A Plan For Covid-19 The Next Normal: Part 1 - A Roadmap

By Steve Brozak for Forbes, Mar 7, 2022

Getting to and Sustaining the?Next Normal: A Roadmap for Living with COVID?is a blueprint written by a who’s who of health, scientific, and policy experts as a comprehensive report to set us on the path to the “next normal” with?Covid-19. The group, assembled and orchestrated by?Dr. Ezekiel Emanuel, is the most detailed attempt to once and for all confront the threat that Covid-19 still presents. This report comes not a moment too soon, as we are hungering for a return to pre-pandemic times. And lest we develop a collective amnesia during this?Omicron?wave respite, this is a must read for not only our political leaders, but every person whose life has been altered by this deadly virus.

Following both?President Biden’s State of the Union?address and the?Covid-19 White House Response Team?press briefings, the 136-page report examines everything from future Covid-19 scenarios to the health and morale of our healthcare workforce. This Covid-19 Strategic Roadmap, is the brainchild of Dr Emanuel, who said in an interview, “this report hopes to influence critical decisions that must be made to positively affect the future of US security, economic and healthcare planning.”

This is all juxtaposed in a global environment where we are experiencing the greatest possible super-spreader event of this pandemic. I refer to the mass evacuation of more than 1.5-million people from Ukraine. Very few, if any of these refugees are wearing masks or practicing social distancing as they stand in endless lines or cram into packed shelters and trains.

The report quickly raises two serious pandemic complications. The first is?fatigue. People are tired of Covid-19 and its attendant restrictions. The second is the ability of the rapidly adapting virus to?surprise?the experts. The latter makes predicting new variants and variant behavior extremely difficult. Because of this uncertainty, effects on schools, lifestyle, work, and the economy are reduced to educated guesses based on past behavior.

Again, infections and deaths in the US have declined from their February highs. But as one of the authors,?Dr. Rick Bright?reminds us, “some think that we are finished with this pandemic, but, with 1,500 deaths a day - we are not. Many of us are done with the virus, but the virus is certainly not done with us. This is the moment when we need to identify the right tools and approaches to address this pandemic and any future pathogen threat.”

Learning from our Covid-19 missteps, the report calls for establishing a Deputy Assistant to the President for Biosecurity (DAP-B). The Deputy Assistant would manage national pandemic policy coordination and prevention efforts, including communications. If the past two years have taught us one thing, it is the importance of clear and consistent messaging. Misinformation and disinformation, not only cause confusion, they also spawn conspiracy theories and pseudo-medical claims that thwart coordinated responses.

In its Executive Summary, the report outlines twelve fundamental elements. Here is an outline of five of them giving a multi-faceted approach for the next normal:

1. We know extraordinarily little about Post-Acute Covid-19 Syndrome (PACS) also known as long-Covid. A significant percentage of patients who recover from acute infection (including those who did?not?require hospitalization and those who were asymptomatic) develop long-term symptoms. Persistent symptoms of fatigue, respiratory difficulties, and cognitive difficulties (brain fog) limit one’s ability to perform daily activities. Such patients may be unable to return to work. Those affected by long-Covid represent a new category of patients, requiring chronic care and support. The toll on our workforce and economy has yet to be calculated. The group calls for concentrated study of long-Covid patients to determine causation and improve diagnosis and treatment of those affected
2. Creating an infectious diseases dashboard to guide both the public and policymakers at the national, state, and local levels on the need to introduce, modify, or lift public health measures is essential. Such a dashboard would provide?“guidance on the distribution of therapeutics and other special protections for the immunocompromised, elderly, and other vulnerable populations.”
3. Accurate, transparent, and accessible data is a basic requirement if we hope to reach the next normal. To this end, the report delineates the need for a robust data infrastructure with information gathered through increased testing and surveillance. Key to this element is?“standardization.” With standardization we will be able to analyze and compare region to region and sub-population to sub-population. This will promote better health equity and avoid creation of health care?deserts.
4. Viruses are often transmitted through the air we breathe. To address this reality the report asks the?“Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) to develop standards to improve indoor air quality.” Again, standardization is essential. Such measures would apply to schools, childcare facilities, private and public buildings. Improved air quality will not only reduce viral transmission but will also offer the potential to reduce the severity of conditions such as asthma and seasonal allergies caused by airborne irritants.
5. Vaccines, monoclonal therapeutics, anti-inflammatory therapeutics and now antivirals have given us considerable defense in this pandemic. However, they are not panaceas. The group advocates for support of new and better therapeutic designs developed through creative thinking. This is needed because of the discovery that additional damage from Covid-19 and other diseases is caused by a disruption of our immune system. An out-of-control (hyperactive) immune response is as damaging as a deficient immune response. Interrupting or preventing immune system hyperactivation through therapeutics has the potential to mitigate the damage of not just Covid-19 but also a host of other diseases. The development of new therapeutics will require a collaborative effort between the public and private sectors. Innovation comes from such undertakings. We must be mindful that availability is different from access and access for all at-risk groups is a fundamental aspect of new discoveries which must be considered.

Other report chapters outline specific action plans for implementation of the fundamentals. To date, we have not seen a clearer presentation. It is the result of collaboration of authorities from multiple areas of expertise. This report does not take the form of a fiat but that of a consensus. Consensus on best practices will lead to the next normal; anything less will keep us riding one wave of infection after the other.

This might be considered an expensive proposition. One might justifiably ask where is all this money to come from to support this effort? The answer is simply that this investment is the only way to safeguard our present and future existence. We cannot afford to do otherwise, lest we continue to repeat the experiences of the last two years. We cannot be blasé and assume that this will pass and that there will not be another threat to our health and well-being. In short, we cannot afford to do otherwise.

The next installment will be:?A Plan For Covid-19 The Next Normal: Part 2 - Therapeutics.

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