COVID-19 Global Outlook &

Strategies
Dr Ahmed Mukhtar
MSc, London School of Hygiene & Tropical Medicine (University of
London), MPhil Medicine (University of London), PhD Medicine &
Therapeutics (Aberdeen University)

May, 2021
Summary
It is not the end of the game. We are at the middle of the battle field against an invisible
enemy. However, we far more equipped than last year as we have medicines, vaccines
and more in-development, control and health measures protocols and resources with
more understanding and information of the COVID-19 pandemic and virus. This fight
could take us around 2-5 coming years globally as it is impossible to eradicate the
pandemic globally for the time being since there are and will be some countries and
pockets around the world with COVID-19 infections. We are returning back to our normal
life and personal activities with new norms, and we are positive that we will get over
COVID-19. We are in the 2nd year of pandemic and every day we learn newer information
about COVID-19 pattern as this is a fundamental step to realize COVID-19 nature. The
countries that have taken the required measures are continuing vigilance, testing, and
contact tracing and vaccination as they are easing control measures and lock downs. The
new mutations emerged as a challenge to policy and decisions makers.
It was reported that even with vaccination efforts in full force, the theoretical threshold for
vanquishing COVID-19 looks to be out of reach. We are withdrawing the idea that we will
hit the herd-immunity threshold and eventually the pandemic will go away for good. The
challenge of implementing responsive strategies to manage transmission and highlight
the impact of health and control measures implementation between-country inequalities.
It is estimated that herd immunity would require around 80-90% of the population to have
COVID-19 immunity, either through prior infection or vaccination. Therefore, public is to
be advised to get the vaccination. Vaccinated people are very unlikely to suffer
asymptomatic COVID-19 infections.
It is worth to mention what US President Joe Biden has said, “COVID-19 must be beaten
everywhere, or it comes back to haunt us again.” COVID-19 knows no borders. The more
people we vaccinate—everywhere—the sooner the pandemic will end.
It is mentioned that the geographic separation tends to result in genetically distinct
variants. Bollinger reported that: “All RNA viruses mutate over time, some more than
others. For example, flu viruses change often, which is why doctors recommend that you
get a new flu vaccine every year.
It is reported that most concerning variants share the same mutations, even when they
appear on different continents. That may mean that the virus can mutate in only a limited
number of ways. However, I believe we have to be cautious that the virus could mutate
in various number of ways. We currently have far better knowledge, information and
resources than we did before.
In a study, the mental health impact of the pandemic after the initial lockdowns in USA
been carried on. The prevalence of depression (39%), anxiety (42%) and psychological
distress (39%) were computed from the PHQ-4 scale. Males were more likely to have
depression, and females were more likely to have anxiety symptoms.
It was reported that the coronavirus has shown the underlying vulnerabilities of
autocracies rather than their strength, while in contrast, democracies are showing their
capacity for innovation and adaptation, as one would expect, and signs of renewal, as
one would hope. Furthermore, it briefly stated that regardless of jurisdiction, the specific
actions many governments have taken to combat the pandemic are ultimately rooted in
politics, not science. The pandemic has made politics extraordinarily relevant. The policy
makers and leaders are trying between science and economy with its social impacts.
McKinsey & Company reported that to flourish during and after the pandemic, companies
need a new set of skills, including social and emotional, advanced cognitive, and digital
capabilities.
As mentioned by Department of Economic and Social Affairs of UN regarding World
Economic Situation and Prospects (WESP) 2021 warns that the COVID-19 pandemic,
which has delivered a heavy blow to economic activities worldwide, may exert devastating
long-run socio-economic effects, unless global policy responses can ensure a robust and
sustainable recovery. Those actions comprise smart investments in economic, social and
climate resilience, revitalization of global trade, avoidance of premature austerity policies.
The COVID-19 pandemic has affected our life and is likely to accelerate the trajectory of
the primary forces transforming the global business landscape — globalization,
technology, demographics and environment. As companies focus on business continuity,
they need to monitor how the pandemic is interacting with these forces and assess the
resulting impacts across the organization. The major points are: Globalization: a new
regionalism gains momentum, global competition accelerates, demographics: aging
catalyzes global rebalancing, and environment: the race against the clock continues.
By now we have successful countries for control strategies and policies to bring COVID-
19 infections to very low rate or nearly zero reported cases, whilst others tried are still on
moderate and high infections rate despite by implementing vaccination and certain control
measures. Nonetheless, the infection rate in not being under control is mainly due to
inadequate control implementation and active population dynamic. There are other
countries are still suffering high infection rate due to lack of vaccination, new mutants,
highly active population dynamic, lack of resources and infrastructure, and in adequate
control measures.
It is the time to have a coordinated, comprehensive, and integrated international control
measures, vaccination and sharing resources. The individual countries have to be vigilant
and check their control policies implementation and deficiencies. Leaders and policy
makers need to look at the pandemic picture scientifically with political and economic
support. Any country’s state of the pandemic infection rate, whether it be good or bad, it
could be changed due to certain factors and we have to be ready for the worst scenarios.
However, we are highly optimistic that we are going to fight this invisible enemy. Eight
global infections pattern have been found.
Index:

