Why weren’t we ready?

For years, experts had been warning us that there could be a global pandemic. Then, one happened. Why weren’t we better prepared to handle it? What things should we be doing to get out of the current situation? How should we be getting ready for the next pandemic?

Global PandemicNot too long ago, many scientists believed that fearsome infections could be a thing of the past. With the invention of antibiotics and vaccines, outbreaks of diseases, like polio and measles, were reduced dramatically. One of the best examples is smallpox, which was eradicated in 1980. However, a new generation of viruses, like HIV and Ebola, began to emerge in the late 1970s and early 1980s. In 1992, a report from the United States Institute of Medicine committee advised that infectious diseases were evolving and posed a global threat. Since then, dangerous outbreaks have been on the rise around the world with the number of new diseases per decade increasing nearly fourfold over the past 60 years and the number of outbreaks per year has more than tripled since 1980. According to study data from Brown University researchers, 2010 had more than six times the outbreaks of pathogens from animal origins than in 1980. In the last century, new viruses keep arising and moving through a population, but eventually dying out. For years, prominent scientists have warned that pandemics, similar to the 1918 flu pandemic that killed between 50 -100 million people, would happen again. Since the human population has more than quadrupled since the 1918 flu pandemic, this is very concerning. Some scientists were writing about this in their work and it was published in science journalists. Others were writing books about the topic, some of which were huge bestsellers. Regardless of where they were published, all of them describe the same dire scenarios. All of a sudden, hypotheticals became a reality and “what if?” became “now what?” with the arrival of COVID-19, which has the perfect mixture of transmissibility and lethality to cause rapid, worldwide spread. Despite the warnings, many places were inadequately prepared to deal with the virus. Why weren’t all of these warnings enough?

History of Pandemic Concerns
The idea of another pandemic similar to the 1918 flu started to come to light in the mid-1980s when Dr. Edwin Kilbourne, a leading influenza vaccine researcher at the Mount Sinai School of Medicine, imagined a virus that had all the qualities that would make it most contagious, most lethal, and almost impossible to control. Dr. Kilbourne referred to this as a “maximally malignant (mutant) virus,” or MMMV. In his view, it would have the environmental stability of poliovirus, the high mutation rate of influenza virus, the unrestricted host range of rabies virus, and the long latency potential of herpes virus. In addition, this super virus would be transmitted through the air and replicate in the lower respiratory tract, like influenza, but it would insert its genes directly into the host’s nucleus, like HIV. The point he was trying to demonstrate was that viruses with “only a few changes can make a huge difference in the way the microbes behave, trying to predict the paths of evolution and emergence can be a treacherous affair indeed.” While the novel coronavirus isn’t an MMMV, it does have a lot of its scariest properties, like being transmitted through the air, lasting days on countertops, and replicating in the lower respiratory tract. Furthermore, people can have mild or asymptomatic cases, which means that even though they are infectious, they feel healthy enough to walk around spreading the virus.

By 1990, the term “emerging viruses” had been devised by a young virologist named Stephen Morse. Experts were detecting conditions that could lead to new, potentially devastating pathogens. Some of these items were climate change, massive urbanization, and the proximity of humans to farm or forest animals that serve as viral reservoirs. Also, the worldwide spread of these microbes could be accelerated by war, the global economy, and international air travel. Another concern was the genetic-engineering tools that have made it easier for terrorist groups or lone madmen to unleash custom-designed killer germs. The primary focus was on influenza and its cousins. The fact the public was informed that this where the threat could come from might have been a mistake because the flu was something that they experienced or got vaccinate against every year. Then, in 1997, a new strain of the flu virus emerged, H5N1. It crossed over from chickens to humans, so it became known as the bird flu. Thankfully, it turned out the virus wasn’t able to spread easily between people, so only 18 people were infected and six died before it disappeared. As a result of this outbreak, the World Health Organization (WHO) started creating protocols for a large-scale outbreak for the first time.

