Perspective on Two Major Pandemics: Syphilis and COVID-19, a Scoping Review

Round 1

Reviewer 1 Report (Previous Reviewer 1)

I have no further comments

Author Response

Response to Reviewer 1 Comments

Point 1. (x) English language and style are fine/minor spell check required

Response 1. English language improvements have been made as requested. We would like to thank you for your valuable contributions to the document. The authors appreciate your feedback.

Author Response File: Author Response.pdf

Reviewer 2 Report (Previous Reviewer 2)

The paper titled "Perspective on two major Pandemics: Syphilis and Covid-19, a Scoping Review" with reference sustainability-2163589 is recommended for minor revision.

STRENGTHS:

The paper is well prepared, with some improvements.

The paper suits this journal Sustainability.

The paper has good flow and organisation.

The paper is well organised and referenced.

The paper has good introduction and discussion.

The authors are well knowledgeable in this field.

The review is detailed but could be improved.

WEAKNESSES:

There should be minor proof reading and some English Language editing, for instance in line 67 Page 2 where "Many famous people have contracted..." should be "Historically, many famous people had contracted..."

The authors should merge the Introduction Section into 3-5 paragraphs as against the present 17 paragraphs.

In both Page 5, line 222, and in Page 7, line 283, remove the hyphen in co-vid-19 as seen in "... syphilis and co-vid-19 - compare?" which should be "... syphilis and covid-19 - compare?"

In academic technical writing, the use of pronouns like 'we, our, you, me, I' are not acceptable. Could the authors rewrite the phrase in line 286, page 7 "we asked ourselves the following question..."?

Also, it appeared a lot in the use of "we" in conclusion section, such as "we analysed". Revise it.

Update the details of some references like Ref [59] Chilamakuri, R. and Agarwal, S., 2022. COVID-19: Characteristics and Therapeutics.

In Page 7, lines 319-321, add the initials of the authors in the brackets as seen in "The first and second author ( ) carried out the general extraction of the data. The third author ( )  examined the findings. The fourth, fifth and sixth authors ( ) identified the common..."

The introduction should present some relevant studies to support the scoping review with similar public health studies that present some protocols. I recommend looking into adding some more references as follows:

https://doi.org/10.4236/cweee.2022.111003; https://doi.org/10.1108/JEDT-03-2021-0131; https://doi.org/10.1177/11786329211033845;

Are there recommendations of the different control systems that are applicable for these two pandemics?

In the methodology section, the authors did state that the Dialectical Structural Model of Care (DSMC) model was used. They should state the scoping review protocols or scoping review framework applied, and why, with reference to similar studies that applied it.

Table 4, Page 15, Pfizer should not have hyphen. 

Also, in the conclusion, add limitations of this study, such as the works not checked. For instance, scoping reviews often include information from clinical trial registers, theses, and conference abstracts. Were these excluded? State it.

Considering that both pandemics happened during different timelines and decades, how did the authors validate the similarities, differences, characteristics and effects of the pandemics in this scoping review? Discuss this in the ethical issues section. Also, understand that you should state how the medical society considered issues on ethics back then and currently in the discussion.

Author Response

Response to Reviewer 2 Comments

Point 1. In both Page 5, line 222, and in Page 7, line 283, remove the hyphen in co-vid-19 as seen in "... syphilis and co-vid-19 - compare?" which should be "... syphilis and covid-19 - compare?"

Response 1. Incorrectly placed hyphens have been removed.

Point 2. In academic technical writing, the use of pronouns like 'we, our, you, me, I' are not acceptable. Could the authors rewrite the phrase in line 286, page 7 "we asked ourselves the following question..."?

Response 2. To begin the review, we askerd ourselves the following question: "how do two pandemics caused by two different diseases syphilis and COVID-19 compare?"

Point 3. Also, it appeared a lot in the use of "we" in conclusion section, such as "we analysed". Revise it.

Response 3. We have reviewed them in the text.

Point 4. Update the details of some references like Ref [59] Chilamakuri, R. and Agarwal, S., 2022. COVID-19: Characteristics and Therapeutics.

Response 4. Chilamakuri, R.; Agarwal, S. COVID-19: Characteristics and Therapeutics. Cells 2022, 10, 206.

Point 5 . IN Page 7, lines 319-321, add the initials of the authors in the brackets as seen in "The first and second author ( ) carried out the general extraction of the data. The third author ( )  examined the findings. The fourth, fifth and sixth authors ( ) identified the common..."

Response 5. The first and second author (A.C.-O and T.K.B-P) carried out the general extraction of the data. The third author (M.P.-A.) examined the findings. The fourth (M.R.P-A), fifth (P.J.P.-Q) sixth (D.S) and seventh authors (M.S.G-C) identified the common […]

Point 6. The introduction should present some relevant studies to support the scoping review with similar public health studies that present some protocols. I recommend looking into adding some more references as follows:

https://doi.org/10.4236/cweee.2022.111003; https://doi.org/10.1108/JEDT-03-2021-0131; https://doi.org/10.1177/11786329211033845;

Response 6. We have checked the references.

Point 7. Are there recommendations of the different control systems that are applicable for these two pandemics?

Response 7. Yes, in both countries institutions were created to fight and try to prevent and stop the disease, all of which is developed in the results.

Point 8. In the methodology section, the authors did state that the Dialectical Structural Model of Care (DSMC) model was used. They should state the scoping review protocols or scoping review framework applied, and why, with reference to similar studies that applied it.

