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TYPE Editorial
PUBLISHED 29 September 2022
DOI 10.3389/fpubh.2022.998998
OPEN ACCESS
EDITED AND REVIEWED BY
Shisan Bao,
The University of Sydney, Australia
*CORRESPONDENCE
Zisis Kozlakidis
kozlakidisz@who.int
SPECIALTY SECTION
This article was submitted to
Infectious Diseases – Surveillance,
Prevention and Treatment,
a section of the journal
Frontiers in Public Health
RECEIVED 20 July 2022
ACCEPTED 20 September 2022
PUBLISHED 29 September 2022
CITATION
Kozlakidis Z and Struelens MJ (2022)
Editorial: Insights in coronavirus
disease (COVID-19) - surveillance,
prevention and treatment.
Front. Public Health 10:998998.
doi: 10.3389/fpubh.2022.998998
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Editorial: Insights in coronavirus
disease (COVID-19) -
surveillance, prevention and
treatment
Zisis Kozlakidis1*and Marc J. Struelens2
1International Agency for Research on Cancer, World Health Organization, Lyon, France, 2Faculty of
Medicine, Universite Libre de Bruxelles, Brussels, Belgium
KEYWORDS
COVID-19, infectious diseases, surveillance, prevention, vaccine, screening,
treatment
Editorial on the Research Topic
Insights in coronavirus disease (COVID-19) - surveillance, prevention
and treatment
Introduction
The achievements made by scientists in the fast-growing field of COVID-19 have
been exceptional over the last 2 years, leading to major advancements in understanding
and managing the new disease, but also transforming the fields of infectious diseases
and public health in general. Following the SARS-CoV-2 outbreak and subsequent
pandemic, the multi-disciplinary work of researchers worldwide has provided an in
depth understanding of COVID-19 pathogenesis, of clinical treatments and outcomes,
of models and dynamics governing disease spread, period of infectivity and containment
interventions. Immunological research focused on the understanding of acquired
immunity, and development of innovative vaccines and effective vaccination schemes,
which have greatly improved disease outcomes across the globe. The required rapid
processing and dissemination of scientific information would not have been possible if
not for the special focus and attention given by scientific journals such as Frontiers in
Public Health and Frontiers in Medicine.
Following on from the success of the first Frontiers COVID-19 Research Topic,
featuring 400 original research articles (1), and Volume II of the same title featuring 163
original articles (2), a dedicated COVID-19 Research Topic was opened for submissions,
entitled “Insights in Coronavirus Disease (COVID-19) - Surveillance, Prevention and
Treatment”. Relative to Volumes I and II, which were broad in scope, this topic, running
from June 2021 to January 2022, focused primarily on novel developments, current
challenges, latest discoveries, and future perspectives in the field of COVID-19. The aim
for this article collection was to inspire, inform and provide direction to researchers in
the field.
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To provide a backdrop, at the time of the launch of this
Research Topic in June 2021, the first wave of the rollout
of population-wide SARS-CoV-2 vaccinations with two doses
was nearing completion in most European countries, while
a severe lack of vaccine availability was still recorded for
resource-restricted settings. Following the vaccination successes
in Europe and North America a gradual relaxation of public
health restrictions was afforded while many countries worldwide
were preparing for resurgences. In total, 176 manuscripts were
submitted, 83 (47%) of which were accepted. As of August
2022, the special topic achieved approximately 255,000 views
and 31,000 article downloads, with readership distributed across
the globe. Frontiers made a significant contribution to the
timely generation and distribution of peer-reviewed COVID-19
publications as the publisher of this special topic, as well as many
other related topics. At the time of writing, the top five most
viewed Research Topics on COVID-19 published in Frontiers in
Medicine and Frontiers in Public Health (1–5) have generated
over 19 million of views, as well as over 8,000 article citations.