Toward the end of 2002, a mysterious and deadly new pneumonia began ravaging southern China and spreading to Toronto, Singapore, and a few other cities. It was caused by a lethal coronavirus that also made the transition from animals to humans. The disease would be named Severe Acute Respiratory Syndrome (SARS), and it changed much of the world’s thinking about epidemics. The reason the title SARS was chosen was to eliminate stigma. Viruses that were discovered earlier were named by geographical association, such as Ebola (a river Africa), Marburg (a city in Germany), Nipah (a Malaysian village), and Hendra (an Australian suburb). The official name of the virus was sars-CoV; however, it was recently switched sars-CoV-1, so that the virus behind COVID-19 could be labeled sars-CoV-2. At the time SARS emerged, coronaviruses were thought to be a pathogen so insignificant that it didn’t get a chapter in the Manual of Clinical Microbiology. SARS not only spread more easily via respiratory droplets and widespread than the 1997 flu, but it also showed that viruses could traverse the globe by plane in hours, which makes a local epidemic much more dangerous. Initially, China covered up the extent of the outbreak, making it hard for scientists to investigate. As a result, they received criticism from the WHO and other public health agencies around the world. The Chinese government changed leadership, who reversed course, which enabled them to get the outbreak under control. They did this by implementing firm measures, like closing schools, providing all healthcare personnel with personal protective equipment (PPE), contact tracing, and quarantining anyone who had come into contact with an infected individual. If you didn’t follow the quarantine, an electronic tracer (ex. ankle bracelet) was attached to you. Some people didn’t follow the quarantine orders, so the government started issuing significant fines with the possibility of jail time. For travelers, it didn’t matter if you were arriving by bus, plane, or automobile, you got screened. The government even went so far as to fine people for spitting. All of these measures worked because by May 2003, the number of new SARS cases was dwindling and by mid-July, there were no more cases. When all was said and done, it infected around 8,000 people worldwide, killing nearly 10% of the people infected. Afterward, China expanded epidemiologist training and increased budgets for new laboratories. Additionally, it started working more closely in public health with the US Center for Disease Control and Prevention (CDC).

A year later, in 2004, the H5N1 virus resurfaced in poultry flocks across Southeast Asia, resulting in more than 40 human infections and killing nearly 70% of the people it infected. In 2005, President George W. Bush had read “The Great Influenza,” which was a history of the 1918 flu, which covered the social and economic devastation a pandemic could cause. Up until then, Washington had spent billions of dollars on measures to protect Americans against smallpox, anthrax, and other biological threats due to 9/11 and the subsequent anthrax attacks. That changed in October 2005, President Bush met with a group of 10 or so officials and said, “I want to see a plan” for pandemic preparedness. By the end of the month, health leaders had put together a 12-page strategy, which included stockpiling vaccines and antiviral drugs, expanding outbreak detection, and otherwise improving pandemic responses. The plan was launched in November and Congress approved $6.1 billion in one-time funding. The CDC started enacting pandemic scenarios and expanded research. Also, the government created the Biomedical Advanced Research and Development Authority to help fund companies to develop diagnostics, drugs, and vaccines. A different team of researchers went through archives of the 1918 pandemic to design guidelines for mitigating the spread of a pathogen when vaccines aren’t available. These tactics now sound very familiar—social distancing, canceling large public gatherings, and closing schools. A year later, a progress report stated that there was a need for more real-time disease surveillance and preparations for a medical surge to care for large numbers of patients, and stressed strong, coordinated federal planning. Most of the $6.1 billion Congress appropriated for the plan was spent to make and stockpile medicines and flu vaccines and to train public-health department staff. Unfortunately, the money wasn’t renewed and over the next several years, governments in the US and elsewhere were constantly on the defensive from global viral outbreaks.