Response 8. About the model used, we consider its use fundamental (other articles using this model, written by the authors:

1. Espina-Jerez, B., Romera-Álvarez, L., de Dios-Aguado, M., Cunha-Oliveira, A., Siles-Gonzalez, J., & Gómez-Cantarino, S. (2022). Wet Nurse or Milk Bank? Evolution in the Model of Human Lactation: New Challenges for the Islamic Population. International journal of environmental research and public health, 19(15), 9742. https://doi.org/10.3390/ijerph19159742
2. Siles-González, J., Romera-Álvarez, L., Dios-Aguado, M., Ugarte-Gurrutxaga, M. I., & Gómez-Cantarino, S. (2020). Woman, Mother, Wet Nurse: Engine of Child Health Promotion in the Spanish Monarchy (1850-1910). International journal of environmental research and public health, 17(23), 9005. https://doi.org/10.3390/ijerph17239005
3. Gómez-Cantarino, S., Romera-Álvarez, L., de Dios-Aguado, M., Ugarte-Gurrutxaga, M. I., Siles-Gonzalez, J., & Cotto-Andino, M. (2022). Queens and Wet Nurses: Indispensable Women in the Dynasty of the Sun King (1540-1580). Healthcare (Basel, Switzerland), 10(2), 316. https://doi.org/10.3390/healthcare10020316
4. Espina-Jerez, B., Romera-Álvarez, L., Cotto-Andino, M., Aguado, M. D., Siles-Gonzalez, J., & Gómez-Cantarino, S. (2022). Midwives in Health Sciences as a Sociocultural Phenomenon: Legislation, Training and Health (XV-XVIII Centuries). Medicina (Kaunas, Lithuania), 58(9), 1309. https://doi.org/10.3390/medicina58091309

Point 9. Table 4, Page 15, Pfizer should not have hyphen. 

Response 9.

Point 10. Also, in the conclusion, add limitations of this study, such as the works not checked. For instance, scoping reviews often include information from. Were these excluded? State it.

Response 10. Line 772-779: As limitations of the study, the rigorous methodology is a strong point of this review; however, the inclusion of studies with other languages would also be relevant. In addition, some research such as scoping reviews, theses and conference contributions were not reviewed and may constitute a limitation. Regarding syphilis, the main figure appearing in the writings is the physician. Despite the fact that it was the nurse who performed the treatments, hardly any literature on this topic was found. As for COVID-19, there are many lines of treatment, but it should be noted that most are still under trial. We will have to wait for studies to come out with the results of the drugs used against COVID-19.

Point 11.  Considering that both pandemics happened during different timelines and decades, how did the authors validate the similarities, differences, characteristics and effects of the pandemics in this scoping review? Discuss this in the ethical issues section. Also, understand that you should state how the medical society considered issues on ethics back then and currently in the discussion.

Response 11. A comparison of the two realities has been made. To do this, it was first necessary to make a historical study of how the two pandemics have evolved. Once this study has been made, we have proceeded to describe both diseases, to talk about how society has understood them, how health professionals have prevented and attacked the disease and in which institutions the actions have been carried out supporting the discourse of this review in the methodology The dialectical structural model of care (DSMC).

Ethical issues line 343-345: documents mentioned in this article attest to the external and internal credibility of the sources used and are open to consultation according to their specific rules.

Author Response File: Author Response.pdf

Reviewer 3 Report (New Reviewer)

Dear authors, 

1.I enjoyed reading this review, which deals with the outbreaks of syphilis and Covid19, which triggered the epidemics that claimed the lives of thousands of people. ?" It was a good review about looking for an answer to the question: "How do two pandemics caused by two different diseases syphilis and covid-19 compare

2. The introduction part of the article was kept too long and moved away from the purpose.

3. What draws attention in the article is the similarity of social reaction in pandemics however, the flow of text is irregular. I suggest that the article be reconsidered with a simpler explanation.

Author Response

Response Reviewer 3

Point 1.I enjoyed reading this review, which deals with the outbreaks of syphilis and Covid19, which triggered the epidemics that claimed the lives of thousands of people?" It was a good review about looking for an answer to the question: "How do two pandemics caused by two different diseases syphilis and covid-19 compare?

Response 1. Thank you for your comment and for taking the time to provide us with a response.

2. The introduction part of the article was kept too long and moved away from the purpose.

Response 2. We tried to shorten the introduction.

3. What draws attention in the article is the similarity of social reaction in pandemics however, the flow of text is irregular. I suggest that the article be reconsidered with a simpler explanation.

Response 3. We have tried to simplify some explanations so that the development of these two pandemics can be well understood.

Author Response File: Author Response.pdf

Reviewer 4 Report (New Reviewer)

The authors are presenting a scoping review on two epidemics, syphilis and covid-19 using a dialectical structural model of care approach.

I would like to share the following comments with the authors:

For readers not familiar with the dialectical structural model of care approach, this should be explained better. By the same token, the different functional unit/element/framework should be explained better.

Albeit it being a scoping review, the number of retrieved, excluded and included references should be documented in a more transparent way. It also seems to me that the authors are missing quite a bit of literature (especially on the syphilis end) which expresses itself in an unbalanced presentation that is focussing more on Covid-19 (see my point below).

