The pandemic has ended. What should we do now?

The announcement a few weeks ago that President Biden is suspending the COVID-19 emergency declaration on May 11th puts a formal end to this pandemic. As is often the case, this declaration comes long after our society has informally ended its own pandemic precautions. There are a few important implications for the president’s declaration, predominantly in changes in health care funding and access, but most people have already moved on.

Even the government has seemingly moved past the pandemic. There are no more impassioned news statements from NIH or CDC officials. The FDA’s vaccine advisory committee has recommended a more rational approach to COVID vaccination. This may involve yearly updates for COVID vaccines, but ends the ridiculous pursuit of a new vaccine every time a slightly different form/variant of the SARS-COV-2 virus is identified.

Schools, travel entities and other public places have mostly made masking optional (although it should be continued for individuals with immune problems). This all was reflected in the last holiday season that saw no major medical-related travel problems as compared to technical concerns (thanks Southwest Airlines!). The world has turned its focus back on dealing with wars, earthquakes and other mundane catastrophes.

Now is the time to carefully examine what happened over the past three years and how it could be instructive in dealing with future infectious outbreaks. There are several areas that require investigation and retrospection to understand how we could better manage future outbreaks. It is important to accomplish these reviews if only to regain American’s confidence in the national public health system. 

This latter point is crucial since a lack of belief in public health will lead to medical disasters like children not being vaccinated and individuals refusing basic preventative medicine. We already have a shortage of health care resources making it difficult for people to get medical care (or at times to even get a physician appointment). These problems will conspire to cause future “pandemics” of chronic disease that won’t end as quickly as COVID!

Several areas must be addressed.

• Examine the potential benefits/costs of the different social restrictions employed in an attempt to control the pandemic. While some aspects of infection control may be unique to different infectious agents, most pandemics are caused by respiratory viruses. We still need to understand the benefits of social isolation approaches versus simply wearing masks and trying to protect the most susceptible individuals. This is one of the primary questions left from this pandemic. We also need to clarify the costs of these approaches including lost education and delayed development in children.

• Resolve issues related to medical interventions, their benefit and purported toxicity. It has been pointed out that despite a larger world population and different methods of counting, COVID resulted in only 12% the number of deaths worldwide as the 1918 influenza pandemic (6 million vs. 50 million). A large part of this reduction was likely due to the rapid introduction of vaccines and anti-viral drugs, but no benefit was observed with other modern interventions like ventilators. Understanding the relative importance of these approaches and how to improve their development times are crucial topics as we move forward.

• Clarify the value of the new mRNA vaccines. Much has been made of the inability of these vaccines to protect against infection from different COVID variants. Some have argued that these vaccines are not as effective as more traditional, protein-based vaccines. Unfortunately, there is no data directly addressing these opinions. The mRNA vaccines are easy to manufacture and are being developed for other types of infections including influenza and the RSV. Defining the risks and benefits of mRNA vaccines for all age groups Is important for individuals to have confidence in these new vaccines.

• Identify the origin and the spread of COVID-19. Many seek to examine the origins of this pandemic in China. Obviously, understanding if this virus truly occurred spontaneously in animals and how it initially entered the human population are important concerns. However, this investigation needs to be much broader. Using molecular methods we now can understand how COVID-19 spread worldwide. This is particularly important in that time when international air traffic allows infections to jump continents in a single day. Knowing what limitations on travel or human interaction made a difference in curtailing virus spread will be crucial to handling emerging pandemics in the future.

The COVID “experiment of nature” that we just survived is an unprecedented opportunity to learn about how respiratory infections can be contained in the human population. It is something that needs to be understood beyond partisan arguments for the greater good. We are morally obligated to do this if for no other reason than to honor those who died as a result of COVID-19.