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Multimorbidity, which is defined as the co-occurrence of two or more chronic conditions, has moved onto the priority agenda for many health policymakers and healthcare providers. Patients with multimorbidity are high utilizers of healthcare resources and are some of the most costly and difficult-to-treat patients in Europe. Preventing and improving the way multimorbidity is managed is now a key priority for many countries, and work is at last underway to develop more sustainable models of care. Unfortunately, this effort is being hampered by a lack of basic knowledge about the aetiology, epidemiology, and risk factors for multimorbidity, and the efficacy and cost-effectiveness of different interventions. The European Commission recognizes the need for reform in this area and has committed to raising awareness of multimorbidity, encouraging innovation, optimizing the use of existing resources, and coordinating the efforts of different stakeholders across the European Union. Many countries have now incorporated multimorbidity into their own healthcare strategies and are working to strengthen their prevention efforts and develop more integrated models of care. Although there is some evidence that integrated care for people with multimorbidity can create efficiency gains and improve health outcomes, the evidence is limited, and may only be applicable to high-income countries with relatively strong and well-resourced health systems. In low- to middle-income countries, which are facing the double burden of infectious and chronic diseases, integration of care will require capacity building, better quality services, and a stronger evidence base.

The European Union has gradually developed a consistent and integrated policy framework to respond to common challenges in the field of health that combines legislation, cooperation and financing: the EU Health Strategy “Together for Health”. The economic crisis compounded the existing challenges stemming from changes in demographics and patterns of disease, technological change, as well as major threats to health. It put an additional strain on the sustainability of health systems and raised the urgency to channel EU efforts towards economic recovery and growth as outlined in the Europe 2020 strategy. Acknowledging this new environment, on 20 February 2013 the European Commission adopted a policy framework more closely linking EU social and health policies to Europe 2020: the Social Investment Package (SIP) including a document dedicated to ”Investing in Health”. This paper extends the EU Health Strategy by reinforcing its key objectives, firmly anchors health in the Europe 2020 policy framework and reaffirms that health is a value in itself and health spending is a growth friendly expenditure. A healthy population and sustainable health systems are decisive for economic growth. Investing in sustainable health systems means that cost-effective spending, structural reforms and sound innovation can bring efficiency gains and secure better health outcomes. Investing in people’s health also boosts economic growth by enabling individuals to remain active longer and in better health. Finally, investing in health requires reducing health inequalities to break the vicious spiral of poor health contributing to, and resulting from, poverty and exclusion.

Abstract The coronavirus disease (COVID-19) caused by SARS-CoV-2 is creating tremendous health problems and economical challenges for mankind. To date, no effective drug is available to directly treat the disease and prevent virus spreading. In a search for a drug against COVID-19, we have performed a massive X-ray crystallographic screen of two repurposing drug libraries against the SARS-CoV-2 main protease (Mpro), which is essential for the virus replication and, thus, a potent drug target. In contrast to commonly applied X-ray fragment screening experiments with molecules of low complexity, our screen tested already approved drugs and drugs in clinical trials. From the three-dimensional protein structures, we identified 37 compounds binding to Mpro. In subsequent cell-based viral reduction assays, one peptidomimetic and five non-peptidic compounds showed antiviral activity at non-toxic concentrations. We identified two allosteric binding sites representing attractive targets for drug development against SARS-CoV-2. Competing Interest Statement The authors have declared no competing interest.

Here we present the crystal structure of SARS-CoV-2 main protease (Mpro) covalently bound to 2-methyl-1-tetralone. This complex was obtained by co-crystallization of Mpro with HEAT (2-(((4-hydroxyphenethyl)amino)methyl)-3,4-dihydronaphthalen-1(2H)-one) in the framework of a large X-ray crystallographic screening project of Mpro against a drug repurposing library, consisting of 5632 approved drugs or compounds in clinical phase trials. Further investigations showed that HEAT is cleaved by Mpro in an E1cB-like reaction mechanism into 2-methylene-1-tetralone and tyramine. The catalytic Cys145 subsequently binds covalently in a Michael addition to the methylene carbon atom of 2-methylene-1-tetralone. According to this postulated model HEAT is acting in a pro-drug-like fashion. It is metabolized by Mpro, followed by covalent binding of one metabolite to the active site. The structure of the covalent adduct elucidated in this study opens up a new path for developing non-peptidic inhibitors. Competing Interest Statement The authors have declared no competing interest. Footnotes * https://www.rcsb.org/structure/6YNQ