Coronavirus may never go away,
even with a vaccine
Embracing that reality
is crucial to the next phase of America’s pandemic response, experts say.
By
May
27, 2020 at 10:15 p.m. GMT+3
Even after a vaccine is
discovered and deployed, the coronavirus will likely remain for decades to
come, circulating among the world’s population.
Experts call such diseases
endemic — stubbornly resisting efforts to stamp them out. Think measles, HIV, chickenpox.
AD
For now, though, most
people have not been infected and remain susceptible. And the highly
transmissible disease has surged in recent weeks even in countries that
initially succeeded in suppressing it. Left alone, experts say, it will simply
keep burning through the world’s population.
“This virus is here to
stay,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the
University of Chicago. “The question is, how do we live with it safely?”
AD
Meanwhile, some states
are rushing headlong into
reopening their economies. Even those moving more cautiously haven’t developed
tools to measure what’s working and what isn’t — a crucial feature for any
prolonged scientific experiment.
AD
People keep talking of
returning to normal, said Natalie Dean, a disease biostatistician at the
University of Florida. But a future with an enduring coronavirus means that
normal no longer exists. “As we find different ways to adapt and discover what
works, that’s how we’re going to start reclaiming parts of our society and life,”
she said.
An urgent intermission
America now finds itself in
a moment of transition. Infections are declining in some states, even as
they rise in others with
worrisome emerging hotspots.
AD
Arriving at this moment of
transition required countrywide shutdowns, soaring unemployment and devastating
blows to our economy and mental health.
All that effort was supposed to buy us time to think, plan and prepare, said
Irwin Redlener, director of Columbia University’s National Center for Disaster
Preparedness.
“What’s concerning is that
I don’t see any signs the federal government has learned any lessons and is
doing anything differently to prepare for the next waves,” he said.
Leaders desperately need to
shift their response from short-term crisis management to long-term solutions,
he and other experts say.
Communities should be
thinking about installing doors that don’t require grasping a handle, and
re-engineering traffic signals so pedestrians don’t have to push crosswalk
buttons, said Eleanor J. Murray, an epidemiologist at Boston University.
AD
More immediately, states
should be using this time to craft quick-response systems and protocols. With
hundreds of cities and counties reopening, think of each as a mini laboratory
yielding valuable data on what will work against the virus in coming years. But
most still lack the tools to capture that data, said Cobey, the University of
Chicago epidemiologist, whose models have been used by Illinois leaders.
The metrics being employed
by states remain crude: daily number of deaths, hospitalization rates and
confirmations of cases long after people show symptoms. All lag behind the
actual transmission of the coronavirus by at least one to three weeks.
AD
What’s needed are more
sophisticated testing strategies, say experts, that could serve as canaries in
the coal mine — increasing our speed and ability to detect surges in the virus.
States could select certain populations or areas to test extensively. They
could establish a handful of sites that test only patients who have developed
symptoms in the last four days, to increase sensitivity to sudden increases in
transmission.
“You need testing
strategies that allow you to put on brakes quickly enough to stop surges,” said
Cobey, who has pleaded with state leaders to implement such strategies.
Another idea researchers
have proposed is universally testing pregnant women to measure the asymptomatic
spread of the virus — among people who have been infected but don’t show
symptoms. The women could be an ideal sample testing population because they
already visit hospitals for delivery and maternity checkups.
AD
One hospital in New
York tested every pregnant woman who
came in to deliver and found 15 percent had the coronavirus. Most of those
testing positive — 88 percent — showed no symptoms, a sign of how crucial such
testing could be.
Living long-term with the
virus also means addressing the mental health effects.
There’s an assumption among many leaders, experts say, that increases in depression and anxiety are
a temporary problem that will eventually disappear along with the virus.
But for some people, the
trauma, fear and stress will accumulate and fester like a wound if left
unaddressed, said Paul Gionfriddo, president of the advocacy group Mental
Health America. “The psychological recovery is going to be as important as
economic and logistical parts of this.”
‘Prevention always sounds easy’
America’s yearning for a
quick fix has turned in recent days toward a vaccine, now being portrayed as a
solution that will quash the virus once and for all.