It seems to me that the depth of presentation is not fully balanced. For example the authors talk extensively about diagnostic tests and treatment for COVID-19, but do not talk about the test difficulties and development for Syphilis, as well as treatment options. But there are many similarities to be uncovered, tests are not always sensitive, post infection there are false positives possible, etc. Treatment initially was unclear for both, later treatment strategies developed. Furthermore, it seems that the authors stopped their analysis of syphilis treatment and care somewhere post WW1. Fig. 2 is unclear in terms of timeline (WWI cannot come before "end of 19th cent"). But the treatment of syphilis is still fluctuating today. In some countries sexual health (poli-)clinics are not administering Benzathine penicillin G, but only Doxycycline (given a IM vs oral administration) and leave IM treatment to hospitals.

Table 2 talks about the 3-stage development of syphilis, but does not cover the long-covid component for Covid-19 - this is out of balance

Terminology should be aligned, sometimes Covid-19 is used, sometimes Sars-CoV2

I don't understand why AIDS is mentioned in line 202.

The discussion and conclusion is unclear to me, what have we learned, what are the gaps closed. This section (and also the Introduction) can be written-up in a much more concise way.

Extensive proof-reading of the MS is necessary, sometimes non-English words are used, Fig.2 heading syphilis, Fig.3, Moscow

Author Response

Response Reviewer 4

Point 1. For readers not familiar with the dialectical structural model of care approach, this should be explained better. By the same token, the different functional unit/element/framework should be explained better.

Response 1. Changes have been made to simplify the explanation, lines 184-201: Using the DSMC model, we have established four thematic blocks to reflect the vision of health professionals, health institutions as well as the treatment of these epidemics and the legislation carried out: (1) health professionals faced with two pandemics; (2) health institutions; (3) treatment of syphilis and COVID-19; and (4) health legislation. Within this model there are three structures through which the object of study is developed. These are 1) the Functional Element (FE) that encompasses, in this case, the people responsible for the implementation of care: understood as a multidisciplinary team, the characteristics of this team that allowed them to address both syphilis and COVID-19.  2) The Functional Framework (FM) in which these pathologies are carried out, i.e. mainly hospitals and clinics; finally, 4) the Functional Unit (FU), which represents the different treatments carried out by these professionals; in addition to the existing regulation and legislation on case reporting.

These structures are a perfect tool for organising and analysing data. The aim is to obtain concrete visions of a given historical phenomenon, but also a current view of two diseases within the perspective of two pandemics.

In this way, four thematic blocks will be established: (1) health professionals facing two pandemics; (2) health institutions; (3) treatment of syphilis and COVID-19 and, (4) health legislation.

Point 2. Albeit it being a scoping review, the number of retrieved, excluded and included references should be documented in a more transparent way. It also seems to me that the authors are missing quite a bit of literature (especially on the syphilis end) which expresses itself in an unbalanced presentation that is focussing more on Covid-19 (see my point below). It seems to me that the depth of presentation is not fully balanced. For example the authors talk extensively about diagnostic tests and treatment for COVID-19, but do not talk about the test difficulties and development for Syphilis, as well as treatment options. But there are many similarities to be uncovered, tests are not always sensitive, post infection there are false positives possible, etc. Treatment initially was unclear for both, later treatment strategies developed. Furthermore, it seems that the authors stopped their analysis of syphilis treatment and care somewhere post WW1. Fig. 2 is unclear in terms of timeline (WWI cannot come before "end of 19th cent"). But the treatment of syphilis is still fluctuating today. In some countries sexual health (poli-)clinics are not administering Benzathine penicillin G, but only Doxycycline (given a IM vs oral administration) and leave IM treatment to hospitals.

Response 2. We would like to thank you for your valuable contributions to the document.The authors appreciate your feedback. All comments have been taken into consideration. The introduction, discussion and conclusion was changed.

We have tried to balance both pandemics considering that the treatment of syphilis has been explained from line 565 to 620. In addition, we have included other types of antibiotics used for its treatment and how depending on the route of administration it is performed at hospital or home level.

Line 555-559: For those allergic to penicillin there are alternatives, although it must be taken into account that the efficacy is not the same. They usually undergo a desensitization process. As a second option, ceftriaxone is the most commonly used, although other antibiotics are also known, but azithromycin is under study as it is considered a good candidate for treatment.

Point 3. Table 2 talks about the 3-stage development of syphilis, but does not cover the long-covid component for Covid-19 - this is out of balance

Response 3.

Point 4. Terminology should be aligned, sometimes Covid-19 is used, sometimes Sars-CoV2

Response 4. This item has been modified. The authors use COVID-19 in this research to refer to the disease, however, to indicate the causative microorganism we speak of SARS-COV-2.

Point 5. I don't understand why AIDS is mentioned in line 202.

Response 5. This has been a mistake. It has been removed.

Point 6. Extensive proof-reading of the MS is necessary, sometimes non-English words are used, Fig.2 heading syphilis, Fig.3, Moscow

Response 6. All points have been translated.

Author Response File: Author Response.pdf

Round 2

Reviewer 4 Report (New Reviewer)

I have seen a previous version of the MS. I m happy to see that there are improvements made, but from my perspective there MS is not yet at a publishable level. I would like to share the following comments with the authors

Selected References: I had asked the authors to provide a proper flow chart of scanned articles and levels of inclusion and exclusion. Please provide that and do not just mention some figures in the text. The reader needs to be able to understand what you did, and based on which inclusion criteria.

