„We are at the stage of the pandemic, where a local approach based on the characteristics of the moment and the application of a high degree of flexibility is required more than ever. Prudence and vigilance are the key words for the periods ahead..."
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We are in a new pandemic wave with an exponential increase in the number of new cases and a doubling of deaths in less than a week.

The red zone is the area where more than 100 new cases have been declared per 100,000 population in the last 14 days and the test positivity rate is more than 4%.

Reuters Covid Tracker reports for Moldova 229 cases per 100,000 population in the last 7 days as of September 16. The positivity rate of the tests is about 12%, which is three times above the permissible limit.

This pandemic wave differs from previous waves in many aspects. To be able to properly control this wave, it is necessary to analyze all these features.

Structure of the population by degree of protection against potential diseases

At the time of writing, the following 6 populations may be identified by the degree of protection against the novel covid-19 disease.

1. People who have gone through COVID-19 in the last 180 days. These people have antibodies produced naturally during illness and have a certain level of protection. This level is in constant decline. These people are advised to be vaccinated with at least one dose of the vaccine to increase antibody titers and strengthen protection against the virus. Adherence to personal protective measures is still mandatory for these people.

2. People who went through COVID-19 more than 180 days ago, that is, between the beginning of the pandemic and March 2021. In these people, antibodies were produced naturally, but their number has already decreased significantly. To cope with new strains, more antibodies are required. Emergency vaccination is the main recommendation for these people to avoid a new infection, backed up by adherence to personal protective measures.

3. People who went through the disease, regardless of the timing, and administered the vaccine according to the protocol with both doses. These people now consider themselves the most protected. Most likely, these people will not get sick anytime soon, but they may be asymptomatic carriers. It is recommended to wear a mask and take precautions to avoid infection and spread of the virus.

4. People who have not gone through the disease but have given the vaccine according to a protocol with both doses in the last 180 days are considered a highly protected group, due to the high antibody titer generated by the vaccine. These people are advised to wear a mask and take precautions, for the same reasons as in the previous group.

There are also people in this group who have given the vaccine but still do not have safe protection (less than 21 days after the second dose). They can easily get sick if they don't follow precautions.

5. People who have not gone through the disease but have given the vaccine more than 180 days ago. This group of people is currently recommended a third dose of the vaccine to strengthen protection against new strains. Numerous debates on this topic have divided the scientific community into two camps. New data from Israel may help to make the right decisions. The fact is that the number of antibodies decreases over time, regardless of how they are obtained, which requires increased protection, including through the introduction of new doses of vaccine.

6. People who have not gone through COVID-19 and have not administered any single dose of the vaccine. This group is the largest in Moldova, and all children are also included in this group. People in this group are most susceptible to COVID-19 infection, including severe forms and potential death. This group is advised to be vaccinated as soon as possible, backed up by strict personal precautions.

In each of these groups, we will also have smaller subgroups divided by age criteria, and in each age segment we can also divide the groups by comorbidities. In each of these subgroups, the risk of infection, the severity of the disease, the risk of hospitalization will be very different.

Also, in each of these groups there will also be people who, for various reasons, have not developed antibodies either as a result of the disease or after the introduction of the vaccine. They remain susceptible to the disease equally with people from group 6.  These people should follow personal protective measures until new recommendations from scientists will come.

However, weekly evolution can be easily analyzed for each of these groups, and it can help us in the short-term planning.

The virus is new and still poorly understood yet, for these reasons it is very difficult to make reliable and correct long-term forecasts. The development of the virus in several countries clearly tells us that it is very difficult to stop its spread forever. People are moving, the virus is generating new strains, vaccination is slow, pandemic fatigue – all of this, taken together, makes it very difficult to stop the spread of the virus.

More and more countries are adopting "controlled spread" strategies aimed at identifying those infected as early as possible and treating patients correctly. To put this strategy into practice, mass testing with high-quality rapid tests of people with symptoms and their contacts, as well as early hospitalization of persons with moderate and severe forms of the disease, is required. High quality of medical care in hospitals is a prerequisite for the qualitative implementation of this strategy.

Prudence and vigilance – key words for the coming periods

We have deliberately detailed the most important characteristics for each group, in the hope that any reader will be able to determine their affiliation and understand what recommendations are currently available for them.

We are at the stage of the pandemic, where a local approach based on the characteristics of the moment and with a high degree of flexibility is required more than ever.

We are at the stage of a pandemic, where large-scale collaboration at all levels of the health system, supported by community efforts, is required more than ever.

We are in the pandemic stage where we have no right to make mistakes that could cost us many lives. To avoid them, we need a lot of caution and vigilance in our daily personal activities.

We are at the stage of a pandemic where we can successfully pass the collective test of "pandemic maturity." We can validate our knowledge and skills to live in a true pandemic, continuing our current activities, maintaining health, saving life, and setting an example of behavior for future generations. Prudence and vigilance are the key words for the coming periods.