AD
But the world has achieved
that only once, with smallpox — a measure of just how difficult it is for
vaccines to wipe out diseases. And it took nearly two centuries after the discovery of a
vaccine — and an unprecedented international effort — to vanquish smallpox,
which stole hundreds of millions of lives.
Eventually, many experts
believe this coronavirus could become relatively benign, causing milder
infections as our immune systems develop a memory of responses to
it through previous infection or vaccination. But that process could take
years, said Andrew Noymer, a University of California at Irvine epidemiologist.
Barney Graham, deputy
director of the federal government’s Vaccine Research Center, said emerging
plans for vaccination are already stretching as far out as a decade.
“I’m thinking about things
in different stages or eras,” Graham said. “We had a discussion this morning
about what can be ready before this winter of 2021, what could be ready for
2021-2022, and what kind of regimen or vaccine concepts would we want after
this has settled into a more seasonal virus.”
The success of those
vaccines will hinge on distribution — a complicated, logistically fraught
process.
In the first few years of a
vaccine, global demand will far outstrip what
manufacturers are able to supply. Roughly 60 to 80 percent of the world’s
population needs to be inoculated to reach herd immunity — that point when
enough people have become resistant to a virus that it has difficulty spreading
widely. Without international agreements worked out beforehand, the short
supply could devolve into bidding wars, hoarding and ineffective vaccination
campaigns.
In the United States, the
crucial job of distribution will depend on federal and local health
departments, which have already shown signs of limited capacity and competence
amid this pandemic. As a preview to the chaos that might ensue, the U.S.
government’s rollout of the first and only treatment for covid-19, remdesivir,
has been described by hospitals as confusing, unfair and
lacking transparency.
“We also assume that
everyone will want the vaccine because of the devastation this virus has
caused, but that’s a big assumption,” said Howard Koh, a top U.S. health
official during the 2009 H1N1 flu pandemic. “Prevention always sounds easy, but
it’s not.”
America already has
vaccines for measles and the seasonal flu, which can be deadly. And yet the
health-care system struggles every year to convince people to
get those shots.
Looking further down the
road, many top experts believe it’s critical that U.S. leaders start planning
for the next pandemic now — even as they contend with this one — because of the
short attention span and lack of political and public support for preparedness
the country has shown in past decades.
“We’ve seen this story so
many times before,” Koh said. “As soon as the crisis is over, people will go
back to whatever is the new normal and they will move on.”
Our future selves
The struggle to get people
to think long-term, of course, is not new to public health.
We know that smoking can
kill us. Yet, it is still responsible for 1 of every 5 deaths in the United
States.
“The problem is people
putting the present ahead of the future,” said Frieden, who led the CDC from
2009 to 2017.
To bridge the divide
between present and future, the CDC launched an ad campaign during Frieden’s
tenure with former smokers showing in graphic, intimate detail the consequences of
lighting up: the removal of their jaw.
Having to speak through an electronic voice box. The emotional devastation to
their families.
The campaign caused more
than 16.4 million people to
try to quit smoking between 2012 and 2018 and about 1 million to quit for good,
the CDC estimates. “We found a way to show them their future selves,” Frieden
said.
The challenge in this
pandemic is few such shortcuts remain to push U.S. leaders and the public into
forward-thinking actions. The CDC has been sidelined by the White House
and blocked from holding public
briefings. Meanwhile, the Trump administration has made clear its
priority is restarting the economy.
Increasingly, leading
experts believe many Americans won’t make the shift toward long-range thinking
until the virus spreads more widely and affects someone they know.
“It’s like people who drive
too fast. They come upon the scene of an accident, and for a little while, they
drive more carefully, but soon they’re back to speeding again,” said Michael T.
Osterholm, director of the University of Minnesota’s Center for Infectious
Disease Research and Policy.
“Contrast that with people
who have lost someone to drunk driving,” he said. “It mobilizes them and
becomes a cause for them. Eventually, everyone is going to know someone who got
infected or died from this virus.
“That’s what it may take.”
The
Washington Post is providing some coronavirus coverage free, including:
No comments:
Post a Comment