Among the five broad areas covered by this Research
Topic, primary focus of the accepted manuscripts was on
Public Health Response (26), followed by Clinical Management
(19), Epidemiology (14). Pathophysiology (12) and Screening
Methods (12). The accepted submissions comprised of Original
Research (50), Brief Research Report (11), Reviews (8), Opinion
(5), Case Report (4), Methods (2), Community Case Study (1),
Hypothesis and Theory (1) and Perspective (1).
Public health response and vaccines
The understanding and comparison of public health
responses has been vital in the design and quick adaptation of
effective mitigation strategies. A number of manuscripts shared
details of investigations of SARS-CoV-2 transmission patterns
and non-pharmaceutical control interventions implemented in
defined geographies, such as China (Lu et al.), the Czech
Republic (Dziedzinska et al.), Germany (Kapnsner et al.),
Portugal (Leite et al.), Romania (Dascalu et al.), Saudi Arabia
(Hakeem et al.) and the USA (Bonacci et al.). Awareness
about the virus transmission within public education settings
and protective practices were also examined in the studies
by Lordan et al.,Middleton et al.,Sombetzki et al., and
Qin et al., as well as within areas of precarious housing
conditions by Zimmermann et al..
As population-wide vaccination programs were
implemented across the world, a number of studies emerged
considering the overall COVID-19 vaccination acceptance,
providing survey-based quantitative estimates (Al-Qerem
and Jarab;Lyu et al.;Zhang et al.). Some of these early data
was summarized by the systematic review of Norhayati et al.
The perspectives and responses of different communities
toward COVID-19 were considered, such as pharmacists
being both vaccinated and vaccinators (Turcu-Stiolica et al.);
of patient groups being vaccinated (Ahmadi et al.); as well
of wider communities within specific geographical areas
(Kuo et al.;Liu et al.). Related to the safety of vaccination
programs and providing a holistic view of the subject within
this special topic, were also the studies describing vaccine
reactions in the USA, EU (Montano) and China (Zhu et al.).
Finally, the protective properties of breast milk for infants
from COVID-19 were outlined in the Hypothesis and Theory
study by Quitadamo et al..
As the impact of the COVID-19 pandemic is multi-faceted,
some studies presented practical and directly implementable
solutions for the many challenges it raised. Drobniewski and
Keshavjee analyzed the similarities between COVID-19 and
tuberculosis, and how the extensive lessons learned from the
older pathogen might transfer to the response against the
newer one. Sehgal and Milton discussed how frameworks
from occupational health might be applicable in navigating
the next, more episodic, phases of the pandemic, while
Shi et al. presented the construction and implementation
of an intelligent voice-response system for COVID-19
information management.
Clinical management
The topic of COVID-19 was approached from a clinical
management perspective as well, with Priori et al., providing
a University Hospital multidisciplinary account from Milan,
Italy, of re-organizing inpatient care during the first wave
of the pandemic. Some studies on disease progression were
in the context of other comorbidities, for example gastro-
intestinal symptoms (Chen et al.) and pancreatitis (Fiore
et al.). Various approaches to assessing prognostic factors and
indicators were reported. Enocsson et al. looked at soluble
urokinase Plasminogen Activator Receptor (suPAR) as a specific
prognostic biomediator. On the other hand, Ranard et al., looked
at a wider set of indicators reporting different patient endotypes
that might be prognostic for COVID-19. One study by Kurban
et al., provided examples of simple triage tools that can be used
to predict severe disease.
Among the articles with a primary focus of clinical
management, another main area of interest was the evaluation
of various new or concomitant therapies with respect to
benefits for COVID-19 progression and outcome. Treatments
evaluated included the addition of baricitinib to standard
care (Masiá et al.); the effect of tocilizumab monotherapy
on biomediators (Hashimoto et al.); the infusion of umbilical
cord mesenchymal stromal cells (da Silva et al.); the use of
A2 adrenergic receptor agonist (Li et al.;Hamilton et al.); as
well as the case report of blood purification for 5 severely ill
patients (Chen et al.). Regarding the prevention of symptoms
or at least the reduction of symptom severity, studies looked
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Kozlakidis and Struelens 10.3389/fpubh.2022.998998
into the supplementation with vitamin D (Arroyo-Díaz et al.)
