political barriers. Confined individuals applaud the extraordinary mobilization of the caregivers who are on the front lines of service and danger. This planetary movement of solidarity extends to all those who perform the ordinary but essential services of life: food, water, communication and energy supply, maintenance and

waste management, transportation and security, and teaching. Businesses and citizens from all walks of life self-organize, providing ingenious solutions to the challenges of these services in a world stalled by COVID-19.

What will be the course of this pandemic at global, regional, local and micro scales? Its development in insufficiently equipped settings could be devastating. Modelling COVID-19 data is using the same principles as those used in weather forecasting. From massive data, credible scenarios are identified in the short and medium term. Uncertainty remains, however, as to how the pandemic will unfold in different parts of the world, with the lack of context-aware data and knowledge gaps about the consequences of blunt public health interventions fueling real anxiety for the future.

As Charles Nicolle described nearly a century ago, all infectious diseases appear, grow and disappear¹². They can also reappear later or in new forms if our vigilance decreases or conditions are suitable. While more than 7 million cases of SARS-CoV-2 infection and 400,000 COVID-19 deaths were recorded in the world when the initial version of this paper was completed on June 18, these numbers have increased rapidly to over 24 million recorded infections and 830,000 deaths as of August 28¹. WHO indicated the coronavirus may “never disappear”, echoing signs that COVID-19 is becoming endemic¹³. It is therefore imperative that the current, overwhelming pandemic wave be used to understand how the virus is transmitted. So far, while there are some data pointing to risk factors for death, risk factors for acquiring the virus are largely unknown and their study is limited to superficial observational inferences. However, the epidemiology of the disease strongly suggests that there are gender, genetic as well as environmental risk factors⁴⁴⁻⁴⁶.

A large part of the international scientific and medical community mobilized to accelerate understanding of SARS-CoV-2 and COVID-19. Researchers, engineers, biologists and doctors have united to facilitate the development of insights into the physio-pathology and epidemiology of COVID-19 in different environmental contexts to fight against SARS-CoV-2 and its devastating effects. A first map of interactions between the virus and human cells is available⁴⁷. Lessons should be learnt from the experience acquired during this crisis from different parts of the world, and the same fast reaction capabilities should be implemented and maintained to prevent and contain new pandemics in non-pandemic times. Many scientific and clinical areas are challenged to rapidly provide industry and health systems with credible leads to design and implement, within a few weeks and months, research projects which formerly took many years to complete. These projects involve patients and their families, authorities from different sectors including health and environment, doctors, researchers, engineers, manufacturers and all stakeholders in economic and social life. Thus, the “Olympiads of Solidarity and Health”⁴⁸ have emerged spontaneously in response to this crisis as self-organized activities based on open and citizen science committed to the free dissemination of knowledge according
to best practices for the conduct of ordinary life as well as research and the dissemination of the results. The COVID-19 crisis is providing a model for how to deal with the many other crises facing society today: to create citizen science-based Olympiads and use their integrated and collective ingenuity to solve the many intractable challenges.

## The COVID-19 Olympiads: advanced collective intelligence to accompany the ongoing metamorphosis

The rapid use of “COVID-19 Olympiads” results by industrial players will serve as a basis for developing and providing doctors and sectors that influence health with effective treatments and interventions to prevent, detect, treat and cure COVID-19. The success of this endeavor will shorten the development time of treatments for other diseases and effective strategies to reduce vulnerability to disease, particularly in the context of cities where the high concentration of people and ecological disruptions increase the risk of emergence of new diseases. Such efforts will inform and contribute to the necessary transformation of our health and urban systems, reducing both healthcare costs that are becoming unmanageable and healthcare need. The power of systems medicine approaches to COVID-19 will be applied to many other diseases and ultimately to population health, thus gradually transforming 21st century medicine.

Medical and computational technologies generate the data needed to make sense of massive medical imaging, genomic and functional studies, as well as the continuous streams of big data generated by connected devices recording human activities and health statuses in real time⁴⁰. By combining human knowledge with the computing capabilities of machines, we are able to implement a collective “advanced intelligence”⁵⁰ taking into account that SARS-CoV-2 affects multiple organs sensitive to environmental variations. This often begins with infection of the lungs, heart and brain, but the liver, kidneys, intestine or skin are other possible entry points for the virus. Old age and associated comorbidities such as diabetes and obesity are aggravating factors for COVID-19⁵¹. Understanding coronavirus-receptor interactions and susceptibilities as well as inflammatory cascades and organ damage will lead to new and more effective solutions to combat this disease, and support advocacy for whole-of-society interventions to prevent these comorbidities.

