SARS-CoV-2 risk misclassification explains poor COVID-19 management
Authors: Juan Martínez Hernández
Journal: The Lancet (2020)

One of the most striking facts about the COVID-19 pandemic is the notable difference in approach, attitude, control measures, case incidence, and mortality rates between eastern and western hemispheres. Results of a recent analysis1Han E Mei Jin Tan M Turk E Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe.Lancet. 2020; (published online Sept 24.)https://doi.org/10.1016/S0140-6736(20)32007-9Summary Full Text Full Text PDF Scopus (506) Google Scholar show lessons to be learnt from the experiences of these countries and regions. The differences in approach and mortality could be explained, at least partially, if not totally, by the misclassification of the infectious agent risk. WHO classifies microorganisms into four risk levels according to its biosafety manual.2World Health OrganizationLaboratory biosafety manual.3rd edn. World Health Organization, Geneva2004Google Scholar National legislation, in accordance with this classification, regulates prevention measures and biosecurity, mainly to protect occupational health.3European ParliamentDirective 2000/54/EC of the European Parliament and of the Council of 18 September 2000 on the protection of workers from risks related to exposure to biological agents at work.https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex:32000L0054Date: Oct 17, 2000Date accessed: September 29, 2020Google Scholar Group 4 includes new or known agents for which there is no vaccine or treatment and which can be spread at community level. Ebola virus and variola virus are categorised as group 4 agents. Group 3, however, includes dangerous microorganisms such as Mycobacterium tuberculosis that have available antibiotic therapy and other well known control measures. When severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China, other Asian countries, Australia, and New Zealand put in place contingency plans against an infectious agent of the highest risk, not only in occupational health but also to protect the general population. Given the uncertainty about the nature and real risk of the threat, governments of these countries decided to take the strictest measures—the same measures that would have been used in a case of smallpox or plague. For this reason, protective equipment similar to that used against Ebola was used, the streets were disinfected with chlorine, patients with COVID-19 were separated from the rest of the patients in monographic centres, and mandatory individual quarantines were ordered. Then collective quarantines in the form of lockdown were implemented. By contrast, the western approach, according to a supposed risk classification of group 2 or 3, initially considered COVID-19 a new kind of influenza and determined that the general management of cases and contacts would be made in general hospitals and outpatients wards, without any type of mandatory quarantine or isolation in monographic hospitals. The European Commission debated in June, 2020, the classification of SARS-CoV-2, categorising it as a group 3 agent. This decision was strongly protested by members of the European Parliament, who disagreed and called for a group 4 categorisation.4European ParliamentCommission Directive (EU) 2020/739 of 3 June 2020 amending Annex III to Directive 2000/54/EC of the European Parliament and of the Council as regards the inclusion of SARS-CoV-2 in the list of biological agents known to infect humans and amending Commission Directive (EU) 2019/1833.https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32020L0739Date: June 3, 2020Date accessed: September 29, 2020Google Scholar, 5Guarascio F Coronavirus is not high threat to workers, EU says, causing outcry.https://www.reuters.com/article/us-health-coronavirus-eu-workers/coronavirus-is-not-high-threat-to-workers-eu-says-idUSKBN23A1H9Date: June 3, 2020Date accessed: September 28, 2020Google Scholar If Europe and other countries in the western hemisphere want to achieve an epidemiological trend similar to Asian countries, then SARS-CoV-2 should be considered an agent of maximum risk in all technical approaches, clinical settings, and social levels. I am former general director of public health of the Community of Madrid, Spain. I declare no competing interests. Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and EuropeThe COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. Full-Text PDF