Despite what had happened in the past, even the last few years, the idea that an unknown virus might come from an animal cross into humans that would then evolve into person-to-person transmission and causing a global pandemic, seemed a distant prospect in 2006. For some, it appeared to be an engaging science-fiction scare. However, the National Center for Zoonotic, Vector-Borne, and Enteric Diseases, part of the CDC, was tasked with envisioning what this could look like. Viruses that can move from animals to people are known as zoonotic, with three-quarters of the new diseases afflicting humans since 1960 having come from animals. The cross from animals to humans is called spillover and while they’ve always occurred, the rapid environmental change wreaked by humans in recent years has accelerated the spread. Since human immune systems haven’t “seen” the virus before, it causes havoc. This also means they emerge unpredictably and are challenging to treat. Considering that nearly all the new infectious diseases originate in animals means we should be studying and planning for this to happen since we can only know which vulnerabilities to mitigate based on whether we’ve appropriately planned for the scenario. Once this is known, political support will need to be garnered to ensure the dedicate the resources necessary to address them.

However, in early 2009, we still weren’t prepared when a new strain of the H1N1 influenza virus (the one that caused the 1918 pandemic) appeared and seemed to be a mix of pig, bird and human viruses, so it was referred to as the swine flu. It was showing up in multiple locations and rapidly spreading from person to person. This caused an emergency response center to be formed in the US and the WHO started implementing its pandemic influenza preparedness plan. For the first time, the action plan created by President Bush’s administration was put into place (under President Obama). By mid-June, swine flu was in 74 countries and the WHO declared it a pandemic. In August, scientific advisers issued a scenario in which as many as 120 million Americans, 40% of the population, could be infected, and up to 90,000 people could die. Thankfully, H1N1 turned out to be much milder affecting just over 60 million Americans and killing less than 13,000. Due to this, the WHO took some heat for calling the outbreak a pandemic too soon. At the start of the pandemic, researchers started to work on developing a vaccine, but it took so long to manufacture that the virus was fading by the time it was finally ready.

A new coronavirus came on the scene in 2012. This one was dubbed Middle Eastern Respiratory Syndrome (MERS) because it first appeared in the Middle East. It was determined to be passed to humans from camels, which is why some called it the camel flu. It killed about 34% of those it infected, yet turned out to be relatively hard to spread, so it infected only about 2,500 people over several years.

In 2013, a virologist at the Wuhan Institute of Virology, Dr. Zheng-Li Shi, co-wrote a paper that was published in the journal Nature, which discussed how some bat-borne coronaviruses succeed in infecting humans. According to her research, the virus’ spike proteins (the knobby projections that give each viral particle its corona-like appearance) attach to receptors on specific cells in the human respiratory tract, known as ace-2 receptors, allowing viral penetration of the cell. Once inside, the virus takes control of some of the cell’s mechanisms to make copies of itself. The findings came from Shi and her team investigating a cave on the outskirts of Kunming, the capital of Yunnan Province. They took samples of bodily fluids from bats that used the cave as a roost. They discovered a great diversity of coronaviruses, including three that had the spike proteins capable of adhering to ace-2 receptors.

When 2014 rolled around, it brought a threat that caused panic across the globe…Ebola. While not a new virus, the outbreak was spreading rapidly among people and regions in March. It took the WHO until August to raise an international alarm and by then, the epidemic was raging. This flareup has become the most massive Ebola epidemic in history, with at least 28,600 people infected and more than 11,300 dead in 10 countries. The occurrence highlighted the consequences of an underfunded, patchwork approach to global health. The United Nations stepped in to create a special Ebola response mission, which is generally managed by the WHO. President Obama sent the US military to Liberia to provide aid. Congress passed a $5.4 billion package in supplemental funds over five years. The influx of money, along with aggressive contact tracing and other steps, helped to stop the epidemic, though it took until mid-2016. As a result, global health experts and authorities called for changes at the WHO to strengthen epidemic response, and it created an emergencies program. The US National Security Council warned that globalization and population growth “will lead to more pandemics” and recommended the US do more to help other countries prepare, which resulted in the CDC, Department of Defense, USAID and other US agencies deciding that they would use their expertise to help other nations improve disease surveillance, build better laboratories and train epidemiologists. Since emerging disease threats were growing, and more than 80% of the world’s countries haven’t met a 2012 International Health Regulations deadline that would allow them to detect and respond to epidemics, this was sorely needed. It also led to the formation of the Global Health Security Agenda, which is launched by the US, WHO, and about 30 partners. The problem was the US was recovering from the 2008-09 financial crisis, which caused public health departments to cut thousands of jobs and outdated data systems weren’t replaced.