I still do not understand Figure 2. Why is the First World War placed above the sections on the 19th century? Why are only two hospitals mentioned?

By the same token: Figure 3: why are there only a few hospitals mentioned? Is this due to the references? Then the references should be provided with a number in brackets. Moscu is still not translated into English.

The "message" of the figures needs to be explained better in the text. In general, the MS suffers from a lack of clarity in the writing style. It seems that the authors really assume the audience to be familiar with their analysis approach, which many of them are not.

Please use "sex work" and "sex workers" instead of prostitution and prostitutes, according to non-discriminatory language use

Author Response

RESPONSE REVIEWER 4:

Tables included in the attached word document

1. Selected References: I had asked the authors to provide a proper flow chart of scanned articles and levels of inclusion and exclusion. Please provide that and do not just mention some figures in the text. The reader needs to be able to understand what you did and based on which inclusion criteria.

Throughout the material and methods we have developed the inclusion and exclusion criteria, as well as the prism requested, leaving it below as Figure 1.

 Figure 1. Search results and study selection. Source: own elaboration of the authors.

2.  I still do not understand Figure 2. Why is the First World War placed above the sections on the 19^th century? Why are only two hospitals mentioned?

The figure has been modified chronologically as requested.

We have written about the hospitals found after the review carried out, these being the ones that appear throughout the research.

3. By the same token: Figure 3: why are there only a few hospitals mentioned? Is this due to the references? Then the references should be provided with a number in brackets. Moscu is still not translated into English.

We have mentioned the hospitals that we found in the search and that met the inclusion requirements.

We have translated the word Moscow and the reference has been modified

4. The "message" of the figures needs to be explained better in the text. In general, the MS suffers from a lack of clarity in the writing style. It seems that the authors really assume the audience to be familiar with their analysis approach, which many of them are not.

For the sake of clarity of the Dialectical Structural Model (DSMC), the researchers have decided to rewrite the material and methods section. Indicating it in this section in addition to having included it again in the article.

2. Material and methods

2.1. Structure of the article

In this article, a review of the scope, from the first records found to the present day, was carried out as a method to address the objective of the study.  The aim is to make a comparison between two pandemics caused by syphilis and COVID-19 and how health professionals acted in both of them, as well as to know the physical spaces where health care was carried out, without forgetting the legislation passed as a result of these pandemics. Through the review, the scope of the existing bibliography on the specific topic of study was determined. They give an idea of the volume of publications and studies available. In addition to knowing the focus of the works, they allow researchers to evaluate, synthesize and criticize the evidence inherent to the objective of the study [17]. Next, various sources of knowledge were used, consulting primary sources such as manuscripts in the national library of Spain. Electronic databases (Scielo, PubMed, Cochrane, Google Scholar) dealing with the topic of study were also reviewed.

 The Dialectical Structural Model of Care (DSMC) was used. This is an organic vision that relates the cultural system with the biological system of the people who integrate it. In other words, people are under cultural pressure that shapes the forms of behavior in the process of satisfying needs from roots in which values, beliefs and feelings nest. This approach allows the interrelation between culture and need satisfaction; that is, the 7 basic needs of people according to Malinowski (nutrition, reproduction, body care, security, movement, growth and health) and a culturally articulated function are related through a response [18,19]. Therefore, this model is suitable for studying the people who carry out socio-health activities and the scenarios where they occur, as well as the links between norms, beliefs, values and social structures [20,21]. For this study, its application is of utmost importance, taking into account the social and cultural aspects that interact in the assistance and care provided by health professionals at a given historical moment, since in pandemics there is a great cultural need for health and the cultural response in this context would be hygiene, care and the places where they were developed. For epidemics have been a setback in the sustainability of public health, economy, environment and society. Without leaving aside, the importance of legislation to address regulations to address Syphilis and COVID-19.

The structures used in the DSMC are: (1) Functional Unit (FU), which represents the social structure of coexistence and socialization that transmits values, norms, beliefs, knowledge and feelings, through which social systems are built. In this case, it has to do with legislation, regulation and standardized treatment protocols, as well as the notification of cases and their repercussions in the socioeconomic sphere. (2) Functional Framework (FF), which refers directly to the socio-health context, which determines the application of care, such as clinics, monographic hospitals, venereal treatment stations, as well as (3) Functional element (FE), integrates the social actors in charge of care, i.e., health and the role of the care figures, as well as the care actions themselves, which in this study is circumscribed to the health professionals who acted in the face of the Syphilis and COVID-19 pandemics and the characteristics of these professionals [15]. This research proposes four thematic blocks (1) healthcare professionals facing two pandemics; (2) healthcare institutions; (3) treatment of syphilis and COVID-19; and (4) healthcare legislation) analyzed through the DSMC, each of which represents structures specific to the cultural and social history model (Figure 1).

2.2. Search Strategy

The review process began with an exploratory research question [17] aimed at systematically synthesising and critiquing existing knowledge [18], in this case: "how do two pandemics caused by two different diseases compare: Syphilis and COVID-19?" To answer this question, DSMC was applied. The review included books, peer-reviewed articles, and official dissertations.

