By mid-March 2020, Europe was the epicentre of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or as it’s more widely known, the novel coronavirus, COVID-19 and it came, as if overnight, in full force.
In the health policy world, we often use the phrase “diseases know no borders” and COVID-19 can attest to this. The virus spread, through the inevitable consequences of globalisation, from Asia to Europe and beyond at a rapid pace and within three months the world neared 1 million cases as healthcare systems struggled to carry the sudden burden.
This unraveled across Europe, as hospitals scrambled for respirators that weren’t there, for Intensive Care Unit beds as they overflowed and to stock enough Personal Protective Equipment (PPEs) for healthcare providers to do their jobs properly and safely.
Now is the time for the European Union to show its strength as a union. Across Europe, not only are people getting infected and dying at an alarming pace but with the “social distancing” guidelines and lockdowns in place across most Member States, businesses are going under, unemployment numbers have spiked, incomes slashed and society has been forced to enter “a new normal” from one day to the next. This new way of life did not just bring a shift to virtual meetings and TV streaming subscription increases, however; mental health across Europe took a significant hit as populations across the continent reported increases in anxiety, depression and stress.
Member States grappled for supplies, support and for the prioritized protection of their own citizens. Borders were closed, face masks were argued over and, at first, coordination seemed lost. Despite attempts of leadership from the European institutions, the EU has continued to find itself entangled between criticism for lack of action and the suddenly-forgotten principle of subsidiarity – which dictates that action should only be taken at the EU level when the desired objectives cannot be effectively achieved by means of action taken at national or regional level. However, lost within the sea of criticism, many Member States have shown that the habitual EU mantra “health is a member state competency” echoes on, growing ever-clearer just how detrimental it can be for our Union.
The European Commission, however, has stood its ground and is working to ensure that Europe’s health systems have the resources they need; that businesses are able to stay afloat and that workers have their jobs and incomes protected. The Commission has promised that the full flexibility of the EU’s fiscal rules is being used to support national governments in tackling the socio-economic impact, activating the General Escape clause in the Stability and Growth Pact, so that national authorities can support their health systems, businesses and workers.
In a recent address to the ENVI Committee, Commissioner for Health, Stella Kyriakides, submitted to the fact that the “EU needs more competence in the area of public health to really improve coordination and to allow the EU ‘to step in’.” It is becoming evident that indeed the EU and the way it functions will face change by the lessons learned from the COVID-19 pandemic.
The pandemic has been treated as a societal emergency, as it should be and as it should continue to be before it can be contained and, hopefully, treated and cured. Infectious diseases, especially those like COVID-19, are societal reminders that health and medical research remain as vital as ever. They serve as a reminder that we as a society are not invincible and have a long way to go in understanding not only the human body but how it reacts to and manifests different diseases.
In these circumstances, it has been an important time for our community to analyse the current situation and reflect. As previously mentioned, society as a whole has seen a worrying increase of mental health issues due to the sudden impact on our daily lives and the constant worry of bad news and fear-inducing guidelines for social conduct. However, society has not only been impacted by these short-term, protective measures. Chronic illnesses have faced deprioritisation in the face of this emergency, with potential repercussions that could impact the longer term running of hospitals and treatment for patients. Priorities have had to be shifted, particularly within hospitals, to be able to accommodate the sudden increase of patients and many hospital departments – both neurological and psychiatric – have seen massive cuts in the ability to see patients, with treatment such as non-emergency surgeries, chemotherapy, diabetes treatment and more interrupted and deemed non-priorities.
Countless statements have been released from within the brain community, calling for awareness of the danger COVID-19 poses on those already living with chronic diseases such as Multiple Sclerosis or Parkinson’s disease; the unacceptable and worrying triage guidelines in place regarding who to prioritize in an emergency and seemingly discriminating against patients living with Dementia; and even the overwhelming spike in mental health complications, such as depression, anxiety and stress brought on by the climate of panic, overwhelming number of deaths and bad news and the social distancing guidelines. As with many other diseases, neurological and psychiatric comorbidities and implications have manifested in COVID-19. Hospitals across the world have seen COVID-19 patients come in suffering seizures, strokes and confusion or agitation due to inflammation in the brain; alongside the first signs of the virus: headaches and loss of taste and smell.
Infectious disease pandemics like this can either be once in a lifetime or, perhaps, occur every few years—they’re unpredictable— and it is important to realise that, meanwhile, on a daily basis, millions of people across the world are living in “pandemics” of their own, be it cancer, cardiovascular disease or diseases of the central nervous system (brain or mental alike).
At present, an estimated 2.1 million people are infected with COVID-19 across the world – 957.551 of those in Europe alone. These are jarring numbers, especially taking into account how quickly these numbers came about, and the people being these numbers are a striking example of how easily a disease can take over not only society but our lives. It is equally as jarring, then, to further think of the numbers and faces beyond infectious diseases – the people living with non-communicable diseases still without proper treatment, care or cures. In the brain space alone, an estimated 179 million Europeans live with brain conditions, neurological and mental alike. As our population ages, this number steadily grows.
If COVID-19 has taught us anything, it is that, as a society, we are not yet fully prepared nor capable to tackle the majority of health epidemics we are currently facing or will potentially face in the coming future. Understanding even the basic mechanisms of cancer took researchers decades and still today an EU cancer plan and mission is a basic necessity for the continued research behind the disease. What can be said for diseases of the brain, which continue to both confound and fascinate researchers all over the world?
The European Commission has proven that actively working together can make an impact and that, we, as a Union, have the ability to tackle whatever may come. It is then perhaps, a window of opportunity now to learn from these difficult times and to work to make a difference, in unity, as we transition through this new normal, through pandemic scars, across Member States, from Horizon 2020 to Horizon Europe. During this shift, it needs to be ensured that funding is uninterrupted and adequate resources continue to be dedicated to addressing the burdens brain disorders place on our society. It is crucial that Horizon Europe begins with a robust and appropriate structure for research, particularly through maintained collaboration opportunities but also through other coordination mechanisms such as a unified and ambitious co-funded brain health partnership.
Diseases do not, indeed, know borders. This is now more vital to understand and recognize than ever. Millions of people are searching for answers, treatments, improvements and care in their daily lives. Aren’t we, during “normal circumstances”, too, rapidly approaching what can only be described as a state of emergency when it comes to noncommunicable diseases, with the brain leading as the highest cause of ill-health and disability worldwide? Could we, too, easily have a noncommunicable pandemic brewing around us?