In 2015, MERS wound up in South Korea. While super-spreader events, where one person infects multiple people, was the push behind this outbreak, the problem was exacerbated by aspects of South Korea’s healthcare system. Citizens get cheap medical care through a national insurance plan. This plan has few restrictions on which hospital they visit, so people often shop for treatment, which led to widespread transmission. Another virus arrived this year, Zika. This one materialized in the Americas and caused neurological problems for unborn infants. The CDC requested more supplemental funding to fight the epidemic, but it took Congress so long to approve it that the agency had to divert funds from other public-health needs, including $38 million from operations in West African countries that were supposed to aid them in recovering from Ebola.

In a paper they wrote in 2017, Dr. Shi’s team warned that their “work highlights the necessity of preparedness for future emergence of SARS-like diseases.” Upon further study of their samples from the horseshoe bats, one strain of coronavirus (labeled RaTG13) has a 96.2% genome similarity to what we now call sars-CoV-2, which makes them first cousins. Due to this genetic similarity, questions were recently raised about the possibility that COVID-19 might have come from Shi’s lab and made it to Wuhan, but, so far, there’s no scientific evidence to support this claim. In fact, there’s considerable evidence against it. Besides finding the bats in the cave, Dr. Shi’s team found signs that humans had been in the cave as well (ex. left behind garbage), which means these individuals could’ve been exposed to coronaviruses.

A year later, in 2018, a group of scientists met at the WHO’s Geneva headquarters to discuss which of the most frightening epidemic diseases deserved the greatest attention. After two days of deliberating, they concluded that the most terrifying possibility was Disease X, or an unknown pathogen with no known treatment or cure that would likely originate in animals and jump to humans and start spreading silently and quickly. While they couldn’t predict the genetic makeup or when it would strike, they knew the pathogen would come. They did point to possible hot spots, including southern China, where such a virus might originate. In hopes of intervening as soon as possible, they developed plans for how to detect and stop it.

Within a short time, just over a year later, Disease X arrived in the form of COVID-19. Despite all of the warnings and planning, governments, businesses, public-health officials, and citizens throughout the world soon realized that they were battling an invisible enemy with few resources and little understanding. So far, the real-world Disease X has killed more than 750,000 and sickened more than 20 million. There are distinct differences between the current pandemic and the two most recent major disease outbreaks—H1N1 and Ebola. Since the 2009 H1N1 pandemic was caused by a type of influenza virus, scientists knew how to make a vaccine for it. This helped to control it. Also, H1N1 isn’t as deadly as COVID-19 is turning out to be. While Ebola has a much higher mortality rate than COVID-19, it’s far less transmissible. Due to the global support, the 2014 outbreak in West Africa was catastrophic to the region but never turned into a pandemic.

The Dangers of a Pandemic
As we’re finding out first hand, the consequences of a major pandemic are world-changing. Before this, the most memorable pandemic was the 1918 flu, which killed between 50 million to 100 million people, or more than the combined total casualties of World Wars I and II. Since humans are more vulnerable now than they were 100 years ago, the risks are exponentially higher. One of the main reasons we’re more vulnerable is that the number of people has doubled in the past 50 years. The increase in population means there are more humans to get infected and to infect others. Another factor is the high volume of global travel that can happen much quicker than it used to thanks to airplanes. This means that an infectious agent can easily transverse the globe in a short period. Just like it was the case in the 1918 pandemic, there won’t be enough resources for everyone. This will result in a higher number of people dying since there are more people on the planet.

