“In the environment, every victory is temporary, every defeat is permanent.” That quote, commonly attributed to Thomas Jefferson, aptly describes our current struggle with COVID-19. After more than a year’s worth of death and tragedy, America finally has the upper hand on COVID, thanks to vaccination and mitigation measures.
But the virus is a relentless foe; we are still experiencing 50,000 cases a day, while cases and deaths surge in India and rise steadily throughout South America and Southeast Asia.
We must rethink the entire situation because it is now a “variant virus” pandemic. While vaccination may permit us to return to “normal”, we may still experience low-level seasonal waves of COVID infection or small regional disease breakouts caused by evolving variants indefinitely. Even now, as we successfully suppress COVID-19, we should prepare for coronavirus infections in coming years, e.g. COVID-22 or COVID-24.
That will require a rededicated scientific effort on a number of fronts. This includes the development of a universal coronavirus vaccine, effective against all variants -something that is harder to achieve than it sounds. To date, we have been unable to come up with a universal vaccine for influenza because the flu virus variants continue to emerge; nature remains stubbornly one step ahead of us.
Along with this, we need effective, inexpensive medications to treat the COVID infection itself. Our current drugs to treat COVID-19 are only partially effective and work only in certain situations. What is necessary is a drug, or drugs, on the order of penicillin and the succeeding generations of antibiotics, which have saved millions of lives not by eradicating but by treating antibacterial diseases. Tuberculosis is an example of a disease that annually affects millions worldwide that has been tamed, but unfortunately not eliminated, by effective drug treatment.
As part of the evaluation of new drugs and vaccines, our scientific community should create a more flexible system for assessing and publishing research in the time of a pandemic. COVID-19 illustrated the challenging choices of making research public in a timely fashion. Traditional journals often take months to publish important medical findings – an impractical gap when urgent help is needed. The only current alternative is a direct online posting of unreviewed research, which can lead to the proliferation of unvetted opinions and spurious research. In the face of a rapidly evolving situation, where people are dying on a daily basis, there must be a middle ground to disseminate reliable information expeditiously.
In the surveillance mode, we need better systems to identify viral variants. It took the United States the better part of a year to gear up to recognize coronavirus mutations that cause variants to spread in different parts of the country. We will need a distant early warning system to detect mutations that could escape vaccine control and cause future outbreaks. All pandemics are at once local and global, and global control is essential to local control. A brushfire somewhere in the world can become a conflagration everywhere. So the United States must be part of a redoubled effort to track coronavirus activity in every part of the world.
Locally, there should be a greater push for affordable, rapid, easy point-of-care saliva testing. Think of this type of testing like at-home pregnancy kits, in the sense they are not completely reliable, but accurate enough to prompt further action like seeing your doctor. Convenient point-of-care saliva testing will permit decision-making in minutes about isolation and contact tracing. Such a system would be invaluable in schools, places of employment, airports, and entertainment venues.
Finally, the country should undertake a long-term project to evaluate the quality of ventilation in all public buildings with the intent of minimizing the chances of indoor airborne pathogen spread in the future. Along with this should come greater attention to the actual risk of the ventilation systems of airline cabins. That risk is believed to be extremely low but will require further study.
The coronavirus is an implacable enemy. It has caused nearly 600,000 deaths and untold suffering in the United States, even as it continues to ravage the rest of the world. Absent some remarkable unexpected development, “zero COVID” – the complete eradication of the pathogenic coronavirus – will not be a reality anywhere in the world, including the United States, any time soon. That’s why, even in the face of our current successes, we must prepare for a protracted campaign.
Alert, alive.
Dr. Cory Franklin is a retired Chicago-area physician. Dr. Robert A Weinstein is an infectious disease specialist at Rush University Medical Center and former chief of infectious diseases at Cook County Hospital. They wrote this for InsideSources.com.
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