This health-digital convergence underlies the emergence of a systemic approach to medicine, and a shift from reactive medicine, intervening after the appearance of symptoms or pathogens, to proactive medicine capable of detecting warning signs that can lead to illness. Intervention at multiple scales from individual to environmental becomes possible early to counteract the development of the disease, thus maintaining health and wellbeing of each person. The attention focused on early diagnosis, prevention and resistance will become the norm, and will require unprecedented collaborations, bridging systems biology data with data from diverse disciplines and sectors to inform intervention development tailored to different contexts.

One concrete example of the response to the COVID-19 challenge within two weeks of the first reported coronavirus infections is the clinical trial initiated by the Institute for Systems Biology (ISB) together with Swedish Hospital within the Providence Saint Joseph Health (PSJH) system, the 3rd largest, non-profit healthcare systems in the United States, a speed made possible by the coronavirus crisis⁵². This study is generating longitudinal high-dimensional data for each patient to deconvolute COVID-19 complexity by collecting billions of measurements on each individual. The study protocol includes genome/phenome analyses, very deep analyses of each individual's immune responses⁵³ and is pioneering a new approach to viral diagnosis employing saliva with an assay that is simple, rapid, inexpensive, and easy to implement (Figure 1).

This approach has attracted partners from academia, pharmaceutical, data generation, technology and diagnostic companies representing virtually all aspects of healthcare, already including 13 different companies and academics from 5 different institutions joining forces to address a hard societal problem. This is creating a COVID-19 ecosystem with two components: 1) a platform containing a very large amount of data from COVID-19 patients and 2) partners that have agreed to immediate data release for all to be able to analyze these big data, and no initial intellectual property constraints, remarkable industrial concessions driven by the COVID-19 emergency. The same study protocol is being implemented in partnership with ISB and the European Institute for Systems Biology and Medicine at Policlinico Gemelli and San Filippo Neri Hospital in Rome, Italy, supported by an ecosystem of 6 academic and 10 industrial partners, and by the network of translational research centers coordinated by the Jiao Tong and Fudan universities in Shanghai, China, supported by an ecosystem of 14 academic and 12 industrial partners. These COVID-19 ecosystems will, after the crisis abates, evolve to take on similar systems-driven clinical trials on major infectious and NCDs and then quickly move seamlessly to the systems medicine analysis of millions of patients then healthy citizens. When extended to other sites, this approach will lead to a transformation of 21st century medicine and healthcare globally. We recognise the inequities in health experienced globally arise not only from inequities in access to healthcare advances but also from exposures in the natural and built environments that determine health. Therefore, a critical role of this evolving ecosystem is to contribute to building stronger health systems for primary prevention⁵⁴.

Another concrete example is the OpenCovid19 Initiative on Just One Giant Lab⁵⁵, an online platform designed for open science, responsible innovation and continuous learning, empowering partners with academic labs, companies, startups, foundations, non-governmental organizations and public services to create participatory research programs for understanding and solving health, environmental, social and humanitarian issues. It currently coordinates the Open-Covid19 program fostering open-source and low-cost tools and methodologies that are safe and easy to use in response to the COVID-19 pandemic. Launched in early March 2020, powered by a global community of more than 4000 volunteers
<figure><img src="image_9.png" /></figure>

The ISB multi-omic data cloud

<figure><img src="image_10.png" /><figcaption>**Figure 1. Coronavirus disease 19 (COVID-19) Immune Response Study.** Depth of the data collected and the analyses performed for each individual. The Institute for Systems Biology (ISB)/Providence St Joseph Health (PSJH) COVID-19 clinical trial started with 200 patients divided into four categories ranging from mild to most severe disease. Blood is collected at 3 times: diagnosis, 7-10 days later and after release to home; and also on patients that recovered at home. Viral infection is measured for all major organ systems. The study will be eventually extended to 600 or more COVID-19 patients at PSJH and at different locations. It employs high-dimensional analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected individuals: genome/phenome, electronic health records, organ-specific blood proteins to determine damaged organs, and deep analyses of both adaptive and innate immune responses to identify disease trajectories as well as protective epitopes key to successful vaccines. Each patient's coronavirus RNA genome will be sequenced and their variation correlated with the patient's disease phenotypes and genome sequence. Autopsy materials from patients who have died allow identification of the various sites (and cell types) of virus infection. One thousand individuals that experienced almost two years of scientific wellness monitoring through genome/phenome analyses serve as healthy controls. These individuals provide a unique opportunity for visualization of the transition from wellness to COVID-19 for the presumptive 20-30 individuals that will have contracted COVID-19. The study will use saliva-based, high-throughput coronavirus assays for reentry in ordinary life: one very simple device and two technicians make it possible to analyze 20,000 saliva samples a day rapidly and for $2 a test. Moreover, a simple, cheap and reliable home microfluidic device is under development to determine whether one is infected with coronavirus. BCR: B-Cell Receptor; TCR: T-Cell Receptor; TBD: To Be Determined. This image is reproduced under the terms of the [Creative Commons Attribution 4.0 International licence](https://creativecommons.org/licenses/by/4.0/).</figcaption></figure>