All along, experts have said that whatever the pathogen is, we wouldn’t have any way to treat it nor a vaccine to prevent it. This is true even for viruses that we know about, like Ebola. When the 2014 Ebola outbreak occurred, it wasn’t a new virus because scientists have known about it since 1976. However, there were still no drugs or vaccines approved to fight it. In fact, there still aren’t either of those available today. The reason for this is mainly the result of there being little incentive for pharmaceutical companies to bring them to market. Vaccines make up only 3% of the worldwide pharmaceutical $1 trillion market. The other problem is the length of time it takes to develop a new vaccine. It requires years of testing as well as over $1 billion to create a single vaccine against just one pathogen. This is why a SARS vaccine never made it to market before the virus faded away and why most infectious-disease experts aren’t hanging their hopes solely on new treatments or vaccines. For example, one potential SARS vaccine didn’t get beyond the early stages, because the National Institute of Allergy and Infectious Diseases (NIAID) couldn’t find a pharmaceutical company willing to take it on.

Global vs US COVID-19 Response
One would think that since the US scored an 83.5 (world’s highest) on the Global Health Security Index, which is a report card that grades every country on its pandemic preparedness, we would’ve been ready for a pandemic. Instead, we’re one of the hardest-hit countries in the world. Despite having high-tech isolation units, top-tier doctors, and world-class scientists, the US healthcare system wasn’t equipped for the stresses of a major pandemic. Part of this was because a pandemic is not like other natural disasters, which tend to be confined to a single location or region. It strikes everywhere at once. Fueled by 9/11, the US was well-prepared for some disease scenarios as a result of fears of bioterrorism, such as anthrax and smallpox, but COVID-19, or something similar, wasn’t one of them.

The new coronavirus can spread from one host to another for several days before the person has symptoms. To contain this type of pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. Country after country issued lockdowns to try to follow these measures. By slowing the spread, the hope was that healthcare systems wouldn’t get overwhelmed. Without enough ventilators and protective equipment, even though scientists have been saying for years that governments need to stockpile these, this was a genuine concern. Some countries were better than others in their response to mitigate COVID-19. For example, Taiwan and Singapore seem to have curtailed the spread and severity of the disease significantly. This was probably due to the fact they had to deal with the 2003 SARS outbreak. Another country that was on top of the response was South Korea. They confirmed their first case on January 20th, which was the same day the US had our first confirmed case. However, officials in South Korea took a very different approach than the US. They promptly met with medical-supply companies and urged them to develop test kits and start mass production. The US didn’t do this even though scientists described the risks, public-health officials charted a response, but agency bureaucrats and national leadership failed to comprehend how bad the outbreak could be. Some felt that modern medicine could cope with any pathogen the world threw at it.

Part of our lack of readiness is due to the other major epidemics of recent decades, either barely affected the US (SARS, MERS, Ebola), was milder than expected (H1N1), or were mostly limited to specific groups of people (Zika, HIV). Essentially, it lulled us into thinking that something was going to happen and then nothing did. COVID-19 is not only different from other diseases but also highlights the systemic challenges of our time. It didn’t help that the WHO rang alarm bells for SARS, mad-cow disease, bird flu, and swine flu but had been wrong each time, making them reluctant to jump the gun again.

Besides not learning lessons from previous outbreaks, the US has had several missteps, which have hindered our ability to lessen the spread and severity of the outbreak. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are quite evident. One of the significant failures is not enough testing and this has undermined every other measure. Despite President Trump saying that “anyone who wants a test can get a test” on March 6th, this simply wasn’t true. As demonstrated by several other countries, if we had accurately tracked the virus, hospitals could have executed their pandemic plans by allocating treatment rooms, ordering extra supplies, organizing personnel, or assigning specific facilities to deal with cases. None of that happened. Instead, our healthcare system, which normally runs close to full capacity, was already dealing with a severe flu season and suddenly facing a virus that was spreading, untracked through communities around the country. Very quickly, hospitals became overwhelmed and supplies began to run out—this fostered competition among regions rather than cooperation.