and zinc (Hardigan and Gordon). The breadth of topics
covered demonstrate the multitude of approaches still being
considered in the effort to improve the current standard of
care for COVID-19, as well as indicating the many clinical
specialties involved in those investigations. This aspect of
plurality in COVID-19 treatments was captured well in the
meta-analysis of randomized control trials by Zhang et al.,
while Wüstner et al., looked into the clinical evidence informing
treatment guidelines, specifically on repurposed drugs for
hospitalized patients during the early waves of the COVID-
19 pandemic, including for corticosteroids, anticoagulants
and other.
Accurate, timely COVID-19 diagnosis and tools used for
diagnosis was another research area of interest in clinical
management, though of reduced frequency as compared with
the earlier special topics on COVID-19. Namely, Avgoulea et al.
in their brief research report focused on the implementation of
rapid point of care diagnostics in a hospital emergency unit.
Finally, it has been well-established that the impact of the
pandemic has not been limited to physical health and acute
disease. Two studies looked at the post COVID-19 sequelae,
in general (Makrydakis et al.) and specifically, as they relate
to chronic fatigue syndrome (Hohberger et al.). Frontiers
journals have initiated distinct special topics on COVID-
19 sequelae, especially on emotional/mental health and post
COVID syndrome assessment (3).
Epidemiology
Of the articles primarily focused on Epidemiology,
disease surveillance remained an area of focus in order to
elucidate the geographical, demographic and behavioral
distribution of confirmed cases at specific time points (or
over time). As such, there were studies regarding COVID-
19 epidemiologic patterns in Burkina Faso (Kaboré et al.),
the Ecuadorean army (Ortiz-Prado et al.), the Colombian
army (Duque et al.), South Korea (Hong et al.), China (Li
et al.), as well as the incidence in cannabis users (Huang
et al.). In order to complement the picture on symptomatic
case identification, Syangtan et al. focused their systematic
review on investigating asymptomatic cases. Finally, the
study by Yadav et al. described an outbreak of Nipah
virus concurrent to COVID-19 in India, reminding that
COVID-19 is cumulative to existing pathogen pressures in
many countries.
Accurate disease surveillance remains a cornerstone for
healthcare systems for the timely implementation of public
health measures as warranted, and for resource and treatment
planning relative to available service capacity. Thus, a clear area
of interest remained the modeling and testing of prediction
models that might be implemented in subsequent waves of the
pandemic. These included work by Inglis et al. in estimating
the local COVID-19 risk during the pandemic curve decline; a
seasonality-aware model by Alser et al.; as well as a model for
short-term COVID-19 prediction, based on USA data by Majeed
et al. Furthermore, the predictive models by Pei Y et al., and Zuo
et al., included vaccination as a co-factor in their framework.
Analyzing available data from Germany and Italy and their states
and regions (January–June 2020), Morfeld et al. provided an
estimate of the excess mortality attributable to acute COVID-19
and highlighted limitations of routine demographic surveillance
systems. The goal of these investigations was to achieve a better
understanding of the individuals/groups with increased risk, and
thus, prioritizing any public health interventions to decrease the
transmission risk to susceptible populations.
Screening methods
Asymptomatic and pre-symptomatic transmission of SARS-
CoV-2 has introduced a greater degree of difficulty and
uncertainty for monitoring the spread of the infection into new
clusters. Thus, population-wide or high-risk group screening
policies have been implemented at various scales in many
countries. The studies included in this special topic describe
the implementation of such screening policies at national
borders (Chua et al.), at schools (Simas et al.), at healthcare
facilities (Raimann et al.). As with any diagnostics, a greater
than acceptable threshold of false-positive or false-negative
outcome, can cause considerable damage both at individual
and public health levels. Therefore, a number of studies
focused on the evaluation of the individual performance
of such test and/or methodologies (Alghounaim et al.;
Yingtaweesittikul et al.;Alqahtani et al.;Eskobar et al.;
Wertenauer et al.;Fernández-Rivas et al.). The investigation
of saliva as a suitable detection fluid was discussed by Pierri
et al.; while the implementation of ELISA-based seroprevalence
for the understanding of asymptomatic transmission levels
was considered by the studies of Sherman et al., and
Breedon et al..
