Hopefully we are drawing to a close of the Covid-19 pandemic or at least getting it under better control although the recent rioting the country has experienced may be leading to a new wave of infections far worse than the resurgence that was previously predicted. Nonetheless, the pandemic seems to have slowed down a bit for now so now may be the time to reflect on the state of the pandemic and some lessons that we may have learned.
First, it is clear that we were by no means well enough prepared for an event such as this. We had had warnings that something like this might happen, but we failed to recognize the warning signs. SARS, MERS and the H1N1 viruses were the warning signs that a worse virus was likely to occur at some point in the future, and it did so in the form of SARS-CoV-2.
The orginal SARS (severe acute respiratory syndrome) broke out in 2002. SARS first affected people in southern China, but it eventually spread to 29 countries. It apparently started in animals, but then spread to humans. There were at least 8,000 cases world wide, and it killed about 800 people giving it a death rate of about 10%. The SARS virus is very similar to the current SARS-CoV-2 virus which causes the illness that we now call Covid-19, but by 2003 there were only 8 laboratory confirmed SARS cases in the US. H1N1, otherwise known as the swine flu, is a different type of virus more closely related to the influenza virus. Between 2009 and 2010 it caused 60.8 million infections in the US and 12,469 deaths. Another coronavirus (MERS-Cov virus) first reported in Saudi Arabia in 2012 also caused a severe respiratory illness known as the Middle Eastern Respiratory Syndrome with (MERS). Only two people in the US have been know to come down with this virus and both survived.
The U.S. should take Covid-19 as a warning and start preparing for the next pandemic as soon as possible. There are many reasons why this is likely to occur. Spontaneous mutations of the Sars-CoV-2 virus and introduction of new viruses from the wild into human populations are just a couple of reasons why this might happen. Given the interconnectivity of people traveling throughout the world, the spread of a new contagious virus in a pandemic fashion is very likely to occur. Shi Zhengli, a Chinese virologist, has warned that we are now dealing with the “tip of the iceberg” when it comes to impending viral epidemics.
This should tell us that we need to expand work on antiviral agents that will have as broad a spectrum as possible in terms of antiviral coverage especially since vaccines take a long time to develop and are not effective once the virus has taken hold in a patient. Think of vaccines as preventive treatments, but treatments that may need to be changed frequently since the vaccines are often very type specific. We also need to develop better pharmacologic agents that will block entry of the virus into the cell so that it does not have a chance to propagate within the cell, and treatments that interfere with the replication of the virus if it indeed manages to enter the cell. Furthermore, we need to work on developing treatments for effects that the virus has on the body if it manages to enter the cells and replicate. This is what triggers intense inflammatory reactions such as the “cytokine storm” and “the multisystem inflammatory syndrome.” So from a patient management point of view we need to work on three things: better antiviral agents with a broad spectrum of coverage; the ability to adapt manufacturing processes for vaccines quickly because the virus will change and new ones will appear; better regimens for treatment of the effects of the virus once it enters the body. Of course all of the above has to be achieved in such a way that we are never dependent on a foreign country, much less a potential adversary, to supply us with the medicines, vaccines or anything else needed for us to treat another pandemic.
We learned that social distancing, as controversial as it may be, likely had great impact on the mitigating the spread of Covid-19, and it is a practice that in all likelihood should be implemented again quickly as soon as the next pandemic arises. The current pandemic showed us that certain areas of the country were more impacted than others for a variety of reasons that we are still being investigated.
Very importantly this pandemic was also a lesson in logistics that should not be forgotten, and it goes hand in hand with the evidence that not all parts of the country were similarly affected by this virus. There has to be mobility in terms of the delivery of healthcare in any crisis situation we may face in the future so that we can deliver medical personnel, equipment and medications where they are needed. This includes the ability to to get mobile hospitals up and running anywhere in the country they may be needed. We demonstrated some of that capability when the Javits Center in New York was converted into a hospital, the hospital ship Comfort arrived in New York and Samaritan’s Purse set up camp in Central Park to help out with the hospital bed shortage. However, for reasons that are as yet puzzling and distressful, none of these facilities was used effectively in terms of terms of relieving the overwhelming burden of the those city hospitals that were inundated with Covid-19 patients. For future medical catastrophes, which are sure to come, we need to be able get mobile hospitals up and running quickly wherever they may be needed.