Title Page
Preface 5
Global COVID-19 Control Strategies 6

Major Global Infections Patterns 9

Herd Immunity 14

Vaccination 15

Mutations & Variants 17

Social & Political Impact 19

Economic & Business Impact 21

Outlook 23
PREFACE
One year has passed for my eBook (lulu.com), published on 2nd June 2020, titled “COVID
-19 & Our Life” (1), and my analysis and predictions for COVID-19 based on health, social,
economic, business, and political factor were correct. We have to be optimistic and view
COVID-19 pandemic at a positive and realistic outlook despite what we have gone
through.
A few believe that the pandemic might last within a few months and eventually reach the
post COVID-19 state. This statement is used highly inappropriately. We currently have
better tools, information, control strategies, vaccines and medicine but still more is
needed.
With collective measures and control strategies conducted globally, it is a matter of time
that we will get through this pandemic. I expected in my eBook, June 2020, it could take
us 3-5 years to obtain good control results globally. Our estimation for global control of
COVID-19 pandemic could be similar as in June 2020, however, I do believe we might
have 1-2 years more depending on global collective and integrated control strategies.
The balance between health and economic status and effects have taken the leaders
around the world to plan the COVID-19 control strategies based on each country.
In comparison to last year (year 2020), we do have better knowledge, information, data
and experience of COVID-19, but there are a lot to be learned and experienced.

This is not a painting, rather than it is created by advanced 3D simulations of the spike
protein in action that crowns SARS-CoV-2, the coronavirus that causes COVID-19. This
protein has settled here into one of its many possible conformations during the process
of attachment a human cell before infecting it. (2)
GLOBAL COVID-19 CONTROL STRATEGIES
In 2020, a survey was of a cross-sectional, online, purpose-designed aimed to analyze
the views of health system staff, tapping into their personal expertise on how the
pandemic was initially handled. The countries formed an emergency task force,
developed communication channels to citizens, organized health services to put the
needed and appropriate control measures. Some countries did this better than others. It
was found several significant differences between the WHO regions in how they are
tackling the pandemic. (3)
COVID-19 control strategies are different for countries. Now the picture is getting clearer
to assess the control strategies. In general, it seems some countries, vaccination
including collective control measures are reasonable approach.

Following are some selected countries with different control strategies measures as ost
are successful ones except Sweden as Control Strategy Change Case):
Vietnam:
The response to COVID-19 has been exceptional, and although some of its success
derives from the country’s unique context. Following are some early approaches taken:
 Investment in a public health infrastructure. (4)
 Early action, ranging from border closures and masks to testing and lockdowns
 Thorough contact tracing can help facilitate a targeted containment strategy
 Quarantines based on possible exposure, rather than symptoms only, can reduce
asymptomatic and presymptomatic transmission.
 Clear communication is crucial.
 A strong whole-of-society approach engages.

New Zealand:
The leaders have taken an elimination strategy as an essential approach. This approach
also been applied by Australia appear to have joined a small group of countries and
jurisdictions pursuing an explicit, or implied, elimination goal, albeit by different strategies.
Others including mainland China, Hong Kong, Taiwan, South Korea, Vietnam and a
number of small island states and territories. Countries can prevent disease and death
from COVID‐19. They been able to move from managing ongoing pandemic transmission
within their populations to have strategic choices about prevention and control options
such as vaccines and therapeutics as they become available. (5)
Sweden (Control Strategies Change Case):

The government by early days of the pandemic. At the beginning of the COVID-19
pandemic, took an alternative route to battle the virus. Instead of lockdown, closing
schools and social spaces, they relied on citizens' common sense and willingness to
follow social distancing rules. As the death rate from COVID-19 is now higher, the
government took new measures to control the virus as it closed its borders with Norway
and Denmark and the King then asked Swedes to wear face masks in public for the first
time, such as on public transport. (6) In a study that was focused on the Swedish case to
quantify the effect of a lockdown on COVID-19 infections and deaths. It was found that:
The effect to be sizable and robust across specifications: it ranges from -27% to -77% for
infections and from -26% to -82% for deaths, and the actual adjustment of mobility
patterns in Sweden suggests there has been substantial voluntary social restraint,
although the adjustment was less strong than under the lockdown scenario. (7)

