Five things we must do to prepare for the next COVID-19 outbreak.

Can we prepare for the next round of coronavirus infection? Will we prevent the disruption of our lives again? What can we do to make sure that fewer people get seriously ill or die from the COVID-19. These are important questions that we need to address in order to prepare for the next round of infection, whether it occurs next fall, winter or spring. 

I think we can be prepared and here are five suggestions of important things to accomplish before the next outbreak: 

1. Establish “centers of excellence” for treating COVID-19 infection. Identify hospitals that have developed substantial expertise in handling this infection and have surge capacity that could rapidly come online as necessary to care for overflow patients. This would be particularly important in supporting patients requiring intensive care hospitalization where regional centers would be important in providing that support. Have these centers share best practices and make this information publicly available to physicians and hospitals across the country. This will help shorten hospitalizations and make healthcare delivery more efficient.

2. Restock all strategic medical stockpiles throughout the country. Make sure we have the adequate PPE (personal protective equipment), medications, ventilators and other necessary equipment, and that it is ready to be transported when necessary. These stockpiles were never fully restocked after the swine flu epidemic in 2009, and that contributed to the current shortages in PPE.

3. Don’t rely on a vaccine to help prepare for the next pandemic. A vaccine will not be available within the coming year and may not be available for an extended period of time. As an example, HIV has been studied for over 40 years and we still don’t have a vaccine despite knowing everything about that virus.

4. Make sure EVERYONE has taken an antibody test to identify who is immune to the virus. An antibody test will identify blood proteins specific for COVID-19, and therefore identify everyone who has been exposed to COVID-19 and developed immunity. Individuals who are immune are very important to identify, in particularly in healthcare where they could care for patients without the requirement of COVID-level PPE. In addition, if we screen the bulk of the populace, we will know how many individuals are at risk for COVID-19 when it returns. This will also help identify at risk individuals with pre-existing conditions who should isolate given a high risk from the infection.

5. Develop a “moonshot” effort around the production of any drug that appears to effectively treat this infection. Small molecule antiviral drugs could be produced in multiple facilities simultaneously. It will be more difficult to produce anti-inflammatory biological drugs, but experience with biosimilars now makes this possible. Scaling up production of any drug may require restrictions of patents or sharing of trade secrets to allow multiple sites to produce any single drug. The government should dictate this and assure that companies will be fairly compensated but may lose control over the drug. In this regard it was especially reassuring that Gilead gave up the orphan drug status for remdesivir. This will assure this drug could be produced in large-scale not just in the US but throughout the world.

If we take these steps we not only will save lives but we will likely avoid the disruptions to our activities we are currently experiencing. The effort must start immediately, however, if we hope to accomplish these goals.