and experts who create solutions to better prevent, detect, and treat COVID-19, and to help forecast evolution of the pandemic. Over the course of three months, the community created 60 projects, 19 of which were awarded micro-grants through an open community peer-review system (Figure 2). To enable this collaborative citizen science process, researchers at the Center for Research and Interdisciplinarity (CRI)⁵⁶ work with the Open Source Pharma Foundation (OSPF;⁵⁷), that is providing an open research platform to support the development of devices, tests, drugs and vaccines to fight the coronavirus pandemic, leveraging the Open Source Discovery community⁵⁷,⁵⁸. Together, they launched an inclusive electronic survey that allows everyone

not only to contribute their medical and well-being data in a distributed, anonymous fashion but also to debate and to contribute their own survey queries throughout the lifetime of the study, allowing participants to play an active role and tailor the survey to their own concerns and communities. Further, all raw anonymized data will be openly shared with the participants, allowing them to draw their own conclusions, discuss collectively and make informed suggestions for policy implementations locally and globally.

The experience acquired during the current crisis will thus be extremely useful for the treatment of other communicable
<figure><img src="image_11.png" /><figcaption>b</figcaption></figure>

<figure><img src="image_12.png" /></figure>

**Figure 2.** The OpenCovid19 Initiative on Just One Giant Lab (https://jogl.io/). **a.** Overview of popular projects on the Just One Giant Lab online platform designed for open science, responsible innovation and continuous learning. Launched early March 2020, its OpenCovid19 Initiative develops open-source and low-cost tools and methodologies that are safe and easy to use in response to the Coronavirus disease 19 (COVID-19) pandemic. The OpenCovid19 program is powered by a global community of 4000+ volunteers and experts who create solutions to better prevent, detect, and treat COVID-19, and to help forecast evolution of the pandemic. These images are reproduced under the terms of the Creative Commons Attribution 4.0 International licence (CC-BY 4.0). **b.** Skill map of the OpenCovid19 community, visualized using Gephi 0.9.2 (https://gephi.org). Skills are linked if they appear in a common project. Node size represents degree. Topological modules are colored using the modularity algorithm. Skills encompass a wide range of disciplines, from education and game design to public health, from project management to data science, or from web development to bioinformatics and biology.

diseases, as well as for many NCDs or genetic diseases. All biomedical research domains will be transformed through foundations for a “World Alliance for Health and Well-being”⁵⁹. These will be developed in partnership with United Nations organizations such as WHO², UNESCO³, UN Habitat⁶⁰, their members, industrial partners and civil society. Although health is a right to all just as is freedom from hunger, we need to recalibrate the balance between health as a right and health as a business. In the last few decades, we have seen the balance tilting in the wrong direction of ever-increasing commodification of health services. Indeed, for decades, the advantages and disadvantages of an emphasis on the open commons or restricted anti-commons has fueled intense debates⁶¹⁻⁶⁵. We need to proactively embrace open source development of tests, drugs and vaccines as common goods of humanity, supported through innovative and realistic mechanisms to ensure their economic sustainability⁵⁷.

There will be no “day after” when all organizations and people confined voluntarily or by necessity resume their activities and habits as if nothing had happened. Our humanity, which is responsible for a cascade of events that turned into a global cataclysm, has responded by a collective attack on COVID-19. As the result, it is undergoing a metamorphosis from which

a different world is emerging. Its success and future depend on us, for the better or for the worse.

Since Antiquity, every doctor has taken the Hippocratic oath at the end of medical studies. Its universally recognized principles are not to harm patients, but to relieve them while respecting their autonomy, will, integrity, dignity, and privacy in full confidentiality, without discrimination and without abusively prolonging the agonies or deliberately causing death. The goals are to promote health in all its dimensions, to be faithful to the laws of honor and probity, and to preserve necessary independence in decision making with the active participation of the patients for their benefit. This requires dedication to public education, starting in primary schools⁶⁶.