Australia:

In early days, the Federal government responded quickly closing international borders
and implementing a mandatory home isolation program for returning Australian citizens.
The returned travelers were checked by police for adhering to quarantine requirements.
Mandatory hotel quarantine system was applied in which hotel rooms were often guarded
by police or military. The states and territories also temporarily shut their borders down.
Australia’s lockdown restrictions and behavioral safety protocols were also enacted
swiftly. These actions have allowed Australia to reach zero cases at certain stages of the
pandemic. (8)

Israel:

Israel is currently one of the highest countries in the world for COVID-19 vaccination.
Katie Wrenn, an epidemiologist at GlobalData, comments: “Israel’s smaller geography,
smaller population size, and a large digitalized medical system has given the country an
advantage in speed of vaccination. This indicates that regions with less-structured
healthcare systems may take much longer to implement such a program. (9)

In a separate study it was mentioned that preliminary findings show evidence of the
effectiveness of vaccines in preventing severe cases of COVID-19 at the national level in
Israel and it was reported that the receipt of COVID-19 vaccines by eligible persons can
help limit spread of disease and potentially reduce the occurrence of severe disease. (10)
 USA:

The diagnosed cases been reduced sharply from as high as more than 260,000 on 9th
January 2021 to around 50,000-80,000 cases per day from 14th April. In this regard,
vaccination ratio been increased, and public awareness increased. (14)

It is now more than 32 million people have been diagnosed. As the vaccine is
administered, it is likely to be some time before most Americans have access, and
infections, hospitalizations and deaths are expected to increase. (12)

CDC as stated will implement activities using a phased approach to the pandemic that
accounts for immediate and long-term public health needs, including anticipating and
preparing for future global public health emergencies. (13)

The goals of CDC’s strategy for global response to COVID-19 are to:

1. Limit transmission of COVID-19;

2. Minimize the impact of COVID-19 in vulnerable populations;
3. Reduce specific health threats that pose current and future risk to the United States;
4. Increase the scientific knowledge about SARS-CoV-2 (the virus responsible for
COVID-19) and provide global public health leadership; and
5. Support the development of long-term health security in low- and middle-income
countries.

UK:

UK succeeded in reducing COVID-19 infection as strict periodical measures

implemented with gradual easing upon updated data. As May 17, 2021 several
measures will be eased. The clear path and gradual easing of control measures in
addition to vaccination have resulted in significant reduction in reported infection
numbers as it was more than 60,000 on 6th January, 2021 and then decreased to around
to 2000-30000 cases daily in first week of May, 2021. (14)

China:

It is the first country to report COVID-19 cases. The government taken swift and prompt
action to control pandemic. Strict lock down upon centralized epidemic response system.
Only 3% of China's elderly population live in care homes, whereas in several western
countries, such facilities have been major sources of infection. (15)

It was reported by Li Bin, deputy head of the National Health Commission, told a press
conference in Beijing "China has endeavored to steadily increase its vaccinated
population," said Li, noting that a total of 15 supervisory groups had been dispatched to
provide guidance across the country. (16)
Major Global Infections Patterns:

Pattern 1: China, New Zealand, Australia, Singapore & Vietnam

Pattern 1 Daily Infections

 The pattern shows direct decrease to very low or zero point. The control
strategies based on swift control and strict lock down measures.

Pattern 2: UK and Israel

Pattern 2 Daily Infections

 This pattern shows sharp decrease in reported infection rate after 2nd / 3rd
wave due to gradual control measures and high vaccination rate.
Pattern 3: USA

Pattern 3 Daily Infections

 This pattern shows high vaccination rate combined with selected control
measures upon different states combined with different active population
dynamic.

Pattern 4: France, Italy, Germany and Spain

Pattern 4 Daily Infections

 The pattern shows ongoing vaccination at moderate rate combined with

gradual control measures affected by active population dynamic.
Pattern 5: Chile and Seychelles

Pattern 5 Daily Infections

 This pattern shows ongoing high infection rate despite high vaccination rate but
low control measures implementation and active population dynamic.

Pattern 6: Brazil and Columbia

Pattern61 Daily Infections

 The pattern shows ongoing high infection rate with low vaccination rate and control
measures implementation.
Pattern 7: UAE and Bahrain

Pattern 7 Daily Infections

 This pattern for the countries with high vaccination rate in addition to high testing
and tracing measures. The ongoing infection rate due to high number of testing
and tracing in addition to active population dynamic. Bahrain is characterized by
high population density and active population dynamic. Extensive control
strategies and measures to be continued.