Pathophysiology
Understanding the pathophysiology of COVID-19 and
its many clinical manifestations is crucial in dealing with
the severe forms of the disease, identifying individuals with
increased risk, and taking timely action toward development
and/or implementation of appropriate treatments. Hayes et al.
provided a scoping review of over 100 persistent symptoms
of long COVID-19; while the study by Cheng et al. described
a text clustering method to identify symptom clustering.
The systematic review by Sodeifian et al. looked into the
drug-induced liver injury in COVID-19 patients; and Zhang
et al. investigated liver fibrosis scores and clinical outcomes
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in COVID-19 patients. There were two Opinion papers in
this special topic, one by Kozlakidis, considering the relative
lack of evidence of genomic recombination for SARS-CoV-
2; and another by Dubina, considering a potential non-
immune prophylaxis against COVID-19 by targeting tolerance
for Angiotensin II.
The link between vitamin intake and COVID-19 clinical
outcomes remains a focal point of research. To this end
the systematic review by Teshome et al. investigated
the impact of vitamin D on COVID-19 infection; while
Chen et al. investigated the relationship between plasma
vitamin C and COVID-19 susceptibility and severity.
The investigation of such relationships allows the deeper
understanding of molecular mechanisms and their link to
clinical outcomes. The relationship between platelet count
and COVID-19 mortality was investigated by Yang et al.;
while another relationship, between cellular and humoral
immune responses after two doses of vaccination were
studied by Mangia et al. The brief research report by Jimah
et al. focused on the monitoring of COVID-19 positive
pregnant women. Finally, Holm-Jacobsen et al. investigated
the clinical implications of rectal SARS-CoV-2 shedding in
Danish patients.
Conclusions
As the COVID-19 pandemic continues and as the SARS-
CoV-2 virus continues to evolve and produce a greater number
of variants, it is likely that the case numbers and hospital
admissions will persist their fluctuations globally. Thus, it is
not surprising that epidemiological studies continue to feature
strongly in the published scientific literature as understanding
of the changing dynamics of COVID-19 remains a public health
priority. To this end, the greater emphasis on public perceptions,
attitudes and behaviors is a welcome development, further
strengthening public health responses and gradually involving
an active participation of “citizen scientists” as advocated
previously (6).
Building on understanding the pathophysiology and
epidemiology of the disease, the development of efficacious
vaccines and treatments have made a clear difference in
addressing severe forms of the disease and mitigating its public
health impact. More contagious and/or virulent variants of the
virus that are able to evade acquired immunity may continuously
emerge, and their widespread dissemination is of concern in the
near future. Novel and/or improved virus screening methods,
therapeutics and vaccines are likely to remain key tools toward
pandemic mitigation. The cumulative burden of “long COVID”
sequelae as well as psychological/psychiatric impact of the
disease and its control measures are crucial topics to study
for guiding long term medical and public health management.
Therefore, concerted research efforts on current topics remain a
crucial part of the continued fight against COVID-19.
Author contributions
ZK compiled/wrote the first draft. MS contributed to the
outline. Both authors reviewed and edited for final revisions. All
authors approved the final version for publication.
Acknowledgments
We would like to thank the thousands of reviewers and
scientists who contributed to this unprecedented scientific
and clinical emergency. Particular thanks go to the staff
of the Frontiers publishing house, for their continuous and
unmitigated support.
Conflict of interest
The authors declare that the research was conducted in
the absence of any commercial or financial relationships
that could be construed as a potential conflict
of interest.
Publisher’s note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed
or endorsed by the publisher.
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