Professor Martin Michaelis and Dr Mark Wass, University of Kent, School of Biosiences, say it is crucial to overcome COVID-19 and to prepare for the next pandemic
We also need to learn our lessons to prepare for future, potentially more deadly outbreaks. Professor Martin Michaelis and Dr Mark Wass of the University of Kent’s School of Biosciences discuss critical points:
“The best time to start thinking about preparing for future major outbreaks of infectious diseases is while we are still learning from the current COVID-19 pandemic. Hence, we should learn our lessons now; including seven crucial aspects that must be considered.”
1. We have seen it coming
“With hindsight, it is very easy to say that we could have seen this pandemic coming. In the last 20 years, we have seen many new diseases caused by emerging viruses that were previously unknown. These include, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), the West African Ebola virus outbreak, Zika virus, human cases of avian influenza (“bird flu”), and the (H1N1) 2009 (or “swine flu”) pandemic. Until recently, we have been lucky. Many of these diseases are associated with high mortality rates, but they are not yet easily transmissible between humans. Chinese scientists have warned for years of a human outbreak of one of the bat coronaviruses, which SARS coronavirus 2 (SARS-CoV-2, the virus that causes COVID-19) is derived from. At least, we could have seen it coming if we had wanted to.”
2. We were not prepared
“Despite all these signs, we have not prepared ourselves. As we can now see, pandemic preparedness plans have not resulted in sufficient hospital capacities. There is a shortage of personal protective equipment (PPE). There was no plan on how and when to initiate a lockdown or of its wider implications. It has become obvious that a lockdown in a pandemic situation is not only a question of health care. It is as important to maintain basic infrastructure and to have a strategy to stop and restart the economy without destroying livelihoods.”
3. COVID-19 is not over
‘Being “over the peak” does not mean that the current pandemic is over, as there is no scientific reason to believe that COVID-19 might just disappear. According to the most recent numbers, less than 10% of the UK population have been infected with SARS-CoV-2, and there are still thousands of infected individuals in the UK. Moreover, SARS-CoV-2 keeps spreading around the world and may be re-introduced into countries that currently have transmission under control. For quite a while “over the peak” will likely mean “before the next peak”. Our best hopes are that SARS-CoV-2 induces long-lasting immunity, that the virus has limited capacity to change and escape this immunity, and that an effective vaccine becomes available soon.
4. The next pandemic will come and it could be much worse
“Even if COVID-19 is under control, there is no doubt among scientists working on infectious diseases that there will be future pandemics and that these pandemics may be much worse than the current. In the same way in which we have observed bat coronaviruses developing into SARS-CoV-2, we may be currently observing the development of further pandemic viruses. As outlined above, the viruses that cause SARS, MERS, Ebola virus disease, and avian influenza are associated with much higher human death rates than SARS-CoV-2, but are currently not readily transmitted between humans, though this may change.
“Data suggests that only a few mutations in some of these viruses may be sufficient to enable them to easily spread in the human population. If one of these viruses acquired the capacity to spread like SARS-CoV-2, then this combination of transmissibility and mortality would result in a pandemic that eclipses the current.
“Further, there are likely to be many more viruses that we are currently unaware of that could cause the next pandemic. This is highlighted by the World Health Organisation’s (WHO) ‘List of Blueprint priority diseases’ (http://origin.who.int/blueprint/priority-diseases/en/), which contains seven viruses and “Disease X”, a novel disease caused by a currently unknown novel infectious agent. “Disease X” also illustrates a key problem in pandemic preparation. It is very difficult to convince people to prepare and allocate resources for the prevention of events, potentially decades away, that may be caused by as yet unknown pathogens.”
5. Our health infrastructure needs to be prepared for large outbreaks of infectious diseases
“For the foreseeable future, the initial response to novel viruses will depend on preventing spread through isolation, contact tracing and social distancing measures; similar to our current experience. It will always take a considerable amount of time until vaccines and specific treatments become available. During this time, which may be months and years, treatment will focus on relieving the symptoms of the disease and largely depend on intensive care for critically ill patients.
Our current system, which runs at about 95% capacity, may be financially efficient during normal times. It will not protect us from peaks in demand, as we see regularly each winter.
“Hence, preparedness plans must include hospital capacities increased to sufficiency, including a large number of intensive care units, ventilators, and extracorporeal membrane oxygenation. There must be a substantial excess capacity beyond what is normally needed. Our current system, which runs at about 95% capacity, may be financially efficient during normal times. It will not protect us from peaks in demand, as we see regularly each winter. These measures depend on the availability of sufficient PPE, which must be secured prior to a crisis. Hence, this may require a level of stockpiling we are not used to.”
6. Society must be prepared for a lockdown economy
“With our current economic system, a lockdown is associated with significant societal and financial damage. To be able to fight pandemics effectively, we need a system in which saving lives and saving the economy do not compete; as they currently do. Plans are required for the provision of essential goods and services without jeopardising the pandemic response and without putting individuals at risk. Now is the time to develop ideas for the formation of a resilient society and economy, which can deliver these tasks.”
7. Lockdowns must be early, before the potential extent is clear
“Several months into the pandemic, it is clear that it could have been prevented if there had been a swift response after the diagnosis of the first cases. Early lockdowns would have prevented transmission of the virus around the world and saved many 100,000’s of lives. However, large scale lockdowns were not considered as an option at the time, and there were no plans for doing this. Nobody could foresee how SARS-CoV-2 would spread, and the damage to the economy was considered as a bigger risk than a COVID-19 pandemic. With hindsight, we now know that only drastic measures, taken at the earliest possible time before the potential scale of an outbreak is even clear, can prevent a pandemic.
“These early measures, contact tracing and isolation, only work as long as you have few cases. Thus, we will need to take drastic measures quickly, if we want to avoid future pandemics. This requires realistic and feasible plans that will take these essential steps to stop novel disease outbreaks before they develop into large epidemics or pandemics.”
8. Effective pandemic preparation requires international coordination and cooperation
“It is necessary to realise that the prevention and fight of large outbreaks of infectious diseases and pandemics is a global task. As long as disease spreads in any region, a threat remains to the rest of the world. Nations must work together and not against each other.
“Future pandemics will happen and may be much more severe than the current. The question of how we prepare for this is a societal one that should be broadly discussed to decide the level of protection that we afford as a society and which risks we want to take.”