Pattern 8: Philippines

Pattern 8 Daily Infections

 This pattern for Philippines and similar countries as Philippines implemented strict
home quarantines and a lockdown on business and transportation in regions with
significant COVID-19 cases with low vaccination rate and high population dynamic.
Control Strategies View

We are in the 2nd year of pandemic and every day we learn newer information about
COVID-19 pattern as this is a fundamental step to realize the nature of COVID-19. The
countries that have taken the required measures are continuing vigilance, testing and
tracing and vaccination as they are easing control measures and lock downs. The new
mutations emerged as a challenge to policy and decisions makers.

The challenge of implementing response strategies to manage transmission and highlight

the impact of health and control measures implementation between-country inequalities.
As reported, the countries with high-income settings have the resources to devote for
health and control measures, while lower-income settings are pressured to emulate such
initiatives, but often lack the resources and infrastructure to do so. (17)

There is an urgent demand for United Nations, leaders and related organizations to look
at inequalities and consider it as an integral part of the global control strategy. The aim
should be to reduce COVID-19 infections to very low and zero point globally. This could
be achieved by world leaders and related organizations well, sharing information,
resources, expertise, and systemic plan. Complete eradication might take time as there
will be remaining areas and small numbers in some countries. This fact shows us that we
might need longer time to have a global complete eradication of COVID-19 pandemic.

Control strategies:

1. Vaccination.
2. Testing, isolation and tracing.
3. Distancing.
4. Personal health measures.
5. Countries health protocols and measures.
6. Partial and complete lock down.
7. Enhancing resources.
8. Adequate health and medical facilities, settings, resources and manpower.

We will overcome the pandemic and will are going to our normal life as we are learning
and adapting to the new norm.
Herd Immunity

It was reported that even with vaccination efforts in full force, the theoretical threshold for
vanquishing COVID-19 looks to be out of reach.
Worldwide vaccination is getting to a steady path and numbers of vaccinated people are
increasing, while people have reasonably begun to ask: how much longer will this
pandemic last? It’s an issue surrounded with uncertainties. As it was reported Long-term
prospects for the pandemic probably include COVID-19 becoming an endemic disease,
much like influenza. (18)
I have discussed on my eBook, titled “Our Life & COVID-19”, we have to cope with new
norms, and we need 3-5 years to overcome the pandemic. (1)
It was mentioned “in the near term, scientists are contemplating a new normal that does
not include herd immunity. Here are some of the reasons behind this mindset, and what
they mean for the next year of the pandemic”. Lauren Ancel Meyers, executive director
of the University of Texas at Austin COVID-19 Modeling Consortium said “We’re moving
away from the idea that we’ll hit the herd-immunity threshold and then the pandemic will
go away for good,” (18)
It was reported that vaccines developed by Moderna and Pfizer–BioNTech, for example,
are highly effective at preventing symptomatic disease, but it is still unclear whether if
they can protect people from becoming infected, or from spreading the virus to others.
That poses a problem for herd immunity. Shweta Bansal, a mathematical biologist at
Georgetown University in Washington DC mentioned that “Herd immunity is only relevant
if we have a transmission-blocking vaccine. If we don’t, then the only way to get herd
immunity in the population is to give everyone the vaccine,”. Matt Ferrari, an
epidemiologist at Pennsylvania State University’s Center for Infectious Disease Dynamics
in University Park mentioned that at least theoretically “A perfectly coordinated global
campaign could have wiped out COVID-19, “It’s a technically feasible thing, but in reality
it’s very unlikely that we will achieve that on a global scale. (18)

The real proportion of the population that has to be vaccinated to induce herd immunity
is not known. This will likely vary according to several factors such as the community, the
vaccine and other factors. However, achieving herd immunity with reliable, safe and
effective vaccines makes disease rarer and saves lives. (19)

It is estimated that herd immunity would require around 80-90% of the population to have
COVID-19 immunity, either through prior infection or vaccination. Therefore, public
advised to get the vaccination. (20) From my point of view, I believe this is more reliable
and appropriate measure for COVID-19 herd immunity.
Vaccination

As reported by CDC, that the best to take the first vaccine available. Vaccines are safe,
effective and reduce risk of severe illness. (21)

As mentioned that vaccinated people are very unlikely to suffer asymptomatic COVID-19
infections. The study findings by CDC showed that fully vaccinated with the Pfizer-
BioTech or Moderna vaccines were 90% less likely to be infected with SARS-CoV-2. Only
1.07% were asymptomatic of infections. (22)

Infectious disease physician Dr. Kent Stock said, age is a factor and out of those who
were hospitalized, most were in their 80s and 90s, “You would speculate that the very old
are less likely to respond to any kind of vaccination and therefore may not generate
protective antibodies,” (23)