We began with an initial search to determine the background and delimitation of the object of study. In this phase, various databases were consulted: (1) Cochrane: (2) PubMed/Medline; (3) SciELO; (4) Scopus, as well as (5) Google Scholar. After this initial search, we proceeded to consult manuals in physical and virtual format from different territories through the service of the National Library of Spain. In order to have up-to-date information, the search was limited to the last 10 years.  However, since this is a historical topic, earlier publications were consulted and selected. For database exploration, a natural or free-text language, normalized and controlled with MeSH and DeCs descriptors, was used. These were combined with Boolean operators ("and/and", "or/or", "not/not"). The search equations and filters used in all databases were as follows: Syphilis and COVID-19; healthcare OR nurse OR pandemic OR treatment AND Syphilis OR COVID-19 OR medicine OR psychologist OR physiotherapist AND treatment AND dispensary OR hospital AND notification are summarized in Figure 1.

Figure 1. Search results and study selection. Source: own elaboration of the authors.

The search of the Spanish Archives portal, known as PARES, provided us with information on historical documents of important value for information concerning Spain and the terms used were "Syphilis", "pandemic", "sanitary", "treatment", "dispensaries", "hygiene", "health care". The period of study was filtered from the appearance of Syphilis to the present day.

2.3. Review Process

The database search was conducted between January and July 2022. The archival search as well as the analysis and transcription of the records found took place between August and October 2022. This type of review aims to explore the existing evidence on a particular topic and historical period, as well as to identify and fill existing gaps.

The inclusion criteria were the following (1) papers directly addressing the subject of pandemics; (2) papers dealing with the origin and evolution of both diseases; (3) pharmacological and non-pharmacological treatment; (5) process of notification of new cases; (6) papers in English, Spanish and Portuguese.

The exclusion criteria applied were: (1) documents that considered the subject from different perspectives to those studied; (2) works included in the study period that dealt with other pandemics; (3) documents that did not exist in full text. By consensus of the authors, articles, books and legislation were reviewed. A total of 38 documents were reached that met the inclusion and exclusion criteria.

2.4. Data Analysis

The documentary analysis was conducted from a qualitative perspective, systematically following the objective of the study. The steps followed in the analysis were: (1) thematic linkage; (2) preliminary classification of the documents according to inclusion and exclusion criteria; (3) selection of relevant information; (4) interpretation and comparison of the documents. The selected material was analyzed from the point of view of the four thematic blocks of study each of them encompassed within the DSMC structures: (1) health professionals facing two pandemics (art. 11, 18-28, 33-43); (2) health institutions (27,35,44-50),; (3) treatment of Syphilis and COVID-19, and (4) health legislation (51-65).

To extract and summarize the data, the first and second authors (A.C-O and T.KB-P) performed a general data extraction. The third, fourth and fifth authors (M.R.P-A, M.A.A-P and P.J.P-Q) examined the results in depth. The sixth and seventh authors (D.G-S and S.G-C) analyzed the thematic blocks encompassed in the DSMC structures, from the Functional Unit (FU) to the Functional Framework (FF) and the Functional Structure (FE). Thus, after working with all the material, it was possible to answer the initial question of this study: "How two pandemics caused by two different diseases Syphilis and COVID-19 can be compared?".

5. Please use "sex work" and "sex workers" instead of prostitution and prostitutes, according to non-discriminatory language use

The word prostitute has been changed to sex worker throughout the text, it has been underlined in yellow in the following contents:

Line 428-429, 447-449, 460 and Table 3.

Author Response File: Author Response.pdf

Round 3

Reviewer 4 Report (New Reviewer)

I have read previous versions of this paper. I have to admit, most likely due coming from a different discipline, I still have difficulties understanding the perspective of the authors. Thus, I would kindly ask them to make their paper more accessible to readers that are not familiar with their approach. Partly, this could also be due to language issues.

For example, the authors added new text in line 105-107. What kind of sustainability is referred to here? What kind of reflection is meant here and what kind of impact on sustainability policies is hinted at? Please explain!

Line 192/193: without leave aside... This sentence does not make sense. There are either words missing, or I just do not understand what the authors want to state here. Again, I would kindly ask the authors to make sure that their work is easy to understand and that resubmissions have been carefully proofread.

Line 274-276: what do the authors want to say here?

Fig 3: syphilis, please correct

line 200: explain "monographic"

line 700: "Health systems become unsustainable in the health care that pandemics cause." such generalized statements require nuancing and/or references, also the language is off. Do you mean: in the health care context that pandemics cause?

Author Response

REVIEWER 4

 Dear reviewer,

Thank you for your comments.

Please consider the following responses:

Answer 1. For example, the authors added new text in line 105-107. What kind of sustainability is referred to here? What kind of reflection is meant here and what kind of impact on sustainability policies is hinted at? Please explain!

Response: “Importantly, public health is responsible for defining the tools, considering global initiatives to address pandemics and future policies for control, harm reduction and early case detection. In fact, it could help to promote healthy public policies for health and even reflect on diseases of public impact, which allows the definition of sustainability policies.”

Answer 2: Line 192/193: without leave aside... This sentence does not make sense. There are either words missing, or I just do not understand what the authors want to state here. Again, I would kindly ask the authors to make sure that their work is easy to understand and that resubmissions have been carefully proofread.

Response: “Consequently, the legislation to regulate the approach to Syphilis and COVID-19 is important.”

Answer 3: Line 274-276: what do the authors want to say here?

Response: We eliminated.

Answer 4: Fig 3: Syphilis, please correct.