The oath of the scientists echoes and complements it prominently at the end of the luminous introduction by Michel Serres of Le Trésor - Dictionnaire des Sciences⁶⁷: "For what depends on me, I swear: not to serve my knowledge, my inventions and the applications that I could draw of these to violence, destruction or death, the growth of misery or ignorance, enslavement or inequality, but to devote them, on the contrary, to equality between men, their survival, their elevation and their freedom."
The world that is being born from the metamorphosis caused by the COVID-19 pandemic will depend on our ability to combine these two oaths, a requirement to leverage the power of systems approaches to complex problems and the incredible transformation potential of the collective of the concerned. We hope that the generations that follow us will grow and flourish in this uncertain world and make it more fraternal, harmonious and human than the one we built, leading to the activation and the rampant spread of the new and destructive coronavirus. This will be the case only if we always remain united and vigilant during and after the health crisis that we are all going through together. This is the fight of all humanity, and we must give primary attention to the most fragile of our citizens, while making concerted efforts to reduce modifiable vulnerabilities, to preserve our most precious common good, health.

As the poet Antonio Machado put it so well, the trajectory
that we will follow to embark on this extraordinary human
adventure depends primarily on us: “Caminante, no hay camino,
se hace camino al andar” (wanderer, there is no path, the
path is made by walking⁶⁸).

A World Alliance for Health and Wellbeing takes
action through a coalition in response to the
COVID-19 pandemic

The path is not drawn in advance, we will have to adapt
wisely to future circumstances. Let us show audacious and
determined solidarity in taking the systems-driven measures that
are essential to overcome the obstacles that hinder us. Let us
bring a lasting systemic response to the global systemic crisis
that challenges our certainties. There is no alternative but action.
Meeting in Paris in 2003, we set out to “rethink research to
understand life and improve health”⁶⁹. We now meet

virtually through links consolidated over decades and, as a first
step, have formed an international coalition to thoroughly char-
acterize patients with COVID-19 during the pandemic using a
shared study protocol and informed consent form (Figure 1).
All results will be publicly available with no initial claims
for intellectual property rights. This World Alliance for
Health and Wellbeing has thus entered into concrete action
with the mission to take a systems approach to understand-
ing COVID-19 and to catalyze the creation of medical and
health products such as diagnostic tests, drugs and vaccines
that become common goods accessible to all on a sustainable
basis. In addition, we recognise that many factors that deter-
mine health lie outside healthcare and that a growing major-
ity of the world population live in cities, where the interwoven
relationship between people, their environments, and emer-
gence of disease is most apparent. As such, we further seek
alliances with diverse sectors adopting systems approaches
across disciplines, bridging biomedical lessons learned with
the complex socio-ecological and technological systems that
characterise urban systems, harnessing human and social
capital for a collective response to future health emergencies.

Data availability

Underlying data

No data are associated with this article

Acknowledgements

We thank Bertrand De Meulder (EISBM) for help in format-
ting the references, colleagues and citizens for useful comments
on the manuscript.

A previous preprint version of this manuscript is available
from SSRN (https://dx.doi.org/10.2139/ssrn.3630412)

References

1. University CfSSaEajH: COVID-19 Dashboard. 2020.
Reference Source

2. WHO: **COVID-19 Pandemic**. 2020.
Reference Source

3. UNESCO: COVID-19 Open Science and Reinforced Scientific Cooperation. 2020.
Reference Source

4. EMBL-EBI: COVID-19 Data Portal. 2020.
Reference Source

5. Government U: Public Health Information - Coronavirus. 2020.
Reference Source

6. OpenAIRE: COVID-19 Gateway. 2020.
Reference Source

7. Zenodo: Coronavirus Disease Research Community. 2020.
Reference Source

8. NIH: Health Information - Coronavirus. 2020.
Reference Source

9. Gámbaro F, Behillil S, Baidaliuk A, et al.: Introduction and early spread of SARS-CoV-2 in France. medRxiv. PrePrint. 2020. Publisher Full Text

10. Salje H, Tran Kiem C, Lefrancq N, et al.: Estimating the burden of SARS-CoV-2 in France. Science. 2020; 369(6500): 208-211.
PubMed Abstract | Publisher Full Text | Free Full Text

11. Bi Q, Wu Y, Mei S, et al.: Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis. 2020; 20(8): 911-919.
PubMed Abstract | Publisher Full Text | Free Full Text

12. Gudbjartsson DF, Helgason A, Jonsson H, et al.: Spread of SARS-CoV-2 in the Icelandic Population. N Engl J Med. 2020; 382(24): 2302-2315.
PubMed Abstract | Publisher Full Text | Free Full Text

