Three areas in the same region of northwest Peloponnesos, Greece, that had varying concentrations of manganese (Mn) in drinking water were selected for study. The Mn concentrations in areas A, B, and C were 3.6–14.6 μg/I, 81.6–252.6 μg/I, and 1 800–2 300 μg/I, respectively. A random sample (62 in area A, 49 in area B, and 77 in area C) of males and females who were at least 50 y of age were submitted to a thorough neurological examination and their whole-blood Mn and hair Mn concentrations were determined. Although all areas were similar with respect to social and dietary characteristics, significant differences were observed for prevalence of chronic manganese poisoning (CMnP) symptoms and hair Mn concentration. The means (both sexes) of neurological scores were 2.7, 3.9, and 5.2, respectively, for areas A, B, and C (Kruskal-Wallis, X ² = 6.44, 2 df, p < .05 for males; X ² = 7.78, 2 df, p < .05 for females). Hair Mn concentrations were also significantly different, the means for which were 3.51, 4.49, and 10.99 μg/g dry weight, respectively (both sexes [p < .001 for each sex separately]). These results indicate that progressive increases of Mn concentration in drinking water are associated with progressively higher prevalences of neurological signs of CMnP and Mn concentration in hair of older persons.

• The COVID-19 pandemic has challenged the healthcare capacity of many countries. • Strict, horizontal lockdowns have adverse social, economic and health effects that have not been fully considered. • Primary and community care have multiple roles in COVID-19 pandemic mitigation. • Greece is a case example of a country which neglected primary and community care, and in November 2020 implemented a second horizontal lockdown. • Primary and community care, represents the only realistic strategy for successful COVID-19 pandemic mitigation in the long-term.