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Hope for a common solidarity future of health for all

At the proposal of the European Union, the 73rd World Health Assembly (WHA) adopted the historic Resolution COVID-19, which was co-sponsored by as many as 146 WHO member states.

From the beginning of the drafting process until the adoption of the resolution, Croatia actively participated in the harmonization of the content of document with other WHO member states. By adopting the COVID19 Resolution, the world symbolically showed unity in the fight against the COVID-19 pandemic.

The process of harmonizing the text of the Resolution was more than challenging.  Namely, the growing geopolitical tensions between the United States and China gave an uncomfortable feeling of accepting the risk of a negative outcome.

This process of harmonizing the views of WHO member states was characterized by the usual separation between countries that were more protective of their pharmaceutical industry and those member stares, aided by civil society groups, who wanted to break patent monopolies over critical health products.

The COVID-19 resolution, with its content, includes proposals for all important items of the common position and coordinated activities of EU countries related to the COVID-19 pandemic: recognition of health workers and everyone on the front lines, especially women; support for the leading role of the WHO and the UN; solidarity; multilateralism, the maintenance of essential health services during a pandemic; EU funding assistance; the equal right of all to medical treatment, therapy and vaccines and a transparent evaluation of everything done during the fight against the COVID19 pandemic.

The COVID-19 Resolution provides the basis for the timely resolution of the common struggle of humanity against all future threats of a similar nature.

By jointly proposing this COVID-19 Resolution, the EU has, above all, demonstrated its unity. Encouraging the unique international cooperation of all the people of the world, the EU has presented itself as an important global player in this challenging period for humanity.

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What is COVID-19 pandemic teaching us about our healthcare infrastructure?

The recent COVID-19 pandemic has brought almost all the countries, most of the industries, and the global economic and health systems to their knees. It has amplified many of the preexisting cracks in the system, but also spurred creativity and innovation, compassion, empathy, and some of the best traits of humankind in order to combat this health crisis.

As part of the solution against the COVID-19 threat, the Architecture, Engineering and Construction (AEC) sector has also mobilized its creative forces to help the healthcare professionals in providing the much-needed hospital capacities of clean and sterile spaces where the patients can receive the life-saving treatments. Nonetheless, the proposed solutions extensively range in speed, cost, and permanence of the newly built hospital facilities.

Given the unanticipated character of the COVID-19 pandemic and ferocity with which it has swept throughout the world, rapid creation of additional intensive care capacities became the primary focus of architects and engineers within the first phase of their response. Hence, numerous designs proposed deployment and construction of alternative care facilities (ACFs). They include temporary solutions such as military field hospitals located in tent-like structures, temporary modular structures built from redesigned shipping containers, and existing buildings such as hotels, convention centers, and arenas converted into temporary healthcare facilities. However, due to their rapid erection and temporary character the ACFs are suitable only for patient triage, preliminary treatment of patients with light symptoms, or residence for uninfected yet immuno-vulnerable portion of the population.

As part of the second phase of COVID-19 response spaces are designed to provide care for the most critically ill patients. Therefore, these solutions should allow for fast and non-disruptive expansion and retrofit of existing hospital departments into intensive care units that adhere to the highest levels of hygiene and sterility. Many of the leading AEC companies and academic researchers are finding the promising solution in the technique of offsite construction where modules consisting of completely equipped medical rooms are assembled in factories and then transported on site. This method of construction allows for complete sterile rooms to be lifted by crane and placed within the existing structural grid of the hospital in a matter of hours. In addition, modular adaptable technologies are designed to reduce the life cycle costs of hospital infrastructure by creating a sustainable ecosystem where all the modules can easily be unplugged form the main structure and reused on other projects. Therefore, these technologies are exhibiting the potential for transforming our healthcare system for long-term resiliency even well after we will have successfully cured the COVID-19 pandemic.