Response: it is already corrected.

Answer 5: line 200: explain "monographic"

Response: the adjective monographic is used to refer to something that deals with the study of a specific and concrete subject, in this case, hospitals dedicated exclusively to the study and treatment of Syphilis, for this reason, the word monographic has been used for these hospitals.

Answer 6: line 700: "Health systems become unsustainable in the health care that pandemics cause." such generalized statements require nuancing and/or references, also the language is off. Do you mean: in the health care context that pandemics cause?

Response: "Pandemics become unsustainable in the systems of the health context that cause pandemics". Line 702.

“Because sustainable health planning requires care that is effective during and after a pandemic.” Line 709-710.

Author Response File: Author Response.pdf

Round 4

Reviewer 4 Report (New Reviewer)

I have read many previous versions of the MS, and I see the improvements that were made. Yet, especially the edits often lead to new problems. Don't get me wrong here, I am not against the paper at all.

Take for example line 108 ff: " In fact, it could help to promote healthy public policies for health and even reflect on diseases of public impact, which allows the definition of sustainability policies.

What are "healthy public policies for health"?, can unhealthy policies exist? and the "sustainability policies" are still not defined. Are the public health policies meant to be sustainable? Please clarify!

By the same token in line 195: is this really legislation? or more of a regulation?

line 702: this sentence does not make sense in English, and/or grammatically

line 709: do not start a sentence with Because (unless you cannot reverse it, which is not possible here), sentence does not make sense as it is.

minor point:

monographic has still not been explained in the paper. It does not suffice to explain it in the editors letter

line 263, remove extra comma

Author Response

Reviewer 4:

Question 1: Take for example line 108 ff: " In fact, it could help to promote healthy public policies for health and even reflect on diseases of public impact, which allows the definition of sustainability policies.

Answer 1: Therefore, the present research study is scientifically relevant for its contribution to filling gaps in the comparison of the performance of two different diseases that have become epidemics. This article allows us to reflect on public health and the performance of health professionals who work to improve and protect the health of the population. In fact, they are in charge of carrying out prevention campaigns promoted by the States, in which they perform among other functions, the control of pandemics. This situation reduces damages, promotes the early detection of new cases because new epidemic outbreaks entail economic, social and death costs and even produce disability in people, which delays sustainable development [2,5,9]. Lines: 103-111.

Question 2: What are "healthy public policies for health"?, can unhealthy policies exist? and the "sustainability policies" are still not defined. Are the public health policies meant to be sustainable? Please clarify!

Answer: Public health policy is characterized by an explicit concern for health and equity in all policy areas, and by accountability for its impact on health. Such policy enables or facilitates citizens to make healthy choices and turns social and physical environments into health enhancers [3].

For more information on the subject: Mandl Stang, J. Gobernanza de políticas públicas saludables en los ámbitos locales: una propuesta para el debate Cuadernos del CENDES, vol. 34, núm. 96, septiembre-diciembre, 2017, pp. 65-86 Universidad Central de Venezuela Caracas, Venezuela.

Sometimes public policies are established that are not healthy for the population, as an example, we have the large number of cars in cities that make it difficult to walk, use bicycles and even increase pollution in cities that is harmful to citizens, the speed that cars reach in cities producing deaths by being run over. In fact, these factors have caused that many places have had to create programs to avoid the agglomeration of these vehicles by encouraging the use of public transportation.

Sustainability policies are those that require the management of natural, human, social, economic and technological resources in order to achieve a better quality of life for the population, while at the same time ensuring that current consumption patterns do not affect the well-being of future generations.

For more information on the subject: Cortés Mura, Hernán Gustavo; Peña Reyes, José Ismael De la sostenibilidad a la sustentabilidad. Modelo de desarrollo sustentable para su implementación en políticas y proyectos Revista Escuela de Administración de Negocios, núm. 78, enero-junio, 2015, pp. 40-54 Universidad EAN Bogóta, Colombia

Health policies are intended to be sustainable because they must achieve the greatest wellbeing of the population in its three spheres: biological, psychological and physical.

Question 3: By the same token in line 195: is this really legislation? or more of a regulation?

Answer 3: The law is what is established by an official rule and approved by the corresponding legislative power. The regulation is the action carried out by this norm.

This is our understanding: Accordingly, the regulation is important to regulate Syphilis and COVID-19. Line 196.

Regulation is the action or effect of regulating. The term is often used as a synonym for regulation.

Question 4: line 702: this sentence does not make sense in English, and/or grammatically.

Answer 4: Pandemics produce deficits in economic and social systems that impact and affect numerous groups. Line 702.

Question 5: line 709: do not start a sentence with Because (unless you cannot reverse it, which is not possible here), sentence does not make sense as it is.

Answer 5: The following sentence is eliminated

Question 6: monographic has still not been explained in the paper. It does not suffice to explain it in the editors letter.

Answer 6: monographic hospitals (which are those hospitals dedicated exclusively to the study and treatment of a specific disease, in this case, to the study of Syphilis and COVID-19). Line 203-205.

Question 7: line 263, remove extra comma

Answer 7: removed.

Author Response File: Author Response.pdf

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Dear authors

I’ve carefully revised your manuscript “Perspective on two major Pandemics: Syphilis and Covid-19, a 2 Scoping Review”, this manuscript aims to analyze what two pandemics caused by different diseases have in common. It is a scoping review made up of papers covering everything related to syphilis and covid-19.

