How do we get to the pandemic’s ‘next normal’?

The COVID-19 pandemic has changed everything. We’re all still trying to figure out how to live with it. What should we know about how you approach the world now? How has the pandemic changed your social life, your work life, your interactions with your neighbors?

This is one of a series of articles in which reporters from WHYY’s Health Desk Help Desk answer questions about vaccines and COVID-19 submitted by you, our audience.

Back in 2020, the coronavirus emerged as a lethal menace the world was frantically trying to understand and, it was hoped, quickly stop.

Two years later, much has changed: More people have access to the vaccine, and there is a range of readily available treatments. But COVID-19 still has not disappeared, and it seems more and more likely we will have to develop ideas for living with the virus.

So 53 of the world’s top epidemiologists, pharmacologists, virologists, immunologists, and policy experts came together to nail down the best ways to do that. Under the leadership of Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania and a former Biden Transition COVID-19 Advisory Board member, the experts have published a COVID Roadmap that details several key strategies.

“We’re not talking about a scenario where it’s possible to eradicate the virus, like we did with smallpox and like we’re close to doing with polio. What we’re really talking about is thinking about what normal looks like next, and what a post-pandemic world looks like, knowing that we’re not, in some ways, going back to what things were like in 2019,” said one of the study’s experts, Dr. John Wherry, director of the Penn Institute for Immunology at the University of Pennsylvania.

“It’s really about getting to what we’re calling the next normal,” Wherry said — and sustaining it.

The experts agreed on three different paths they thought the pandemic could take:

• A pessimistic scenario, in which the virus changes, a new variant arises that is as concerning as omicron, and population immunity fades — all of which could lead to more serious illness, and therefore, increased interventions.
• A middle-of-the-road scenario, in which the virus continues to evolve in ways that are less harmful, but still significant. Population immunity would continue to be strong, but certain groups of people would not be as protected by the vaccines.
• And an optimistic scenario, in which the omicron wave is the last wave of significant human impact, and COVID-19 becomes a seasonal respiratory infection like influenza.

Then the experts came up with several strategies to advance the world to the optimistic scenario. Here are some highlights:

The vaccine

The roadmap’s authors are calling for vaccine research, development and distribution to be more effective and swift, including for universal vaccines that fight all variants.

Should a variant-specific vaccine be necessary, the appropriate funding and infrastructure must be in place to ensure doses are on the shelf when needed.

Testing and surveillance

The experts suggest that people who test positive for COVID-19 get linked to treatment the same day, rather than wait five days for symptoms to appear.

They also recommend collecting testing data nationally, so officials know what the trends are.

“We have an opportunity to capture an enormous amount of data in these rapid tests, and we haven’t done that efficiently yet,” Wherry said. “If you were to link that kind of information to viral surveillance for new variants arising in, for example, wastewater monitoring, animal populations, so we can see trends in viral evolution over time, like we do for influenza virus, we can link these two things together to actually say, ‘Well, we picked up an increase in this variant in these wildlife population and in wastewater, and you know what? We’re seeing an increase in test positivity in ZIP codes associated with those environments.’ That’s a trigger for action.”

The roadmap’s authors also recommend immunological surveillance to better understand when antibodies are declining. That would help health officials determine when boosters are necessary. The authors say the surveillance could be achieved via blood donations, or by point-of-care antibody testing, which could be similar to performing glucose tests.

Therapeutics

Increased investment for therapeutics and making them affordable for patients is needed, the experts say, as are efficient strategies for testing and approving therapeutics to get them to market quickly.

Wherry said there’s a need for more research to discover therapeutics, repurpose drugs, and create high-quality assays. That can be challenging, he said, because it must take place in Biosafety Level 3 laboratories, where research is slow and cumbersome because of containment issues.

Clinical trials must also become more efficient and swift, he said.

“We wasted an enormous amount of time and energy, and frankly, physician and patient times, testing things like hydroxychloroquine and ivermectin that simply didn’t work and had poorly designed trials early on that made us continue to waste our time,” Wherry said. “So one of the biggest hurdles is having a very efficient, well-organized and well-structured trial system, so we get a definitive answer as quickly as possible. And then, making the regulatory and financial hurdles to moving something through approval and into patients as efficient as possible.”

Long COVID

A common definition of long COVID must be decided, and a better understanding of it gained, the experts say. Once it is understood and defined, clinical trials can be developed to treat, manage and reverse it, they say.

“That’s a big call for science in the area of long COVID, but probably also some advocacy and recognition of long COVID as an important clinical entity and how to appropriately integrate addressing long COVID into our clinical care,” Wherry said.

Structural opportunities

The roadmap’s authors are calling for improved ventilation systems in buildings, such as schools. When it comes to education, they stressed the importance of balancing safety and emotional and social well-being.

“When should we stop masking in schools? Now, definitely now,” Wherry said. “What criteria should we use to make those kinds of decisions in the future while keeping safety first, recognizing there are costs to everything we do? And how do we make sure we have resilient child care so that we can keep our workforce working and keep our children safe at the same time?”

The experts recommend investing in the health care, public health, and research workforce so the fields are better prepared to manage a health crisis in the future. They also want improved health system data infrastructure for testing, vaccination status, and patient outcomes.

“It’s very clear now if we had a good system for doing this across the country, we would have actually been able to identify emerging areas of risk for health care system collapse during the pandemic before anything ever got to that state,” Wherry said.

Communication and education

The experts recommend creating a role of deputy assistant to the president for biosecurity, who would coordinate public communications. This person would also tackle misinformation and disinformation.

“How will we handle the next outbreak? Who is going to do what? What kinds of communication do we need, and how do we prepare?” said road map author Dr. Dolores Albarracín, a professor of social psychology and communication at the University of Pennsylvania and director of the Annenberg Public Policy Center’s Science of Science Communication Division.

The experts also are calling for a plan to encourage people to support the mitigation efforts public health officials establish.

They recommend expanding health education in K-12 schools to equip children to depoliticize health, and strengthen their knowledge of what a virus is and how to prevent infectious diseases.

The children also would be trained on ethical issues surrounding public health: “What does it mean to have a mandate? Why mandates might be necessary during certain critical points. And teaching kids how to identify unbiased sources of information and to think more critically,” Albarracín said.

There is also an opportunity to address health disparities through the education system, she said.

“You have an opportunity to teach communities to navigate the health system, to trust the health system, to respond in a way that allows them to get better health services,” Albarracín said.

“So you can actually take kids through the whole process of getting an appointment, and take the class to the doctor, and how do they respond if they don’t like what they hear or if they feel mistreated or discriminated against?” she said. “These things could be long-term solutions to some of that mistrust and distrust, which in some cases is rational given the community’s experiences.”

Also urged: clear standards for public health messages that prevent political interference, and an independent advisory council to the Centers for Disease Control and Prevention.

“And there is a precedent for this — it happened during the HIV epidemic, actually. The community of behavioral and social scientists were really brought to the table and convened to think through the process of how to actually achieve behavioral change,”  Albarracín said.

“In this pandemic, we’ve seen a lot on how do we get the latest biomedical innovation? So how do we get good vaccines? Which, of course, were needed. But once you have the vaccine, you still need to get people to actually accept it. And this is the case with everything we’ve seen, right? Masking and vaccines, medications, seeking treatment, testing, and lockdowns.”

She added that social media companies need to monitor misinformation and disinformation more closely.