Prevention in COVID-19 time: from failure to future

The COVID-19 pandemic has developed as a consequence of sheer prevention failures, leading in many countries to a sizeable number of deaths and over-saturation of intensive care units. This triggered the imposition of generalisd quarantine ('lockdown') of variable stringency in different countries: with the decrease of the epidemic, the lockdown is now gradually relaxed and replaced by tight tracing and isolation of new cases and their contacts. Prevention, however, remains not a constant priority, as the objective may be avoidance of saturation of intensive care beds or more generally of healthcare facilities rather than the minimisation of the disease incidence. This combined with the fact that notwithstanding repeated warnings in past years the epidemic occurred as a surprise denotes a way of thinking in which prevention is an important option but not a guiding principle of choice and action within the health system. To modify this way of thinking and place prevention at the core of the system, non-negligible changes are required: they may become possible in light of emerging hazards like new viruses and climate change, huge economic costs of failed prevention and initial changes in the health system already induced by the COVID-19 epidemic.