Here my comments to improve your work:

MAJOR

1.       Please revise your abstract for effectiveness and remember your abstract should be a brief summary of the manuscript.

2.       In the introduction, I would advise you to provide more context on your research problem and not merely defining both diseases, the introduction should begin with a presentation of the problem and end with a statement of the question to be answered or the knowledge to be generated.

3.       Suggest you better explain the process of analysis, including some discussion of the procedures with a principle of transparency.

4.       Please make sure to use rigorous and transparent methods to comprehensively identify and analyze all the relevant literature pertaining to a research question

5.       Please revise your search strategy, it is recommended that you use subject headings, descriptors, etc and that you adapt the search to each database.

6.       Please revise your conclusion for effectiveness and your recommendations should be based on your findings.

7.       Please consider revising your discussion and how you’re interpreting your results, considering the limitations and the strengths of your study.

8.       Please also include the strengths of your study.

9.       Please make sure to discuss what are the implications of your research in clinical practice.

Minor comments

1.       Please further revise your manuscript and the references for errors.

2.        I would suggest you revise the length of your manuscript and to be more concise.

3. Please consider presenting your work as a perspective or an opinion article.

Reviewer 2 Report

The paper Manuscript ID sustainability-1890096 is a review on the "Perspective on two major Pandemics: Syphilis and Covid-19, a Scoping Review" is recommended for revision.

STRENGTHS:

The paper has good flow and content.

The arrangement, structure and presentation of the manuscript is very acceptable and it covers the objective of the study.

The authors are technically sound and understand the subject area.

The method used is technically correct on this study.

The structure of the English Language structures is fine and has been checked but may need to be proof-read again.

The paper has good highlights.

Good abbreviations seen in the abbreviations used, as presented.

Good abstract. It is well captured.

However there are some technical observations as follows:

WEAKNESSES:

In Section 1, authors did well but they could include an image of typical image for COVID19 virus being used by WHO or discussed by other researchers, so that readers who are non-technical can easily understand it.

I do also recommend that this graphical abstract be included. The study has great potential.

In Section 1, the Introduction is sufficient but could be improved upon. Also, state why we need this scoping review design in introduction?

The authors should include a table of comparison between Syphilis and COVID19, to show the symptoms and brief information on both in Section 3.1. 

The authors should include a table of timelines in Syphilis and COVID19 based on their spread , and treatment from clinics to hospitals in Section 3.2. What is common in both times too? They could also include their similarities.

The authors should add a table on COVID-19 Vaccines, showing the type of vaccine, the manufacturer and date of approval, approval location/zone and the references/ sources. Typical tabulated data like this would help readers make judgements, and appreciate this study better. Also include the zone, such as Europe, USA, Canada, etc.

In the paper, another weakness is some statements made were not backed by references. DID the authors have sufficient knowledge of these statements or they were there? Some statements require references to show readers, so they can read on it and also make more findings, as well as agree that your statements are not without evidence. It is a technical writing which should be evidence based, as a scoping review too. An example of such statements  is in Page 10, lines 429-434 "These dispensaries were not sufficient, so numerous monographic hospitals were created, such as the Hospital San Juan de Dios and the General Hospital of Valencia in  Spain.  The first was founded in 1552 and was run by the brothers of the Order of St. John of  God. This hospital achieved worldwide fame and was considered one of the best health 433 centers for the mercurial treatments applied to treat syphilis."

Some English language editing and minor proof reading is recommended.

The writing style of the authors should be improved with less use of paragraphs in technical writing of papers (see related Sustainability papers). Each section presented an excessive use of paragraphs, they should be joined. Such that:

Section 1 which has 14 paragraphs should have 3-5 paragraphs. 

Section 1.1 which has 14 paragraphs should have 3-5 paragraphs.

Section 2.1 which has 5 paragraphs should have 3 paragraphs; and Similar findings for other sections, etc.

Also, in technical academic writing, the use of pronouns like "we" is not acceptable, as seen in "What we do know..." in Page 3 line 136, "We are looking at a..." in Page 3 line 138, "We are therefore faced..." in Page 2 line 63, "In terms of epidemiology, we currently..." in Page 2 line 88, ... "How can we compare two..." in Page 6 line 246,

Also, a similar pronoun "they" was used in the technical writing which is another issue, but should be revised as in "They state that they comply..." in Page 6, line 254. Who is "they"? Be specific. Such as "The authors state that compliance to the journal requirements and publication ethics for the research were adhered to."

It would be better to also add the month and year in the statistics of the COVID19 cases listed in the last paragraph of Section 1 cited from Ref [9], that "In terms of epidemiology, we currently know that there have been around 88 572,609,869 confirmed cases worldwide, with 46.46% of the population having fallen ill in 89 Europe, 15.74% in the Americas, 33.86% in Asia and the Middle East, 23.96% in Oceania 90 and only 0.88% of people in Africa having contracted the disease. On the other hand, up 91 to 6,389,428 deaths due to coronavirus are known worldwide [9]". Is this as at May 2022 or August 2022? Specific timeline here should be included, please as the cases are changing.

The literature review may need to be improved upon a bit more by including more relevant papers that are related to this study, such as those on Scoping review or from Sustainability or IJERPH or CWEEE or related journals. This will help to increase the importance of this paper in the health sector. It will also increase the relevance, impact, viewability and citation of the paper.