13. Jones TC, Mühlemann B, Veith T, et al.: An analysis of SARS-CoV-2 viral load by patient age. medRxiv. 2020.
Publisher Full Text

14. Xu B, Gutierrez B, Mekaru S, et al.: Epidemiological data from the COVID-19 outbreak, real-time case information. Sci Data. 2020; 7(1): 106.
PubMed Abstract | Publisher Full Text | Free Full Text

15. Ferretti L, Wymant C, Kendall M, et al.: Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science. 2020; 368(6491): eabb6936.
PubMed Abstract | Publisher Full Text | Free Full Text

16. Zhang X, Tan Y, Ling Y, et al.: Viral and host factors related to the clinical outcome of COVID-19. Nature. 2020; 583(7816): 437-440.
PubMed Abstract | Publisher Full Text
17. Senghore M, Savi MK, Gnangnon B, et al.: Leveraging Africa's preparedness towards the next phase of the COVID-19 pandemic. *Lancet Glob Health*. 2020; 8(7): e884–e885.

PubMed Abstract | Publisher Full Text | Free Full Text

18. Zhou J, Li C, Liu X, et al.: Infection of bat and human intestinal organoids by SARS-CoV-2. *Nat Med*. 2020; 26(7): 1077–1083.

PubMed Abstract | Publisher Full Text

19. Barnes BJ, Adrover JM, Baxter-Stoltzfus A, et al.: Targeting potential drivers of COVID-19: Neutrophil extracellular traps. *J Exp Med*. 2020; 217(6): e20200652.

PubMed Abstract | Publisher Full Text | Free Full Text

20. Wilk AJ, Rustagi A, Zhao NQ, et al.: A single-cell atlas of the peripheral immune response to severe COVID-19. 2020.

PubMed Abstract | Publisher Full Text | Free Full Text

21. Wikipedia: Wikipedia entry on Severe acute respiratory syndrome coronavirus. 2020.

Reference Source

22. Wikipedia: Wikipedia entry on: Middle east respiratory syndrome - related coronavirus. 2020.

Reference Source

23. Boni MF, Lemey P, Jiang X, et al.: Evolutionary origins of the SARS-CoV-2 sarbecovirus lineage responsible for the COVID-19 pandemic. *bioRxiv*. 2020.

Publisher Full Text

24. Du Z, Javan E, Nugent C, et al.: Using the COVID-19 to influenza ratio to estimate early pandemic spread in Wuhan, China and Seattle, US. *EClinicalMedicine*. 2020; 100479.

PubMed Abstract | Publisher Full Text | Free Full Text

25. Anfinrud P, Stadnytskyi V, Bax CE, et al.: Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering. *N Engl J Med*. 2020; 382(21): 2061–2063.

PubMed Abstract | Publisher Full Text | Free Full Text

26. Stadnytskyi V, Bax CE, Bax A, et al.: The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission. *Proc Natl Acad Sci U S A*. 2020; 117(22): 11875–11877.

PubMed Abstract | Publisher Full Text | Free Full Text

27. Rossman H, Keshet A, Shilo S, et al.: A framework for identifying regional outbreak and spread of COVID-19 from one-minute population-wide surveys. *Nat Med*. 2020; 26(5): 634–8.

PubMed Abstract | Publisher Full Text | Free Full Text

28. Segal E, Zhang F, Lin X, et al.: Building an International Consortium for Tracking Coronavirus Health Status. *medRxiv*. 2020.

Publisher Full Text

29. Aarestrup FM, Albeyatti A, Armitage WJ, et al.: Towards a European health research and innovation cloud (HRIC). *Genome Med*. [Research Support, Non-U.S. Gov't]. 2020; 12(1): 18.

PubMed Abstract | Publisher Full Text | Free Full Text

30. Labhive: We align efforts for more SARS-CoV2 tests. 2020.

Reference Source

31. Wolkenhauer O, Auffray C, Brass O, et al.: Enabling multiscale modeling in systems medicine. *Genome Med*. 2014; 6(3): 21.

PubMed Abstract | Publisher Full Text | Free Full Text

32. Auffray C, Noble D, Nottale L, et al.: Progress in integrative systems biology, physiology and medicine: towards a scale-relative biology. *Eur Phys J A*. 2020; 56: 88.

Publisher Full Text

33. Montuori A: Edgar Morin's Path of Complexity. 2008.

Reference Source

34. Price ND, Magis AT, Earls JC, et al.: A wellness study of 108 individuals using personal, dense, dynamic data clouds. *Nat Biotechnol*. 2017; 35(8): 747–56.

