COVID-19: Where do we go from here?

Infectious disease threats have been a part of the human experience since the first human took a step on earth. Every day we deal with myriad potential infectious threats that are present in our environment. We also must contend with emergent strains that emerge relatively frequently, such as COVID-19. Certainly, we know that every year will bring a new strain of flu. In response to COVID-19, we took the unprecedented step of quarantining the healthy. The impact of that approach on the world’s economy has been profoundly negative. Importantly, the negative impact on the US health care system has been immediate and will be prolonged and is and will degrading our health care delivery system. That the costs of the response to COVID-19 are extraordinary is not debatable. What is highly questionable is whether there were any benefits that derived from this unprecedented approach.

Tragically, we also experimented with a leaderless approach to responding to an emergent infectious threat on both a worldwide and national level. There can be little debate that the failure of the US government to play a leadership role both internationally and domestically has contributed to the chaos, which in turn has meant that more lives were lost, and greater economic burdens ensued. Arguably, more ominous long term is that the lack of worldwide leadership has led to worsening of nationalism and factionalism that increase the risk a significant destabilization of world order. Consider the impact of the economic losses on the economies of the oil producing countries like Iran and Saudi Arabia. Further destabilization of the Middle East is in no one’s interest. And here at home, we have witnessed Governors closing states to travelers from other states, suing city officials for requiring masks to be worn in populace areas and exacerbation of the rift between science and technology and non-scientists. If another epidemic ensues this winter-which is likely, how far will this factionalism go if we take another leaderless approach? We simply can’t take that risk.

Sadly, the failed response to COVID-19 has suggested that humans are at a more heightened risk of infectious agents than in the past. Nothing could be further from the truth. We live a time of privilege. Arguably, the greatest miracle delivered by the pharmaceutical industry is the virtual eradication of many infectious scourges that killed the young, the old, the healthy and the compromised generation after generation. In the developed world, almost no one dies of the bacterial infections that killed billions of humans in earlier generations. (Yes, there are drug-resistant strains, but just look to the childhood deaths from bacterial infection through the 1940s). Numerous viral illnesses have been eliminated with effective vaccination efforts. No more measles, mumps, polio, and other illnesses that killed many even into the 1960s and 70s. We even responded to the very challenging emergent threat of AIDS with highly effective treatments. We have minimized the impact of infectious threats in an extraordinary way.

But the world has changed. The economies of the world are interlocked and interdependent, travel around the world is constant, we share the same Earth with ever growing numbers of other humans, meaning that the spread of infectious diseases can be much faster than even our parents experienced. We also know more. In fact, this is the first decade when genomics enables the rapid identification of new infectious life forms such as we experienced with COVID-19. So, we know more and that is great. But knowledge without the wisdom and leadership to put the threat in context and to respond simply heightens fear and factionalism. Sadly, we are seeing those frightening responses in abundance with COVID-19.

We are urgently in need of leadership that recognizes that infectious disease threats are a constant and the new risks emerges constantly. We must do better, and I propose that we take a few commonsense steps that begin with the simple fact that infectious agents are threats to our species that know no boundaries. These are not the EU’s of the US’s or China's problems any more than they are Atlanta’s problems and they must be dealt with globally.

First, convene a world-wide group to leaders to develop global guidelines and create a global response. This group should include experts in infectious diseases and epidemiology, but the group cannot be myopic. It must have experts in health care delivery and non-infectious disease representatives to assure that in trying to reduce an infectious disease threat, we don’t make other disease outcomes worse or do greater harm to the world’s health care systems. It needs economists and business leaders, experts in finance as well because all of these elements are intertwined and must be considered. This is not a problem that can be managed effectively without scientists and physicians. Nor is it a problem that can be left solely to the discretion of the scientific and medical specialist because of the interdependence of all systems in the modern world.

Once that group presence a consensus report that outlines appropriate measures, then a permanent group needs to be put together and empowered to provide global guidelines for dealing with emergent threats in real time on a global basis. This could be managed by the WHO, but perhaps it would better if it were independent and would report directly to the most senior national leaders responsible for major populations.