Apart from doing more thorough testing, we could’ve encouraged people to stay home to lessen the spread, but this wasn’t done. There’s no question that this is a huge step and persuading people to remain home voluntarily is not easy, especially without clear guidelines from the White House. This is why many citizens continued to crowd into public spaces. The need for social distancing should have been impressed upon the public while reassuring and informing them. Rather than doing that, President Trump has repeatedly downplayed the pandemic and has been misleading. Both of which have deepened the crisis. An example of this was his message saying that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. This way of thinking overestimates our ability to assess a person’s risk and underestimates how badly the virus can hit “low-risk” groups.

A factor that has been a long time in the making is the lack of spending in preparedness. When spending big money, especially public money, there is a risk, which is particularly true if you’re using it to ensure against a greater risk. Since electoral cycles are short, politicians usually focus on the short term. Their rationale is if they spend a billion dollars or tens of billions, and the pandemic doesn’t occur during their term in office, they probably won’t be reelected. People are good at remembering people who fix problems but don’t acknowledge those who avoided it altogether. The result is political leaders and private donors who react when there is a crisis, but the cash flow disappears when the threat does. The problem with this form of reaction became clear during Ebola when Congress issued more than $5 billion in much-needed emergency spending, but it took nearly five months after it was called a crisis by international health groups to do this. A few years later, during Zika, it took almost nine months for Congress to distribute $1.1 billion to fight the disease and they required that some of the funding to come from the existing Ebola funding. The data shows that federal money issued to prepare for pandemics and other emergencies fell 35% between 2003 and 2020. The annual funding for NIAID, which was placed in charge of research of the coronaviruses peaked in 2004 after SARS at $104.7 million but dropped to $14.9 million in 2010. It rose following the outbreak of MERS in 2012 but was at $27.7 million in 2019. Rather than providing funding on an as-needed basis, governments should treat it the same as being prepared for war. They buy vast armories of weaponry, hoping they won’t be used, which is the mindset we need to have when it comes to pandemics and supplies.

There have been some recent cuts to several government agencies, which have left us even less prepared. Since President Trump came to office, he has left key government positions unfilled and he has proposed a budget that would have cut critical funding at the Department of Health and Human Services (HHS) by $15.1 billion. Part of these reductions would impact the National Institutes of Health (NIH), which is the branch of government that NIAID falls under. In addition, he wanted to reduce the State Department and foreign aid budget by 28%. Both of these are vital in efforts to stop diseases overseas. The biggest issue was getting rid of the Global Health Security and Biodefense, part of the National Security Council (NSC), in 2018 under John Bolton, who was the national security advisor. According to Mr. Bolton, the move was designed to improve NSC operations, but global health remained a priority. Obviously, this didn’t happen. Another setback that had recently transpired was deteriorating relations with China, which resulted in a reduction of our CDC personnel and activities there. The CDC decreased the number of staff from 44 to 14 and said it expects to have that down to 10 by the end of this year. This started happening when we needed people on the ground to help understand and alert us to potential threats the most.

A major problem that we’re dealing with is skepticism about the guidance of experts from scientists at NIAID and CDC. This isn’t due to the experts being wrong, but because they’ve had trouble getting their voices heard by the politicians above them. The politicians are looking out for their interests rather than speaking the truth to the American people. Unfortunately, the misleading information that is being put forth by politicians is influencing what the public is believing. So, when the scientists go to correct them and the information isn’t what the people want to hear, they assume the scientists are lying. The other difficulty with this is that local and state public health agencies are autonomous but usually follow the guidelines they get from the CDC. When these aren’t clear and coherent, it leads to the inconsistent responses that we’re seeing. As a result of the political reaction to COVID-19, the US has become a public health experiment.

