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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Int. J. Public Health</journal-id>
<journal-title-group>
<journal-title>International Journal of Public Health</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Int. J. Public Health</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">1661-8564</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
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<article-meta>
<article-id pub-id-type="publisher-id">1609023</article-id>
<article-id pub-id-type="doi">10.3389/ijph.2025.1609023</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Letter to the Editor</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Lessons to Be Learned From the COVID-19 Pandemic: Some Further Ideas</article-title>
<alt-title alt-title-type="left-running-head">Donzelli</alt-title>
<alt-title alt-title-type="right-running-head">The COVID-19 Pandemic: Further Lessons</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Donzelli</surname>
<given-names>Alberto</given-names>
</name>
<xref ref-type="aff" rid="aff1"/>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/3186928"/>
</contrib>
</contrib-group>
<aff id="aff1">
<institution>Allineare Sanit&#xe0; e Salute Foundation</institution>, <city>Milan</city>, <country country="IT">Italy</country>
</aff>
<author-notes>
<corresp id="c001">
<label>&#x2a;</label>Correspondence: Alberto Donzelli, <email xlink:href="mailto:adonzelli55@outlook.it">adonzelli55@outlook.it</email>
</corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-02-02">
<day>02</day>
<month>02</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2025</year>
</pub-date>
<volume>70</volume>
<elocation-id>1609023</elocation-id>
<history>
<date date-type="received">
<day>28</day>
<month>08</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>17</day>
<month>12</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2026 Donzelli.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Donzelli</copyright-holder>
<license>
<ali:license_ref start_date="2026-02-02">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<related-article id="RA1" related-article-type="letter" journal-id="Int. J. Public Health" journal-id-type="nlm-ta" xlink:href="10.3389/ijph.2025.1607727" ext-link-type="doi">A Letter to the Editor on <article-title>What Lessons can Be Learned From the Management of the COVID-19 Pandemic?</article-title> by Quinn GA, Connolly R, &#xd3;haiseadha C, Hynds P, Bagus P, Brown RB, C&#xe1;ceres CF, Craig C, Connolly M, Domingo JL, Fenton N, Frijters P, Hatfill S, Heymans R, Joffe AR, Jones R, Lauc G, Lawrie T, Malone R, Mordue A, Mushet G, O&#x2019;connor A, Orient J, Pe&#xf1;a-Ramos JA, Risch HA, Rose J, S&#xe1;nchez-Bay&#xf3;n A, Savaris RF, Schippers M, Simandan D, Sikora K, Soon W, Shir-Raz Y, Spandidos DA, Spira B, Tsatsakis AM and Walach H (2025) Int. J. Public Health 70:1607727. doi: <object-id>10.3389/ijph.2025.1607727</object-id>
</related-article>
<kwd-group>
<kwd>COVID-19 lockdown</kwd>
<kwd>COVID-19 vaccine myo-pericarditis</kwd>
<kwd>vaccinated vs. unvaccinated mortality</kwd>
<kwd>infection and transmission</kwd>
<kwd>boosters and SARS-CoV-2 infections</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was not received for this work and/or its publication.</funding-statement>
</funding-group>
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<fig-count count="0"/>
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<ref-count count="5"/>
<page-count count="2"/>
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</front>
<body>
<p>Quinn et al. [<xref ref-type="bibr" rid="B1">1</xref>] have done an exceptional work. I offer some further suggestion.</p>
<p>The Authors state:</p>
<p>(<italic>page 8</italic>) &#x201c;the progression of the pandemic was largely independent of government measures&#x201d;. Indeed, some government measures were even counterproductive for hard outcomes. For example, all-cause mortality excess in 2020 (pre-vaccination era) versus mean mortality 2015&#x2013;2019 (Our World in Data) was not favorably associated with the lockdown index (Oxford University Database). Rather, it was slightly unfavorably associated with mortality both globally, and in subanalysis by gross domestic product <italic>per capita</italic> ($ &#x3c;21,000; 21,000 to &#x3c;45,000; &#x2265;45,000), population size (&#x3c;17; 17 to 50, &#x3e;50&#xa0;M), population density (inhabitants per km<sup>2</sup>: &#x3c;100, 100 to &#x3c;1,000, &#x2265;1,000), and proportion of older adults (75&#x2013;84, or &#x2265;85&#xa0;years).</p>
<p>(<italic>page 15</italic>) &#x201c;the incidence of&#x2026; transient myocarditis and/or pericarditis is not &#x2018;rare&#x2019;, but rather &#x2018;uncommon&#x2019;&#x201d;. The correct term is &#x2018;common&#x2019; (i.e. 2.33%&#x2013;2.8% in the two cited [<xref ref-type="bibr" rid="B1">1</xref>] studies, as per international rules).</p>
<p>(<italic>page 16</italic>) &#x201c;some studies comparing all-cause mortalities between vaccinated and unvaccinated groups found slightly increased risks among vaccinated groups&#x201d;. Indeed, in the cited study, in the 2&#xa0;years 2021 and 2022, the mortality risk in vaccinated people with one or two doses was statistically significant, and twice or more than the risk of unvaccinated. Moreover, a study based on the UK Office for National Statistics (ONS) data [<xref ref-type="bibr" rid="B2">2</xref>] shows that the regression lines, both for all-cause deaths and for non-COVID-19 deaths, start from very low values for all the age groups, with almost linear progressive increases as the months progress. For the age groups 18&#x2013;39, 80&#x2013;89 and 90&#x2b; years, both regression lines intersect and overcome the reference line of unvaccinated during the study period. The same occurs for the age 50&#x2013;59, limited to non-COVID-19 deaths. For the other age groups, the month of the intersection was predicted calculating the angular coefficients. The last intersections would have occurred in 2024, but the ONS stopped publishing mortality data by vaccination status after May 2023.</p>
<p>(<italic>page 17</italic>) &#x201c;by late 2021, it was abundantly clear that the vaccines did not prevent COVID-19 infection&#x201d;. Indeed, by March 2022 it was clear that, in the Delta variant era, they did not prevent even the transmission; instead, they significantly increase the transmission from infected people, &#x2265;90 days after dose 2 [<xref ref-type="bibr" rid="B3">3</xref>].</p>
<p>Moreover, many recent studies (e.g., [<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B5">5</xref>]) showed that multiple inoculations are progressively and proportionally associated with SARS-CoV-2 infections.</p>
</body>
<back>
<sec sec-type="author-contributions" id="s1">
<title>Author Contributions</title>
<p>The author confirms being the sole contributor of this work and has approved it for publication.</p>
</sec>
<sec sec-type="COI-statement" id="s3">
<title>Conflict of Interest</title>
<p>The author declare that they do not have any conflicts of interest.</p>
</sec>
<sec sec-type="ai-statement" id="s4">
<title>Generative AI Statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<fn-group>
<fn fn-type="custom" custom-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/943079/overview">Nino Kuenzli</ext-link>, Swiss Tropical and Public Health Institute (Swiss TPH), Switzerland</p>
</fn>
</fn-group>
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