Humankind will most certainly show strength through unity and we will victoriously overcome this pandemic crisis, but even more importantly we will be prompted to learn and improve our healthcare systems for future challenges. Hence, exciting times are ahead where new technologies will be innovated to maximize the long-term benefits of modular adaptable design and construction in providing a sustainable system with life cycle economic, social, and ecological sustainability of the future healthcare infrastructure. As Albert Einstein said, “In the Middle of Difficulty Lies Opportunity”. Now it is up to all of us to work towards this brighter future!

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Risk of influence of covid-19 pandemic on the possible development of other epidemics

Although routine immunization for other pre-existing infectious diseases is generally maintained in most countries, there is evidence that COVID-19 virus adversely affects these activities. There is a reasonable risk that further outbreaks of other existing infectious diseases will override health systems already struggling with the effects of COVID-19.

“As the world strives to develop a new COVID-19 vaccine at record speed, we must not risk losing the fight to protect everyone and everywhere against other vaccine-preventable diseases,” said Dr Tedros, WHO Director-General.

Concerning the current situation of the COVID-19 pandemic, ongoing clinical research on five different vaccines for the COVID-19 virus. The worldwide pharmaceutical industry is focused on the invention and production of therapies and vaccines for COVID-19. Negotiations with regulators are ongoing on the possibility of reducing the legislation that needs to be respected by the time the vaccine is used. There are also problems in transferring vaccine production technology to other pharmaceutical centres, and in need of quality control of vaccine production.

At the same time, there is an increased risk that the COVID-19 pandemic will consequently affect the development of other epidemics. Research on nearly 20 million children worldwide indicates that more than 1 in 10 has missed additional measles, diphtheria, and tetanus vaccinations, and approximately 13 million children have never received these vaccines. Most of these children live in countries with already fragile health care systems, which limits their access to basic health services when they become ill. Measles remains a threat, especially if the immunization rate is reduced. Current projections indicate that as many as 800,000 people could be infected with the disease, and there is even greater concern about another resurgence, especially if the percentage of clefts is reduced by delays or suspension of planned immunization activities as a result of COVID-19. Additional outbreaks of polio, diphtheria, and yellow fever are also of concern. Specifically, global coverage for Polio immunization is still far from the 95 per cent coverage needed to fully protect communities from a preventable epidemic of this disease. The future availability of vaccines with a longer period of immunization against the Poliovirus, for which research has been conducted before the onset of the current COVID-19 pandemic, is still out of reach.

Although worldwide supply availability has been largely maintained so far, the longer the COVID-19 pandemic lasts, the greater the risk of reaching critical supply levels. At the service level, however, potential supplies can be foreseen due to reduced supply or disrupted distribution. Furthermore, there are indications of diminished demand for vaccines in some countries due to lack of personal protective equipment for healthcare professionals, declining visits to health centres, psychological factors (eg fear of infection, false rumours) and lack of communication, coordination and specific community involvement on COVID-19. answer.

As the response to COVID-19 continues, health systems need to take additional action on immunization to reduce the possibility of outbreaks of other infectious diseases and new losses of life. These include the provision of emergency epidemic programs in places where services are disrupted, the provision of strong supply chains, disease surveillance and trained health professionals. The new WHO Immunization Guidelines and COVID-19 recommend that temporary immunization campaigns be suspended where there is no active epidemic of a vaccine-preventable disease. However, it is urged that priority be given to continued routine immunization of children, as well as adult vaccination, as in the case of influenza, for the groups at highest risk. If immunization activities are to be discontinued, vaccination should be compensated as soon as possible, favouring those at the highest risk.

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Covid-19 pandemic as a wake-up call for bolstering psychological resilience

The current pandemic of Covid-19 is definitely facing us with many challenges in various areas of life, such as economy and health which accounts for both mental and physical health. Mental health goes hand in hand with physical health, so no wonder that besides our medical immunity the current situation asks for the psychological immunity as well. The psychological immunity, also called the psychological resilience, is the ability to positively adapt and bounce back, rather than break, in the face of the adversity. What does it mean to positively adapt to the given unfortunate circumstances? Positive adaptation refers to keeping the adequate level of internal well-being, while maintaining relatively stable, healthy levels of social and developmental functioning. Although it sounds challenging, it is veritably possible as proven by multiple studies.