How will COVID-19 end?
We all want to know this. There are three leading solutions to help get it under control. The first is that every nation simultaneously defeats the virus, similar to what was done with SARS. Given the pandemic is so widespread and many countries aren’t handling it well, this isn’t going to happen. The second option is the virus moves through the world and leaves behind enough immune survivors that sooner or later, it struggles to find viable hosts. This is usually called herd immunity. While it would be quick, it would come at a terrible cost. Since COVID-19 is more transmissible and fatal than the flu, it would result in millions of deaths and devastate healthcare systems. The third scenario is sort of what we’re doing, which is trying to put out outbreaks while living as close to normal life as possible until a vaccine is ready. It’s longer and more complicated but doesn’t come with as huge of a loss of life.

With the virus is unlikely to disappear entirely, experts are predicting that it’ll be a part of American life for at least a year, if not much longer. The lockdowns and social distancing that were followed for a brief period show the positive impact these measures have. However, as we try to reopen these areas, we’re seeing a surge in cases again. This doesn’t mean that we must stay on a continuous lockdown until there is a vaccine ready. As an alternative, we need to be prepared to do multiple periods of social distancing. This will ensure hospitals don’t become overwhelmed and there are enough supplies to take care of the sick. It will also allow scientists to work on creating antiviral drugs that could combat the virus and testing kits to be widely distributed. To do this effectively, we need a government that’s competent, coordinated, and capable of rapid and intensive intervention. As of right now, we don’t have that.

The other component is the development of treatments and, ultimately, a vaccine. Since there are no existing vaccines for any coronavirus, researchers are starting from scratch, which means it’ll take 12 – 18 months before a vaccine is ready. Then, it’ll take longer still to make it, ship it, and inject it into people’s arms. The other problem is finding a way to manufacture it on a massive scale. Since viruses can mutate and evolve, the vaccine will need to be updated repeatedly, which means people may need to get revaccinated regularly, such as they do for the flu. The moving target is how long does immunity lasts. For instance, when people are infected by the milder human coronaviruses, such as those that cause the common cold, they have protection for less than a year. However, those that were infected by SARS, which is far more severe than the common cold, were immune for much longer. The assumption is that COVID-19 falls somewhere in the middle. So, the goal with vaccine development is to get COVID-19 to a place where it’s managed by a vaccination that is given a reoccurring basis, making it not as deadly as it is currently. There had been talk, and hope, among experts that COVID-19 would be seasonal as is the case with other coronaviruses. While this might eventually be the case, it certainly isn’t happening now since the number of cases is rising rapidly each day and it’s the middle of summer. This is most likely the result of the fact that the virus has many immunologically naive hosts it can infect.

The Long-Term Impacts of COVID-19
The effects of COVID-19 are going to be felt far into the future. One significant impact is going to be the bearing it has on mental health. Typically, when we’re feeling dread and uncertainty, we want to be around people that we care about and who can comfort us. Due to the nature of the virus, this isn’t possible without putting those we care about at risk. The separation will most likely result in a rise in cases of isolation, loneliness, and depression, especially for elderly individuals. Not surprisingly, most of us are feeling anxious and worried, but for those with anxiety or obsessive-compulsive disorders, they’re struggling. A disturbing but not shocking finding is that incidents of domestic violence and child abuse are spiking since people are forced to stay in unsafe homes. Also, after the pandemic, people who’ve recovered from the virus might be shunned and stigmatized, as were survivors of Ebola, SARS, and HIV.

The pandemic has brought about social change, too. Many people, businesses, and institutions have quickly adopted practices that they might once have resisted, including working from home, online conference-calling, proper sick leave, and flexible child-care arrangements. Hopefully, the take away from this will be that preparedness isn’t just about masks, vaccines, and tests, but about fair labor policies and a stable and equal healthcare system. In addition, after the pandemic is over, we’re going to have to rethink our identity as a country since a good portion of our values has seemed to work against us during the pandemic. Our views on individualism, exceptionalism, and equating doing whatever you want with an act of resistance have hindered our response to COVID-19. There is light at the end of the tunnel though, some communities are finding new ways of coming together, even as they stay apart. Another area that will hopefully change is our attitudes to health. Simple things, like washing your hands for 20 seconds, have been historically ignored consistently. Chronic conditions, such as obesity, diabetes, and heart disease, all place individuals at higher risks for complications from the virus and have primarily gone unaddressed on a national scale. Hopefully, the pandemic will shift the focus on these issues. Ultimately, it’s up to us to decide what the future will look like.