Many vaccinated people are getting side effects such as fever, headache, feel nauseous
or bogged down with fatigue. However, these indicate immune response has been
activated. Even not having vaccine side effects, body still protected. (24)

It was reported in a more than 365,000 households in the United Kingdom that a single
dose of the COVID-19 vaccine (Pfizer or AstraZeneca) cuts risk of transmitting SARS-
CoV-2 to their closest contacts by as much as half. (25)

It is worth to mention what US President Joe Biden has said, “COVID-19 must be beaten
everywhere, or it comes back to haunt us again.” COVID-19 knows no borders. The more
people we vaccinate—everywhere—the sooner the pandemic will end. (26)

As per Thursday, 13th May, 2021 there were 257 vaccines are in development, 78 are
now in clinical testing and 14 in use. (MILKEN INSTITUTE) as following: (27):

1. Janssen Pharmaceutical Companies/ Beth Israel Deaconess Medical Center/

Emergent BioSolutions/ Catalent/ Biological E/ Grand River Aseptic Manufacturing
(GRAM)/ Sanofi/ Merc. Vaccine type: Non-Replicating Viral Vector.
2. Moderna/ National Institute of Allergy and Infectious Diseases (NIAID)/ Biomedical
Advanced Research and Development Authority (BARDA)/ Lonza/ Catalent/ Rovi/
Medidata/ BIOQUAL/ Baxter BioPharma Solutions/ Sanofi. Vaccine type: RNA-
Based.
3. BioNTech/ Pfizer/ Fosun Pharma/ Rentschler Biopharm. Vaccine type: RNA-
Based.
4. University of Oxford, Oxford Biomedica, Vaccines Manufacturing and Innovation
Centre, Pall Life Sciences, Cobra Biologics, HalixBV, Advent s.r.l., Merck KGaA,
 the Serum Institute, Vaccitech, Catalent, CSL, and AstraZeneca/IQVIA. Vaccine
type: Non-Replicating Viral Vector.
5. Chumakov Federal Scientific Center for Research and Development of Immune
and Biological Products of the Russian Academy of Sciences. Vaccine Type:
Inactivated Virus.
6. Anhui Zhifei Longcom Biopharmaceutical/ Institute of Microbiology, Chinese
Academy of Sciences. Vaccine type: Protein Subunit.
7. Gamaleya Research Institute, Vaccine type: Non-Replicating Viral Vector.
8. CanSino Biologics/ Beijing Institute of Biotechnology/ Petrovax. Vaccine type:
Non-Replicating Viral Vector.
9. Research Institute for Biological Safety Problems, Republic of Kazakhstan.
Vaccine type: Inactivated Virus.
10. Wuhan Institute of Biological Products/ Sinopharm. Vaccine type: Inactivated
Virus.
11. Sinovac/ Instituto Butantan/ Bio Farma. Vaccine type: Inactivated Virus.
12. Beijing Institute of Biological Products/ Sinopharm. Vaccine type: Inactivated Virus.
13. Federal Budgetary Research Institution (FBRI) State Research Center of Virology
and Biotechnology "VECTOR", Vaccine type: Protein Subunit.
14. Bharat Biotech/ Indian Council of Medical Research/ National Institute of Virology/
Ocugen/ Precisa Medicamentos. Vaccine type: Inactivated Virus.

As there are already several vaccines undergoing 3rd stage trials, therefore it is
expected more vaccines to be in use in coming 2-3 months.
Mutations & Variants:

After the first genetic sequence of SARS-CoV-2, Wuhan-Hu1 (the first genetic sequence
identified) and USA-WA1/2020 (the first identified in the United States) more variants
been emerged due to change in the genetic sequence of the SARS-CoV-2 virus. A new
variant (virus variant or genetic variant) of SARS-CoV-2 may have one or more mutations
that differentiate it from the reference sequence or predominant. (28)

It is mentioned that the geographic separation tends to result in genetically distinct

variants. Bollinger reported that: “All RNA viruses mutate over time, some more than
others. For example, flu viruses change often, which is why doctors recommend that you
get a new flu vaccine every year." While Ray says, “There is new evidence from laboratory
studies that some immune responses driven by current vaccines could be less effective
against some of the new strains. The immune response involves many components, and
a reduction in one does not mean that the vaccines will not offer protection. (29)

It is noted that mutations happen every year for flu virus, similarly, we have to look at this
point of view for COVID-19.

