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Lessons for the next pandemic — Act very, very quickly





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© David Morrison / Associated Press


Here’s how the next outbreak of a dangerous new virus should develop:

Several people in one city develop fever and cough, and some end up in hospital. Machine learning algorithms quickly detect abnormalities in lung scans. Scientists notice a pattern of strange infections in routinely collected blood samples. Whatever got people sick is spreading, the champions suggest.

Both systems send an alert to health authorities, who identify the new virus within hours, then deploy an army of investigators to contain it by isolating and treating those who are sick or have been exposed.

One of the biggest lessons of the Covid-1

9 pandemic is that speed matters. The window of opportunity to find and stop a rapidly spreading virus is incredibly small and error intolerant.

“Once you get past the curve of these epidemics, it’s really hard to reverse it,” said Jeremy Farrar, director of the Wellcome Trust, which funds health research. “Acting late is a disaster.”

In a series of articles on the pandemic and its origins, the Wall Street Journal showed how the slow reactions of governments and officials in the crucial first weeks had serious consequences. Chinese health authorities have stumbled to identify the cause of the outbreak. The World Health Organization has been bypassed by the virus, exposing flaws in its design and operation. The United States failed to launch the tests. New York City closed too late.

Around the world, the world was unprepared to handle a pandemic of this magnitude – in which more than a million have died – despite two decades of warnings and billions of dollars spent.

Public health leaders and scientists are now drawing lessons from Covid-19 to find ways to avoid the next. Smarter lung scans and blood sample screening are two of their ideas. They are also working on new tools and approaches to find infections before they spread, to stifle budding epidemics, to respond quickly with better public health systems, drugs, vaccines, and to improve global cooperation and strengthen WHO.

To do this, they say nations must invest in epidemic preparedness in the way they prepare for war or any other threat to national defense, with constant funding, accepting the expense as a necessary cost to keep society safe even when not there is an epidemic. Without such investments, governments will not have sufficient infrastructure to respond quickly. Faster action could help prevent the need to punish blockages.

“We need to be ready for something this serious,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force.

Officials have focused in recent decades on preparing for a pandemic caused by a new strain of flu, which remains a huge risk. But Covid-19 shows they must also anticipate an unknown “Disease X” that spreads in unique ways.

“We have to think differently,” said Sally Davies, a former chief medical officer for England and now a teacher at Cambridge University’s Trinity College. It recently formed a Trinity Challenge coalition, which includes Northeastern University, Facebook and the Bill & Melinda Gates Foundation, to share data and insights on how to better prepare for health emergencies.

This includes protecting the shocks to the economy and society, not just the health impact, he said.

One thing is certain: there will be a next time. Meat production, deforestation and other economic and social changes have brought people closer to wildlife and livestock, and the number of outbreaks from new “zoonotic” animal pathogens is on the rise. “Epidemics in the 21st century will be more frequent,” said Dr. Farrar. “They will be more complex.”

The best way to prevent an epidemic is to prevent animal viruses from spreading to humans in the first place, said Peter Daszak, president of EcoHealth Alliance, a New York-based nonprofit that has identified the hot spots of the spread all over the world.

Funding for that research has been modest, but the US government is pouring more into it now. The NIAID recently established a global research network to research the animal viruses most likely to infect humans, the ecological and behavioral factors that cause epidemics, and strategies to prevent them. The US Agency for International Development is funding a consortium of wildlife and human disease experts to work with countries on reducing the risk of animal virus outbreaks.

An initiative called the Global Virome Project aims to find and sequence every currently unknown animal virus that could infect humans. This would cost $ 3.7 billion, project leaders estimate. They estimate that between 631,000 and 827,000 such viruses have the potential to infect humans.

Stopping any spillover is impossible, many epidemiologists say. Instead, their goal is to quickly stop or at least limit the spread of new pathogens affecting people.

Could Covid-19 have been found before the end of December 2019? It was then that Wuhan officials first recognized cases of pneumonia. “Of course we could, if we had the right systems in place,” said Prof. Davies.

One idea to speed up detection is to design equipment that will report unusual chest scans. A doctor could then examine the scan to see if it signals something “really strange,” said Prof. Davies. Scientists are also working on better and faster diagnostic tests.