PubMed Abstract | Publisher Full Text | Free Full Text

35. Nations U: 17 Goals to Transform Our World. 2020.

Reference Source

36. Hood LE, Lazowska ED: Every life has equal value. *Cell*. 2013; 154(6): 1178–9.

PubMed Abstract | Publisher Full Text

37. Auffray C, Chen Z, Hood L: Systems medicine: the future of medical genomics and healthcare. *Genome Med*. 2009; 1(1): 2.

PubMed Abstract | Publisher Full Text | Free Full Text

38. Hood L, Balling R, Auffray C: Revolutionizing medicine in the 21st century through systems approaches. *Biotechnol J*. 2012; 7(8): 992–1001.

PubMed Abstract | Publisher Full Text | Free Full Text

39. AFP: Coronavirus: l'équipage du porte-avions "Charles-de-Gaulle" probablement contaminé lors d'une école à Brest. *Le Monde*. 2020.

Reference Source

40. AFP: Coronavirus: les contaminations diminuent en Chine, mais progressent ailleurs dans le monde. *Le Monde*. 2020.

Reference Source

41. Bouissou J: La crise économique provoquée par le coronavirus pourrait être la plus dévastatrice depuis 150 ans. *Le Monde*. 2020.

Reference Source

42. Nicolle C: Naissance, vie et mort des maladies infectieuses. Paris: Librairie

Félix Alcan. 1930.

Reference Source

43. WHO: Coronavirus disease may never go away. 2020. Reference Source

44. Wolrdbank: Gender and COVID-19 (coronavirus). 2020. Reference Source

45. Wilingham E: Genes may influence COVID-19 risk, new studies hint. 2020. Reference Source

46. Spencer EA, Brassey J, Jefferson T, et al.: Environmental weather conditions and influence on transmission of SARS-CoV-2. CEBM; 2020 [updated 3 July 202027/08/2020].

Reference Source

47. Ostaszewski M, Mazein A, Gillespie ME, et al.: COVID-19 Disease Map, building a computational repository of SARS-CoV-2 virus-host interaction mechanisms. *Sci Data*. 2020; 7(1): 136.

PubMed Abstract | Publisher Full Text | Free Full Text

48. Auffray C: The Olympiads of Solidarity and Health. 2020. Reference Source

49. Auffray C, Balling R, Barroso I, et al.: Making sense of big data in health research: Towards an EU action plan. *Genome Med*. 2016; 8(1): 71.

PubMed Abstract | Publisher Full Text | Free Full Text

50. Kitano H: Artificial Intelligence to Win the Nobel Prize and Beyond: Creating the Engine for Scientific Discovery. *Al Magazine*. 2016; 37(1): 39. Publisher Full Text

51. Caussy C, Pattou F, Wallet F, et al.: Prevalence of obesity among adult inpatients with COVID-19 in France. *Lancet Diabetes Endocrinol*. 2020; 8(7): 562–564.

PubMed Abstract | Publisher Full Text | Free Full Text

52. ISBscience: COVID-19 Immune response study. 2020. Reference Source

53. Su Y, Chen D, Lausted C, et al.: Multiomic immunophenotyping of COVID-19 patients reveals early infection trajectories. *bioRxiv*. 2020. Publisher Full Text

54. Oni T, Mogo E, Ahmed A, et al.: Breaking down the silos of Universal Health Coverage: towards systems for the primary prevention of non-communicable diseases in Africa. *BMJ Glob Health*. 2019; 4(4): e001717.

PubMed Abstract | Publisher Full Text | Free Full Text

55. JOGL: Open COVID-19 platform. 2020. Reference Source

56. CRI: Center for Interdisciplinary Research. 2020. Reference Source

57. OSPFoundation: Open Research Platform. 2020. Reference Source

58. OSDD: Open Source Drug Discovery. 2020. Reference Source

59. Auffray C, Sagner M, Abdelhak S, et al.: Viva Europa, a Land of Excellence in Research and Innovation for Health and Wellbeing. *Progress in Preventive Medicine*. 2017; 2(3): e006.

Reference Source

60. Environment CcaHwt: Integrating health in urban and territorial planning: a sourcebook. Geneva, Switzerland. 2020. Reference Source

61. Heller MA, Eisenberg RS: Can patents deter innovation? The anticommons in biomedical research. *Science*. 1998; 280(5364): 698–701.