The risk of new variants will be as before for people who are elderly or have significant
underlying health conditions. While a virus being more infectious and equally dangerous
will in itself lead to more deaths in an unvaccinated population. Some research suggests
(Evidence is not conclusive) the UK variant may be associated with a 30% higher risk of
death in individuals. In one study, it suggests the Brazilian variant may resist antibodies
in people who've already had Covid and should therefore have some immunity, while it
was reported that the Pfizer vaccine can protect against the new variants, although
slightly less effectively. Existing vaccines can be redesigned to better tackle emerging
mutations. (30)

Gronvall said "It's possible that more variants might emerge that are not covered by the
vaccine," "That's why it's important that these breakthrough cases are investigated”. In
this regard Ravel from the University of Maryland said “If, on the other hand, "you start
seeing over and over the same variant in that population, that's when you start to be
worried,". It was shown that the vaccines generally are working extremely well, even
against the variants. In the latest real-world findings from Israel, where the variant first
identified in Britain is dominant, the Pfizer-BioNTech vaccine was 95% effective, while in
a study in Qatar, where the variant that emerged in South Africa made up half the cases,
the Pfizer-BioNTech vaccine was only 75% effective. (31)
Most concerning variants share the same mutations, even when they appear on different
continents. That may mean that the virus can mutate in only a limited number of ways.
As Gronvall said: "Maybe it's not possible for the virus to have entirely different mutations
that we haven't seen yet and still function." (31)

Investigators and experts around the world are studying and keeping eye on COVID_19
variants and mutations. the mutation E484K present in the South African variant B.1.351
seems to create a greater risk for reinfection and decrease some of the efficacy of COVID-
19 vaccines. The same E484K mutation has also been found to be present in the Brazilian
variant P.1 and the New York variant B.1.526. While some investigators think
that the rate of change in the virus may start too slow as they are considering that the
virus may reach a fitness level whereby multiple mutations have evolved at once, leading
the virus to not evolve at the same pace as it did initially. Gottlieb explained, “It did a lot
of evolution very quickly because of the intense pressure it was under and its wide
spread,” Gottlieb said. “Now, it’s reached a new fitness level, and it’s rate of change is
going to start too slow.” (32)

In regard to what Gronvel commented, it might mean that the virus can mutate in only a
limited number of ways, I think we have to be cautious and take into our account of the
possibility that mutations can have more ways rather only limited number of ways. We do
not have full and complete picture of COVID-19.

The advice to avoid infection remains the same for all strains: wash your hands, keep
your distance, wear a face covering and be vigilant about
Social & Political Impact

Social Aspect:

A study focusing on the mental health impact of the pandemic after the initial lockdowns
in USA has been carried on. It was that the prevalence of depression (39%), anxiety
(42%) and psychological distress (39%) were computed from the PHQ-4 scale. Males
were more likely to have depression, and females were more likely to have anxiety
symptoms. It was concluded that interdisciplinary and multisectoral approaches are
recommended in the USA along with population-based interventions on mental health
improvement given the high prevalence of depression and anxiety. (33)

Pew Research (USA) gave the public a chance to tell us in their own words how the
pandemic has affected them in their personal lives. Accordingly, it was found that the vast
majority of Americans (89%) mentioned at least one negative change in their own lives,
while a smaller share (though still a 73% majority) mentioned at least one unexpected
upside. Most have experienced these negative impacts and silver linings simultaneously:
Two-thirds (67%) of Americans mentioned at least one negative and at least one positive
change since the pandemic began. (34)
Political Aspect:

It was reported that the coronavirus has shown the underlying vulnerabilities of
autocracies rather than their strength, while in contrast, democracies are showing their
capacity for innovation and adaptation, as one would expect, and signs of renewal, as
one would hope. (35)
Keith Grint, Emeritus Professor, Warwick University, UK, mentioned that the coronavirus
has revealed that some of our contemporary myths are suspect – particularly the UK and
US's claim of exceptionalism. The role of leadership is not to pretend that the unique values
of a country will save them, but to support those that need help, and suppress those that
remain irresponsible, for whatever reasons. (36)

It was mentioned that regardless of jurisdiction, the specific actions many governments
have taken to combat the pandemic are ultimately rooted in politics, not science. The
pandemic has made politics extraordinarily relevant. (37)

The challenge of COVID-19 resulted in different outcomes around the world. Problems of
reporting and standards do not make precise comparisons easy, but few would disagree
that the reported deaths by South Korea, Thailand, and Vietnam together represent far
better results than the reported deaths reported by Brazil, the United Kingdom, and the
United States. Adjusting these figures for population—the first group has about a third of
the citizens of the second group—does not explain why COVID-19 mortality differs by a
factor of nearly 500. Neither typical proxy measures such as gross national income per
capita nor national rankings on the 2019 Global Health Security Index have any
meaningful association with performance on covid-19. (38)