What is being done to improve response time to future pandemics?
Even though we’re in the current pandemic, we need to start planning for the next one because it will come and we don’t want to be as unprepared as we were with COVID-19. An essential thing to have is to have enough masks, gloves, and other personal protective equipment stockpiled and the ability to rapidly produce more. This is vital because we know that if healthcare workers can’t stay healthy, the rest of the response will collapse. In the current situation, some manufacturers are rising to the challenge, but their efforts are piecemeal and unevenly distributed. We need to prevent having this type of response in the future. We can do this by using the Defense Logistics Agency. This is a 26,000-person group that prepares the US military for overseas operations. It has assisted in past public health crises, like the 2014 Ebola outbreak. The agency would also be able to help with rolling out tests. The reason tests for this pandemic have been so slow is due to several different shortages, including masks to protect the people administering the tests; nasopharyngeal swabs for collecting viral samples; extraction kits for pulling the virus’s genetic material out of the samples; chemical reagents that are part of those kits; and trained people who can give the tests. There have also been strains on supply chains to get the tests where they’re needed most. By having a specific agency in charge of all of these tasks, it would decrease the disruption significantly.

Another area that needs to be bolstered is the use of genetic sequencing. Scientists are using it to track the spread of a disease through changes in its genetic makeup. By understanding this, it helps us to understand how the virus is spreading. For example, in the 2014 Ebola outbreak, a geneticist from MIT and Harvard, Dr. Pardis Sabeti, used the technology to determine that the virus was spreading primarily from human to human and not from animal to human as was initially thought. This discovery dramatically altered how experts were fighting the spread of the disease in the field. With this information, it can mean the difference between an outbreak that kills hundreds instead of millions. The goal is that scientists will be able to use genetic sequencing to predict how a pathogen will behave before a single person ever becomes ill. This isn’t likely to happen soon since microbes evolve about 40 million times faster than humans.

While most governments haven’t focused on infectious agents as a threat, some global health experts are doing what they can to aid in the preparations that are sorely missing. One of these individuals is Bill Gates. In a TED talk, he has warned that the threat of an infectious disease pandemic would pose a far greater threat to the world than nuclear war and urged world leaders to invest more in preparing for one. As a result of his concerns, Mr. Gates and his wife Melinda have put their weight behind a major public-private initiative called the Coalition for Epidemic Preparedness Innovations (CEPI), which was started in 2016. The Gates Foundation alone will provide $100 million over the next five years to CEPI. The objective is to speed the development of vaccines against known diseases, like MERS, and to invest in next-generation technologies that can aid in responding to future threats. To achieve these targets, CEPI aims to raise and spend $1 billion over the next five years. A different program, PREDICT, was launched in 2009 and is designed to detect and respond to emerging pathogens rapidly. The program is funded by the US Agency for International Development (USAID) and has helped discover nearly 1,000 new viruses in animals and humans so far. The program operates in 30 countries and spends about $20 million a year to accomplish its aims. A third program, the Global Virome Project, is trying to identify, characterize, and sequence the nearly half-million viruses that have the potential to spillover. It’s estimated that it would cost $3.4 billion to complete, but it’s believed that the project would easily pay for itself many times over if it could successfully stop a single pandemic.

The late, inadequate, confused, and confusing response of the federal government to COVID-19 is unacceptable and will likely result in us ending up with the worst COVID-19 outbreak in the industrialized world. Our government should do better. We deserve better. While we may not have been ready for COVID-19, it’s not too late to be prepared against the next pandemic. To do this, America can’t sit by idling and become complacent. We need to take the appropriate steps to make sure we’re ready. This also means we need to help other parts of the world when they need assistance because a disease anywhere is a disease everywhere. While we can’t stop outbreaks from happening, we can prevent them from becoming epidemics or pandemics.