PubMed Abstract | Publisher Full Text

62. Hardin G: The Tragedy of the Commons. *Science*. 1968; 162(3859): 1243–8.

PubMed Abstract | Publisher Full Text

63. Mayor F: The Universal Declaration on the Human Genome and Human Rights. *C R Biol*. 2003; 326(10–11): 1121–5.

PubMed Abstract | Publisher Full Text

64. Auffray C: Sharing knowledge: a new frontier for public-private partnerships in medicine. *Genome Med*. 2009; 1(3): 29.

PubMed Abstract | Publisher Full Text | Free Full Text

65. Knoppers BM, Thorogood A, Chadwick R: The Human Genome Organisation: towards next-generation ethics. *Genome Med*. 2013; 5(4): 38.

PubMed Abstract | Publisher Full Text | Free Full Text

66. Cesario A, Auffray C, Russo P, et al.: P4 medicine needs P4 education. *Curr Pharm Des*. 2014; 20(38): 6071–2.

PubMed Abstract | Publisher Full Text

67. Serres M, Farouki N: Le Trésor: dictionnaire des sciences. Paris: Flammarion; 1997. Reference Source

68. Wikipedia: Wikipedia entry on Antonio Machado. 2019. Reference Source

69. Auffray C, Chen Z, Hood L, et al.: Foreword: from the TRANSCRIPTOME conferences to the SYSTEMOSCOPE international consortium. *C R Biol*. 2003; 326(10–11): 867–75.

PubMed Abstract | Publisher Full Text
# Open Peer Review

Current Peer Review Status: ? ? ?

## Version 1

## Reviewer Report 22 February 2021

https://doi.org/10.5256/f1000research.28801.r77874

© 2021 Mazza T. This is an open access peer review report distributed under the terms of the [Creative Commons Attribution License](https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<figure><img src="image_13.png" /></figure>

IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy

In a period when all readings get deeper into details of infection, mechanisms of molecular interaction, and strategies of analysis, it was a pleasure reading a commentary on humanity, solidarity, and shared science against COVID-19.

Even if some of the authors are eminent representatives of research areas that intersect mines, I must admit that their community was unknown to me. It was interesting to read that already in 2003, they have joined their forces to rethink the way health research is done. However, I must also say that it is not clear how they are doing it in practice in this particular emergency time.

The manuscript goes through a long, clear-headed introduction to the history of the virus and its ancestors. I would somehow focus more on low-income countries and their difficulties to screen the population and enabling prevention actions. I'd refer here to two of the 17 UN's sustainable goals, e.g., poverty and inequality referred to later in the text.

Another point in this section regards the relationships between CoV-1 and CoV-2. CoV-2 is indeed much less virulent than CoV-1 and SARS if virulence is meant as the extent of damages caused to hosts. However, I'd remark that in the face of similar transmissibility, CoV-2 doubles the CoV-1 incubation time (2-7 days), thereby advantaging its spreading. Enhanced spreading is precisely the reason why we are going to live with this virus for a long time.

The web developed by CERN is mentioned as a spur to organize other similar initiatives. I'd liked to read more on the CERN's web and what has been done in this pandemic.

Throughout the manuscript, the authors speak several times about the need for proper integrative and analytical techniques and initiatives to better tackle health emergencies. I have noticed that this claim, which I share personally, is cluttered through the manuscript, and any time I bumped against it, I felt like it was only a claim and a general thought. Only at the end of the manuscript, when a couple of successful projects (ISB's clinical trial and OpenCovid19) were briefly discussed, I could reconcile the feeling of missing information on systems biology/medicine that accompanied the whole reading. In this regard, I could not understand what's the study protocol that ISB, together with the European Institute of Systems Biology and the Gemelli and S. Filippo Neri hospitals have implemented. I was not aware of this collaboration, neither I've read anything
in the local newspapers. Being this reviewer Italian, he would be particularly interested to know
how these two important hospitals are contributing to the project.

Figure 1 is a sort of mixed graph with directed and undirected edges. This is fine when the aim is illustrative, as in this case. However, it is not clear what the multi-edge between some nodes, e.g., PROTEOMICS and Aptamer proteomics, do they mean.

I like Figure 2B. However, it is not high resolution, and the text of small nodes is unreadable. It aims at representing the skills of the members of the OpenCovid19 community. In the figure legend, the authors refer to a broad range of skills; however, the high-degree nodes, which are the only readable, curiously report mostly computational and technical skills. Graphic design is the highest degree node. This tickles my curiosity about the composition of this community.

I look forward to reading more about it and its activities. I thank all the authors for this piece of science.