The politics role as reported that it is ranging from authoritarianism in China, to single
party socialism in Vietnam, to representative democracy in New Zealand, successful
efforts to thwart the pandemic’s spread seem to rely less on politics, and more on national
cooperation. In Western Europe democracies, Belgium’s hard lockdowns did not win strict
public adherence, and Sweden’s laissez-faire policy did not achieve the hoped-for herd
immunity. In the Americas, conservative leaders in the US (Till Feb, 2021) and Brazil
turned a blind eye to reality with their live-and-let-die philosophy. All, to a varying extent,
resulted in disturbingly high COVID per-capita death tolls. The response to the
pandemic—or lack thereof—became politicized in many countries, often resulting in the
least favorable outcomes. Political opinions pervade modern public health, vastly
impeding progress towards population health, achieving unity for the greater good, and
protecting our fellow human beings. But the disease itself is not political; thus, the
response should not be politicized. (39)
Economic & Business Impact
In my eBook, June 2020, I discussed my own social model of pandemic briefly stating
that we will go through coping period. In this regard, it also was reported by McKinsey &
Company, May 2021 that during the pandemic, we learned to cope; in the post pandemic
world, we need to learn to thrive. (40)

McKinsey & Company reported that to flourish during and after the pandemic, companies
need a new set of skills, including social and emotional, advanced cognitive, and digital
capabilities. Boards and management responded to the pandemic by working harder and
collaborating more on crisis management. In the survey, 73 percent of respondents said
they believe that conditions will improve in the next six months. Sentiment is most buoyant
in North America and Greater China and most negative in India and Latin America, where
the pandemic has recently taken a devastating toll. Meanwhile, workers may be too
groggy to feel optimistic about anything. (40)
The pandemic has intensified the need for a digital shift for organizations and individuals,
who are encouraged to approach work, interpersonal engagement, and communication
differently. The pandemic has intensified the need for a digital shift for organizations and
individuals, who are encouraged to approach work, interpersonal engagement, and
communication differently. (41)
The pandemic will lead to a permanent shift in the world and its politics, especially in
health, security, trade, employment, agriculture, manufacturing goods production and
science policies as for the world economy to recover from the contraction will take time.
Since this new world might provide great opportunities for some countries that did not
dominate world production before, governments should develop new strategies to adjust
the new world order without much delay. (42)
M. Szmigiera reported that there is widespread agreement among economists that it will
have severe negative impacts on the global economy. Early estimates predicated that,
should the virus become a global pandemic, most major economies will lose at least 2.9
percent of their gross domestic product (GDP) over 2020. This forecast was already
restated to a GDP loss of 4.5 percent. To put this number in perspective, global GDP was
estimated at around 87.55 trillion U.S. dollars in 2019 – meaning that a 4.5 percent drop
in economic growth amounts to almost 3.94 trillion U.S. dollars in lost economic output.
(43)
Guan and colleagues used real-time ship tracking data from before and during the
pandemic model. It was the supply chains to some countries with strong trading links to
China (for example, Australia and Malaysia) have been affected in ways that resemble
the results of their model (although to a lower extent than predicted), others with equally
strong links (for example, Vietnam) have managed to increase their trade, contrary to the
model’s predictions. Understanding the propagation of the economic shock from COVID-
19, which can be informed by real-time observations as well as model predictions, will
help to better allocate international aid and economic stimuli. (44)
As mentioned by Department of Economic and Social Affairs of UN regarding World
Economic Situation and Prospects (WESP) 2021 warns that the COVID-19 pandemic,
which has delivered a heavy blow to economic activities worldwide, may exert devastating
long-run socio-economic effects, unless global policy responses can ensure a robust and
sustainable recovery. Those actions comprise smart investments in economic, social and
climate resilience, revitalization of global trade, avoidance of premature austerity policies.
(45)

Results suggest that containment measures have had, on average, a very large impact
on economic activity—equivalent to a loss of about 15 percent in industrial production
over a 30-day period following their implementation. Using novel data on fiscal and
monetary policy measures used in response to the crisis, we find that these policy
measures were effective in mitigating some of these economic costs. We also find that
while workplace closures and stayat-home orders are more effective in curbing infections,
they are associated with the largest economic costs. Finally, while easing of containment
measures has led to a pickup in economic activity, the effect has been lower (in absolute
value) than that from the tightening of measures. (46)
Outlook
The COVID-19 pandemic have affected our life and is likely to accelerate the trajectory
of the primary forces transforming the global business landscape — globalization,
technology, demographics and environment. As companies focus on business continuity,
they need to monitor how the pandemic is interacting with these forces and assess the
resulting impacts across the organization. Major points:
 Globalization: a new regionalism gains momentum
 Technology: global competition accelerates
 Demographics: aging catalyzes global rebalancing
 Environment: the race against the clock continues
It is noted that the pandemic is unfolding in different time frames and ways in regions
around the world, leading to divergent economic, political, and societal implications.
COVID-19 has intensified China’s growth slowdown, but Beijing has used past crises to
make geostrategic shifts for long-term advantage and may do so again. The pandemic is
unfolding in different time frames and ways in regions around the world, leading to
divergent economic, political and societal implications. COVID-19 has intensified China’s
growth slowdown, but Beijing has used past crises to make geostrategic shifts for long-
term advantage and may do so again. (47)