What is crucial to know is that resilience is not something that is ingrained in our personality, but it is a capacity that we can nurture and develop throughout our lives. When we are young, our resilience is affected by different factors such as the attachment to our caregivers and their mental health, while later on it is affected by individual attributes such as problem solving skills, sense of life as meaningful, hope, mastery motivation etc.

In these times of trouble it is important to remember our resources within ourselves and our families and community that could help us in prevention and overcoming the main potential psychological problems – anxiety and depression. In other words, this is the right time to work on our resilience in order to cope with this crisis in the most salutary way.

What can you do to address and promote your resilience?

  • Identify your personal strengths and write them down. This helps you elevate your self-esteem and strengthen your belief in your own abilities to deal with this situation.
  • Use humour. Humour is proven to serve as a stress buffer.
  • Bring your attention to the positive aspects of this situation. Some may jokingly say, You get to work on your resilience for starters. On a more serious note, now you have more time to further explore your interests by taking upon free online courses or simply to enjoy that long relaxing bath you have been longing for.
  • Openly communicate with your family and friends about your feelings. Distress in this type of crisis is normal and expected. Try to support each other and repair potential existing conflict.
  • Use mindfulness techniques such as meditation which can help with grounding. You can look the instructions for the techniques online or on plenty of apps available in app stores.
  • Get in contact with your therapist or schedule an appointment if you are new to the therapy. Psychotherapy is a great way to talk out your feelings and problems with a certified mental health care professional who could provide you not only with the relive of the acquired emotional distress, but also with knowledge and skills such as active coping in order to successfully combat life’s adversities.

Those are just a few of many ways to promote your resilience. Do not hesitate to try some of them and remember: “A good half of the art of living is resilience.” – Alain de Botton.

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EU motion for the Resolution COVID-19 on the WHA 2020 has been agreed

This COVID-19 infection knows no boundaries and neither should it know our aggregate reaction. It is just by cooperating on the response, in collaboration with all partners, and in support and under the initiative of the World Health Organisation (WHO) that we will win.

Executive Board Room WHO

As we are living in remarkable occasions, the chance of keeping up a virtual World Health Assembly 2020 (WHA 2020) presents the unprecedented open door for Health Ministers of all WHO Member States to show their solidarity and their basic determination to beat the difficulties we as a whole face in reacting to this COVID-19 pandemic. Following the “period of silence” of all EU Member States, the EU motion for the Resolution COVID-19 on the World Health Assembly (WHA 2020) has been agreed. The EU proposition report has flowed to the other WHO Member States with a solicitation for support and co-sponsorship. The EU Ambassador officially introduced this in his address to the WHO Director-General, Executive Board and Member States during the WHO briefing.

Diplomatic representative of the Republic of Croatia at WHO

The draft resolution tend to a scope of activities for the Member States, partners, non-state actors and the WHO-Secretariat in the general COVID-19 reaction. It likewise gives a chance to us all to salute the endeavours, far above what was required, of health professionals and frontline workers everywhere all over the place, just as to the WHO staff, for their devotion and skilful work for us all.

Croatia at the WHO meeting

By actively participating in the preparation of this document, Croatia has contributed to the drafting of the EU motion for the Resolution COVID-19 and to impart a solid sign that the united EU is starting to lead in fighting the COVID-19 pandemic.

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Does the COVID-19 pandemic build resilient health care systems?