**Is the topic of the opinion article discussed accurately in the context of the current literature?**

Yes

**Are all factual statements correct and adequately supported by citations?**

Yes

**Are arguments sufficiently supported by evidence from the published literature?**

Partly

**Are the conclusions drawn balanced and justified on the basis of the presented arguments?**

Yes

**Competing Interests:** No competing interests were disclosed.

**Reviewer Expertise:** computational and systems biology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Reviewer Report 25 November 2020

https://doi.org/10.5256/f1000research.28801.r74443

© 2020 Khalili H. This is an open access peer review report distributed under the terms of the [Creative Commons Attribution License](https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

? Hossein Khalili

<footnote n="1">¹ UW Center for Interprofessional Practice and Education (UW CIPE), University of Wisconsin-</footnote>
Madison, Madison, WI, USA

² Adjunct Research Professor Ontarion, Western University, Ontarion, Canada

Thank you for the opportunity to review this article. The article is well written and very needed. Here are a few comments for the authors to consider in order to further improve the quality of their work:

The authors could consider and highlight/call the COVID-19 pandemic as not just a health crisis, rather both health and social crises that affect every aspect of our lives.

When referring to the need for global systemic response to the pandemic, the authors could discuss concepts like the *Whole-of-Government Approach, Health in All Policies, Interprofessional Collaborative Practice*. In line with those when referring to treatments of COVID, it would be best if they use languages like 'healthcare providers' (rather than doctors as there are number of different professionals providing care to patients and families), and 'health care' (rather than medicine).

When discussing the equity and access to COVID-19 treatments, the authors could refer to WHO's Universal Health Coverage, Triple Billion Targets, and Sustainable Development Goals.

Last, but not least, the authors should also highlight the need for resilience (training/development) among healthcare providers, students, teachers/educators, researchers, and the society for a success transition/overcome of the pandemic-related challenges.

**Is the topic of the opinion article discussed accurately in the context of the current literature?**

Partly

**Are all factual statements correct and adequately supported by citations?**

Yes

**Are arguments sufficiently supported by evidence from the published literature?**

Yes

**Are the conclusions drawn balanced and justified on the basis of the presented arguments?**

Partly

**Competing Interests:** No competing interests were disclosed.

**Reviewer Expertise:** Medical-surgical, healthcare system and policy development, interprofessional collaborative practice, higher education, research and scholarship.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
Reviewer Report 25 November 2020

https://doi.org/10.5256/f1000research.28801.r74650

© 2020 Chadwick R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<figure><img src="image_14.png" /></figure>

Ruth Chadwick

Cardiff University, Cardiff, UK

This is an interesting piece giving a high-level overview perspective on the implications of the COVID-19 pandemic for the future of medicine, medical ethics and health care systems. Apart from the description of features of the pandemic, it is written in a very broad sweep way, which is necessary, given the predictions made about the future of health care. Specific points are, however, made about the avoidance of initial intellectual property claims in the context of the global cooperation that is going to be needed to address health care challenges such as the one currently faced across the world.

There are interesting points made about ethical implications. Given that it is claimed that what is needed is a transcendence of disciplinary boundaries and collaboration between science and the humanities, it would be good to see these fleshed out a little. For example, what does it mean to say that concepts of individuality will be challenged? The concept of solidarity is appealed to, and towards the end an interesting point is made about the link between the Hippocratic Oath and scientific ethics.

It is particularly important that these points are elaborated in order to avoid the possible perception that the claims about a future in which 21st century medicine is transformed constitute an ideal only, which may not be realised as a model for dealing with other future crises. Can we be sure that business as usual will not be resumed? What practical steps need to be taken so that a new ethic is internalised?

In what ways, precisely, does research need to be rethought - is it envisaged that current international principles of research ethics need to be rewritten?

**Is the topic of the opinion article discussed accurately in the context of the current literature?**

Yes

**Are all factual statements correct and adequately supported by citations?**

Yes

**Are arguments sufficiently supported by evidence from the published literature?**

Yes

**Are the conclusions drawn balanced and justified on the basis of the presented arguments?**
Yes

**Competing Interests:** No competing interests were disclosed.

**Reviewer Expertise:** Biomedical ethics, gene-ethics, Health care policy

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

The benefits of publishing with F1000Research:

* Your article is published within days, with no editorial bias

* You can publish traditional articles, null/negative results, case reports, data notes and more

* The peer review process is transparent and collaborative

* Your article is indexed in PubMed after passing peer review

* Dedicated customer support at every stage

For pre-submission enquiries, contact research@f1000.com