ABSTRACT
The c Owl)-19 pandemic and other major public health emergencies of international concern occurred in the last zo years remind us of the close interconnections between human, animal, and environmental health and the need for collaborative and multisectoral approaches to address complex health threats. These outbreaks also serve to highlight the importance of timely sharing of pathogens, which are used to characterise the causative agent of an outbreak, understand its spread, and develop diagnostics, antiviral treatments, and vaccines. Despite their relevance to preparedness and response, neither One Health nor pathogen sharing are grounded within the International Health Regulations (IHR). This paper analyses the existing institutional and normative gaps within the IHR, including examining how other regimes within the international legal landscape have sought to 'fill the gaps'. We explore possible solutions and make proposals to strengthen interinstitutional cooperation and coordination through mechanisms alternative to IHR reform or a global pandemic treaty.
ABSTRACT
The International Health Regulations (IHR) have been severely tested by the COVID19 pandemic. Recent reviews have identified a number of gaps and challenges and proposed improvement, but the Regulations should be analysed in their context as a constitutional instrument deeply embedded in WHO's governance to better understand their systemic strengths and weaknesses. The IHR embody a managerial model of health governance that aims at depoliticizing international response to health emergencies and coordinating it on the basis of expertise and persuasion. The political crisis accompanying the C OVID-19 pandemic, however, reveals the need for a different and more political approach that injects states in the governance of the IHR following models tested by other international agreements. It also highlights the need for a more effective framework of cooperation and coordination that builds upon WHO's practice of inter-institutional cooperation but complements it through institutional consultation structures involving directly states parties.
ABSTRACT
The International Health Regulations (IHR), of which the World Health Organization is custodian, govern how countries collectively promote global health security, including prevention, detection, and response to potential global health emergencies such as the ongoing COVID-19 pandemic. While Article 44 of this binding legal instrument requires countries to collaborate and assist each other in meeting their respective obligations, recent events demonstrate that the precise nature and scope of these legal obligations are ill-understood. A shared understanding of the level and type of collaboration legally required by the IHR is a necessary step in ensuring these obligations can be acted upon and fully realized, and in fostering global solidarity and resilience in the face of future pandemics. In this consensus statement, public international law scholars specializing in global health consider the legal meaning of Article 44 using the interpretive framework of the Vienna Convention on the Law of Treaties. © Margherita M. Cinà et al., 2020.
ABSTRACT
Introduction. Coronavirus disease 19 (COVID-19) is the greatest pandemic in modern history. The aim of this study was to investigate the alteration and prognostic potential of routine blood tests in a series of consecutive Italian patients with COVID-19. Methods. Clinical data and routine laboratory tests of a consecutive series of 62 COVID-19 patients treated in the Units of Infectious and Respiratory Diseases of the University of Sassari from 15 March through 30 April 2020, have been retrospectively collected. Differences in laboratory tests performed at hospital admission between COVID-19 survivors and non survivors were statistically searched and analyzed. Results. Patients in non-survivors group had higher number of WBCs (median: 9.16 x109L;IQR: 6.29-13.07 x109L vs 6.37 x109L;IQR: 4.95-9.04 x109L, p=0.037), neutrophils (mean: 9.2±6.0 x109L vs 5.4±2.7 x109L, p=0.001), and lower lymphocytes number (median: 0.6 x109L;IQR: 0.6-0.85 x109L vs 1.0 x109L;IQR: 0.7-1.2 x109L, p=0.013). In addition, non-survivors showed lower albumin (median: 3.2 g/dL;IQR: 2.9-3.4 g/dL vs 3.5 g/dL;IQR: 3.0-3.9 g/dL, p=0.035), and increased PCR/albumin ratio (median: 3.65;IQR: 2.17-6.86 vs 1.56;IQR: 0.64-4.36, p=0.035) and De Ritis ratio (median: 1.14;IQR: 0.89-1.48 vs 1.73;IQR: 1.29-2.27, p=0.002). Increased levels of LDH (median: 359 IU/L;IQR: 259-504 vs 273 IU/L;IQR: 197-356 IU/L, p=0.017), procalcitonin (median: 0.28 ng/mL;IQR: 0.19-0.52 ng/mL vs 0.07 ng/mL;IQR: 0.03-0.17 ng/mL, p=0.0006) and troponin (median: 0.181 ng/mL;IQR: 0.068-0.193 ng/mL vs 0.004 ng/mL;IQR: 0.000-0.017 ng/mL, p=0.002) has been found in nonsurvivors. In ROC curve analysis the better performing indexes were troponin, with a threshold of 0.037 ng/mL, 86% sensitivity and 100% specificity (AUC=0.908, 95% CI 0.701 to 0.989, p<0.001) and procalcitonin with a threshold of 0.18 ng/mL, 79% sensitivity and 79% specificity (AUC=0.807, 95% CI 0.681 to 0.900, p<0.001). Conclusions. Differences in routine laboratory test alterations between COVID-19 survivors and nonsurvivors have been detected;troponin and procalcitonin were the biomarkers which showed the highest prognostic abilities in our study.