The present COVID-19 pandemic has brought up the conversation of how to build resilient health care systems.  For a health system to be resilient, it has to be able to detect threats before they strike, which means having good epidemiological surveillance.   While a pandemic, like the current COVID-19, represents a significant shock even for the best health care system, resilience also means creating a health care system that will ensure  that the existing care needs do not go unmet, particularly to the most vulnerable segments of the patient population.  For countries with fragile health care systems, a real challenge is ensuring that, during times of crisis, women keep having access to sexual and reproductive health services, as the example of the Ebola crisis resulted in significant increase in maternal mortality due to unmet needs.  We are yet to assess the effect of the COVID-19 pandemic on the ability of health systems to meet the regular needs of its populations.

A healthcare worker carries a baby suspected to have the Ebola virus at a hospital in Oicha, in the Democratic Republic of the Congo, Goran Tomašević/Reuters

A resilient or strong health care system also has to be adaptive, which means being able to recover, that is, return to its normal, pre pandemic functioning after the extraordinary event has passed.  In order to do that a health care system requires adequate funding, addressing existing weaknesses in  the  provision of care (both public and individual), and multi sectoral integration that deploys resources far beyond the health care system.

Consistent and planned funding is crucial because we know that weak health systems are a result of boom and bust cycles in funding that come as a consequence of addressing particular and immediate needs when they arise and often diverting resources away from some areas and into those of pressing need, rather than planning strategically for the long run.  Levels of health system resourcing needs to be pinned to the GDP and connected to needs.  Thus, while the level of funding is important, it also has to reflect the health needs of the population.

We have seen that the current pandemic has an effect not only on public health,  but has also economic and social repercussions: job loss related stress that leads to an increase in substance abuse, as well as an increase in gender based and domestic violence caused by isolation policies and exacerbated by increased uncertainty and loss of security.  This points to the need to, when planning for and building resilient health care systems, not only look at health system funding and organization, but rather take an approach of multi sectoral partnership to health system strengthening that will address external consequences of the pandemic and respond adequately to prevent a disaster.  It also underlines the interconnectedness of social and economic conditions and their impacts on health.

Medical staff wait outside rooms at the Red Cross hospital in Wuhan, China, Getty Images

Finally, the key to long term sustainability of a resilient health care system is in linking practice, policy, and research. The present pandemic is an opportunity to learn from the processes taking place and analyze what it takes to manage it successfully, and where more improvement is needed. The effects of the COVID-19 pandemic are significant in terms of the toll on human lives and it is important to use the evidence from this learning process to create policies which allow for the implementation of practices creating more resilient health care systems and minimize avoidable tragedies.

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Are there new options for COVID-19 therapy?

The history of medicine is saturated with examples of drugs that have worked in the lab but have not acted on a living human body or were actually harmful. World Health Organization President Dr. Tedros has urged individuals and countries to refrain from using therapies that have not been shown to be effective in treating COVID-19.

The possibility of using reconvalescent blood plasma as a potential drug for COVID-19 infected patients is being explored. Namely, patients who have recovered from COVID-19 in the blood have antibodies that can be effective against infection. These antibodies in blood plasma can be administered to COVID-19 patients to stimulate the host immune system in its own response.Cloned antibodies from recovered COVID-19 patients showed impressive ability to neutralize SARS-CoV-2, a cell-borne virus, and reduced the percentage of live cell-binding virus by almost 100%.

COVID CLINICAL TRIALS

Early clinical trials in China on 10 patients showed a “significant improvement” within 1 to 3 days after receiving blood plasma transfusions, with 2 of 3 patients discarded from mechanical ventilation shortly after transfusion. Chinese experts have based their knowledge on limited success in treating other coronaviruses, such as SARS and MERS.

A patient who is recovering with a previously confirmed laboratory diagnosis of COVID19 can donate blood plasma only 2 weeks after the symptoms have resolved, and only if he is then tested with a negative result for COVID-19. Blood donation thus donated is given to a patient with severe COVID-19 disease after undergoing other intended laboratory infusion testing.

Although a promising type of therapy, reconvalescent blood plasma is not effective for every disease, including viral diseases such as Ebola. Success in cell culture testing has yet to be demonstrated on a living human organism.