Six prominent thinkers reflect on how the pandemic has changed the world as following
(48):

 James Manyika: The world after COVID-19 is unlikely to return to the world that
was. Many trends already underway in the global economy are being accelerated
by the impact of the pandemic.
 Daniel Susskind: As time has passed, it has also become clear that much of what
is most distressing about this crisis is not new at all. Striking variations in COVID-
19 infections and outcomes appear to reflect existing economic inequalities.
 Jean Saldanha: In The Pandemic Is a Portal, Indian author Arundhati Roy writes,
“Historically, pandemics have forced humans to break with the past and imagine
their world anew. This one is no different. It is a portal, a gateway between one
world and the next.”
 Sharan Burrow: The world after the first wave of COVID-19 must be more inclusive,
resilient, and sustainable. Too many countries suffered the external shocks of
COVID-19 without universal social protection, robust public health systems, a plan
to reach net-zero carbon emissions by 2050, or a sustainable real economy with
quality jobs.
 Sergio Rebelo: COVID-19 will leave a lasting imprint on the world economy,
causing permanent changes and teaching important lessons. Virus screening is
likely to become part of our life, just like security measures became ubiquitous after
9/11.
  Ian Bremmer: The global order was in flux well before the COVID-19 crisis.
Coronavirus has accelerated three of the key geopolitical trends that will shape
our next world order… which will await us on the other side of this pandemic.

Ten characteristics post COVID-19 world as reported by Credit Suisse: (49)

1. Inflation tail risks: Fears of rising inflation may be exaggerated, but the concern is
that the post-COVID-19 world will be one of sluggish growth and barely visible
inflation.
2. Multilateralism: The COVID-19 pandemic has affected geopolitics, primarily by
exacerbating existing trends away from multilateralism to increasing multi-
alignment.
3. Democracy/autocracy: There is no evidence that authoritarian regimes are more
successful than democratic countries in fighting pandemics
4. Big state: The policy reaction to the COVID-19 pandemic has been swift and
forceful, and the extension of state powers may well outlast it.
5. Nearshoring: Though globalization will not reverse (but rather slow further), we can
expect more emphasis on regional diversification, nearshoring of production, and
resilience rather than cost-efficiency.
6. Surveillance: In the twenty-first century, we will view nations in terms of their
information capacity (their ability to analyze situations and make rapid changes).
7. Work: Having experienced the benefits and challenges of remote working during
the pandemic, employers and employees may want to continue these working
practices, but the legal framework for these new forms of work must change as
well. Demand for office space and business travel will probably decrease because
of the shift toward remote working and cost pressures that companies face.
8. Education: The growing demand for EdTech, which the COVID-19 pandemic has
brought about, may change the way we learn and the approach education.
9. Inequality: COVID-19 is likely to exacerbate income inequalities and uneven cross-
country wealth distribution and inequality of opportunities.
10. Decentralization: By opening up alternatives for workers to exercise their
professions at a greater distance from the city, remote work is fostering a
decentralization of economic activity in developed countries. Rural areas and small
cities are becoming more attractive.

KPMG 2020 CEO Outlook Reported following Key developments include (50):

 Talent and a new working reality: Businesses are looking to change their
recruitment strategies as remote working has widened their potential talent pool
and companies may be rethinking their office space in the short-term while also
considering the future of work.
  Shifting risk agenda: Since the start of the pandemic, ‘Talent risk’ has risen to be
named as the most significant threat to the growth of their businesses ahead of
‘Supply chain risk’ and a ‘Return to territorialism’.
 Digital acceleration: Business leaders are betting on major dimensions of digital
transformation and the majority have seen this accelerate during the lockdown.

Philips "Future Health Index (FHI) 2021" as reported (51):

 The FHI identified three key trends for post-pandemic healthcare: the acceleration
of virtual care delivery; a stepwise approach in digital transformation from
telehealth to AI adoption; and an increased focus on building sustainable
healthcare systems.
 As the threat of the pandemic decreases and vaccination programs roll out across
the world, the disparities and health inequities that were illuminated have affected
political change
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