At the last paragraph of Section 1 on Page 2 line 92, add signposting to tell what each section will be presenting in line 91-92. Such as: "Section 1 introduces the study, while Section 2 presents the materials and methods behind the investigation. Section 3 presents the results while section 4 presents the conclusions."

Section 1.1 is for two pandemics but most of the discussions are on one pandemic. Improve on it.

Check where hyphens were used unnecessarily, such as "..the amount of in-formation.." in Page 4 line 150;  "No re-strictions were..." in Page 6 line 215; "By ad-dressing this question, we can focus..." in line 178 Page 5;  "Syphilis and co-vid-19 are diseases..." in Page 14 line 628; "...to observe how a pandemic disease 635 in-teracts with other existing diseases." in Page 14 line 635-636.

In Section 3.1, authors could add an image of the surgeon and his apothecary as used in Line 314-316, and obtain permission where possible. This is used in Page 8 line 314-316 "In some monographic hospitals there is the figure of the surgeon and the apothecary. 314 During the 16th century, the physician measured the heart rate of the syphilitic patient 315 and analysed his urine. He would..."

Also, why use the pronoun "he" or "his" when the authors can state that "The doctor..." as in Page 8 line 314-316-318 " He would then dictate to the surgeon the cures to be performed 316 as well as the bleeding and shaving to be done. Another of his functions was to tell the 317 apothecary what medication to prepare.."

Add a section on Control of pandemics, and look at studies that worked on it, such as the following should be added:  https://doi.org/10.1108/JEDT-03-2021-0131;   https://doi.org/10.4236/cweee.2022.111003; https://doi.org/10.1016/j.pdisas.2020.100080; https://doi.org/10.1515/cclm-2020-0711; https://doi.org/10.1177%2F0748233720967522

Conclusion should be improved upon. Make it into one or two paragraphs, and add more. Which of the databases used had more publications on the search? What was specific trend observed in the study? In conclusion, state the highlights of this study. Are there limitations of this scoping review from the model presented? Can you add that in conclusion section.                   

Reviewer 3 Report

Thank you for the opportunity to read this interesting paper. I was intrigued by your idea to compare two very different diseases which have impacted human history in very different ways.

Your use of English is good, but the manuscript would benefit from competent editing by a native English speaker. Many of your words are used inappropriately or oddly, which detracts from the readability of your work. There are also quite a few typos, such as in line 254 on p6 - I believe you mean "plagiarism" not "plagium", or line 289 on page 7 "...with one French magazine even reading the headline..." Or line 324, "...where the GP after an anamnesis, indicates to carry out the relevant tests..." It is not entirely incoherent, but it is jarring and not clearly written due to the inappropriate use of certain words.

There are many other issues with grammar, such as in line 325, why is the GP referred to as "he or she" while in line 327, the public health nurse is referred to as "she". The authors need to choose one method of pronoun usage and be consistent.

And meanings are often unclear:;to wit, in lines 320-323, do the authors really mean that in the 1970s, people were offered housing and food in exchange for caring for syphilis sufferers?

In lines 296-299, the authors describe health care professionals being the targeted victims of violence. This is somewhat confused and conflated with violence against those who refused to wear masks (presumably not the health professionals) and ignores the fact that many people praised and lionized health care professionals for being on the front lines. I was expecting, but did not see, comments about clinicians who chose not to be vaccinated getting discriminated against by licensure authorities and employers who required it for continuing to practice. This seems an odd omission.

In line 359, "impressive" is an odd choice of words. The authors do not seem to appreciate the potential negatives in regulatory authorities approving medications without significant evidence.  Line 363 also needs work: "...bioethics made sense at a calamitous time..."  as its meaning is not clear.

The graphic between lines 438/439 is backwards - showing progression but going backward in time??

The discussion on telemedicine (lines 582-591) is very parochial, being limited to Spain and is quite basic in its managing of the numerous issues.

In discussions of COVID 19 treatments, why is Paxlovid not mentioned?

Lines 617-618: the authors include no other reasons for why during a global pandemic reporting of other illnesses may have decreased, other than that incidence is down??

You provided competent historical and scientific descriptions of both diseases, but the paper's purpose suffers from a lack of clarity. Is this meant to be a clinical monograph on the two diseases? A historical comparison? A sociological treatise on how different centuries react to pandemics? It seems to be all of these things in different places, but it lacks a coherent and unifying thread.

I found your conclusions disappointing, as many of the statements are trite and basic: "health professionals are valuable", "there is a lot of work to be done", "we must continue to invest in drugs", "governments have the final say"... However, you do not explore even one of these statements and point out the challenges or complexities involved in them. For example, governments may have the final say, but what do you do when policy decisions are hampered by political agendas (as with early Chinese attempts to deny the virus' existence out of fear of backlash) or lack of knowledge  (as with many American policymakers being lawyers with a poor understanding of biology and chemistry)? You did not even acknowledge the difficulties inherent with these ideas, merely trotting out the platitudes.

I think you would be better served if you re-edit the manuscript (with the assistance of a skilled English-language editor) with a clear goal for it in mind. The novelty of the work lies in its comparison of two very different diseases, so I would limit the scientific description of the two (eg going into the Jaricsh-Herxheimer reaction, itemizing different treatments) and focus more on the historical and sociological similarities AND DIFFERENCES of the two.

Thank you again for sharing this work.