Prof. Davies and other scientists envision searching for new pathogens when they silently circulate in a population, such as looking for genomes in wastewater at potential hot spots, rather than waiting for people to get sick and request tests. Several groups, including Northeastern University, are already testing wastewater for the novel coronavirus.

Another way to see what pathogens are spreading is a “global immunology observatory” of blood samples, said Michael Mina, epidemiologist and immunologist at Harvard T.H. Chan School of Public Health, who proposed the idea in a paper earlier this year. It would regularly scan blood samples in all major cities around the world for antibodies showing which diseases people have been exposed to, known and unknown diseases, he said.

If a public health surveillance system like that had been in place in the United States earlier this year, when no diagnostic tests were widely available, it would have shown that Covid-19 was spreading, Dr. Mina.

“It would have been abundantly clear that the virus was spreading to New York,” he said. “This could potentially have saved tens of thousands of lives.”

An infectious disease prediction center, modeled after the National Weather Service, will project how an outbreak will develop, helping public health officials know how to respond, said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.

Vaccines and drugs against Covid-19 are being developed in record time. Not so for people suffering from job loss, closures and long months of social distancing. Next time they will have to go faster and be ready before a virus spreads globally, said Dr. Farrar. With Covid-19, it took about 100 days, he said. “This is the pace that determines what we need to do,” he said.

The vaccines will be ready soon next time, predicted Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations, a global partnership that funds the development of vaccines for epidemic diseases.

Many are made using new technologies, Dr. Hatchett said. Once approved by regulators, these technologies can be used to make future vaccines, he said. The process will be much faster. The “platform technologies” they use, such as viral vectors or protein delivery systems, are essentially building blocks for a vaccine, to which sequences of new pathogens are then added, saving time.

After the pandemic, “We could have half a dozen new vaccine technologies,” said Dr. Hatchett. “It’s a turning point. The pandemic will have done in a year or 18 months what we could only have aspired to do in the next decade.”

This approach could also be used to develop drugs, the scientists said, especially antibody-based treatments, which proved potent against Ebola in a clinical trial last year and were also developed for Covid-19.

NIAID scientists are studying common characteristics within virus families to develop vaccines and therapies that would work against any new ones, Dr Fauci said. “We absolutely need a universal coronavirus vaccine, and that is not out of the question,” he said.

Countries that brought Covid-19 under control have strong public health systems. Many of them have learned from the United States how to build them. Now, some are giving lectures for the United States

Vietnam, with the help of US health officials, has built stronger outbreak detection and response capabilities after battling severe acute respiratory syndrome, or SARS, in 2003. The country has reported just over 1,100 cases of Covid- 19 and 35 deaths.

Officials began screening for possible cases in early January and quickly isolated the sick, said Pham Quang Thai, an epidemiologist at the National Institute of Hygiene and Epidemiology of Vietnam and a member of an outbreak control committee for the Ministry. of health. They track down people who have been exposed and their contacts. Anyone who enters the country is quarantined.

In the United States, Vermont implemented restrictions and closures to slow the spread of the virus when it had a handful of confirmed cases. The state hired contact detectors to help keep the outbreaks under control.

Today, Vermont has one of the lowest rates of positive Covid-19 tests in the nation. But it is at constant risk if visitors import the virus from other areas where transmission is present. So Vermont requires those visitors to quarantine before or when they arrive in the state.

A national travel restriction and quarantine policy would more effectively keep the virus contained, said Mark Levine, Vermont health commissioner. National coordination would also ensure that tests and supplies are distributed equally to states, he said. “This cannot be a state-by-state bulk proposal,” he said.

Prevention and public health are a smaller part of health budgets in the United States than in other countries, said Dr. Levine.

Hospitals need better systems to ensure the provision of protective equipment and quickly find beds when there is a surge of patients.

The thousands of contact tracers nationwide could be kept permanently active after the end of the pandemic to provide basic health services to the community, said Johns Hopkins’ Dr Rivers. They could help people with underlying medical conditions, whose rates of serious illness and death from Covid-19 have been high, access treatment quickly.

“I think it would be a missed opportunity if we hire all these contact locators for Covid and then when the emergency is over we let them go,” he said.

This would require funding for thousands of extra workers, a challenge for current local and state budgets.

“There will be things with increasing frequency that come our way, and we need to be prepared for that,” said Dr. Levine. “If we fail now, I cringe at the thought of what will happen.”

Write to Betsy McKay at betsy.mckay@wsj.com

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