It had been 100 years since the 1918 influenza pandemic, and researchers knew it was only a matter of time until another deadly disease arrived. Even before 2020, Dr. Helen Chu was worried.
“Another pandemic was inevitable,” says Chu, pointing to Ebola and avian flu as examples. “We had seen an acceleration of different pathogens coming through, accelerating because of global travel.” Chu is an associate professor at the University of Washington’s schools of medicine and public health and part of a team of investigators thinking about potential pandemics.
“The recipe is there, with a human-animal interface, the fact that people are traveling from place to place very quickly, and based on what’s happened in recent history,” she says.
At the time, the team realized the need for better disease surveillance at the lab and community levels. Better genomic sequencing could demonstrate in real time how the virus mutated as it spread within the community.
The COVID-19 pandemic has exerted a brutal toll, but also provided opportunities to deploy that genomic sequencing, along with community testing and surveillance, vaccines and other approaches. The experience has helped advance some techniques in preparation for the next big storm — and highlighted areas for improvement along with mysterious facets we don’t yet understand.
The pace of novel viruses being discovered has only accelerated in the past 20-40 years, Chu notes. The 2022 monkeypox outbreak is a recent example of a human-animal disease able to infect continents rapidly, assisted by international travel. “It is coming, but we are better prepared than we were in the past,” Chu says. “Substantially better prepared.”
Learning and lessons
Newer mRNA vaccines deployed during COVID-19 are proving effective at preventing severe disease in the broader population, Chu says. Technical feats addressed the timeline of disease arrival, genomic sequencing, and vaccine development. Widespread vaccine and treatment deployments reduced deaths. These processes and applications can potentially be used in future outbreaks.
In addition, advances in home testing offer rapid results without waiting in long lines. It’s a “game-changer,” Chu says. Knowing your infection status changes behavior, she says. If you get a positive test before going to a party, staying home can help stop the spread. “It’s technology can be applied to other pathogens, moving forward.”
The development of monoclonal antibody therapy is another “amazing” development with promise for the future, Chu says. Monoclonal treatment relies on “the ability to draw a blood sample from the individual and turn it into a therapeutic, within months.”
Simple behavioral approaches also offer promise, Chu says. From the current pandemic, we’ve learned that masking works and what steps can slow a pandemic’s spread. Businesses and schools’ preparedness plans have reduced transmission risk using clear and timely communication, social distancing, and masking, which could be extended for the next pandemic, says Dr. Molly McNairy, an associate professor at Weill Cornell center global health and attending physician at New York-Presbyterian Hospital in New York City.
“Whatever companies can do to build that now that can be used and again and again,” McNairy says. “Without it, you go back to shutting everything down, which nobody wants to do.” McNairy feels that the workplace safety and wellness industry will grow over the next 2 to 5 years.
Some changes may stay in place long term. For example, masking in hospitals has been shown to reduce flu transmission and deaths, Chu notes, particularly in the very vulnerable.
Mysteries and inequities
Researchers are still working to unravel some challenges. For example, what’s termed “long COVID” can cause debilitating, long-term illness, with symptoms that persist beyond 30 to 60 days, Chu says. Experts know little about the numbers affected and why some get sick while others don’t.
Chu says that untangling long covid’s triggers is a top concern at the moment. Vaccines can reduce long COVID-19 risk, but breakthrough infections still occur, and vaccines aren’t completely protective against long covid.
While effective in the past, it’s unclear how effective vaccines will be against newer variants, and boosters may be required. Parents of children under age 5 have also been waiting a long time to protect their children with the vaccine. “We know it’s pretty effective,” Chu says of the vaccine, leading to high protective antibody titers.
Policymakers and healthcare providers may also play a role. The pandemic revealed enormous gulfs in access to healthcare, particularly among people of color, says McNairy. McNairy has provided international pandemic care, working with patients coping with HIV, cholera, and Covid. She’s also a consultant on pandemic-related workplace safety, risk reduction and outbreak preparedness.
“A lot of Americans, particularly vulnerable communities and people of color, don’t have access to affordable health care,” McNairy says. The path forward also requires more community partnerships around messaging and developing trust with individual patients, McNairy says. “It points to a larger crisis in America of social and racial health disparities that are not necessarily getting better,” she says.
Unfortunately, public health messaging has been impacted by politics, and some populations don’t trust data as a result. Some top-level messaging from institutions such as the CDC has been unclear, such as around masking guidance, Chu says.
New approaches
Due to the severity and rapidity of emerging infectious diseases, McNairy says that a timely, transparent warning system — much like a hurricane or severe weather surveillance system could help everyone respond faster to outbreaks.
With hurricanes, “we give you a warning and alert to take individual risk reduction,” she explains. “Board your house and windows, move inland, and then there are population-level interventions if the risk rises such as evacuation of communities to safer ground. We don’t have that set up nationally yet for COVID and pandemics coming down the line. Everyone is working on how we can do surveillance better.”
The first step is to capture risk and community transmission data accurately and rapidly, similarly to the U.K. and Israel — both have national data systems to collect that data, Chu points out. The system could then broadcast how long until the virus arrives, how much transmission might occur, and preventive measures to be taken at the personal and community-wide level, depending on severity, Chu says. The community could then switch to masking and other protective measures.
It may be necessary sooner than later. “These are lessons that we’ve learned in this pandemic that make us much, much better prepared for next time, so we can use those tools we have,” Chu says. “This is not over, but we are better prepared for what is to come, and things are only going to get better, not they’re not going to get worse. Fingers crossed.”
Since 1975 The M.J. Murdock Charitable Trust has sought to strengthen the educational, social, spiritual and cultural base of the Pacific Northwest by investing in innovative and sustainable work.