4) Prepare now.
Disease surveillance capabilities, governmentwide coordination, the stockpiling of medical supplies and the ability to maintain resilient supply chains are essential preparations.
5) Reliable, real-time data is vital.
Data that enables public officials to track a virus also enables them to respond quickly to local outbreaks. But in the United States, a disjointed and poorly funded public health system and fragmented health delivery made collecting data challenging. This difficulty was exacerbated because public and private health systems did not provide complete data to state and local public health agencies. The federal government lacks authority to require real-time data collection unless there is an emergency. The federal government should mandate or create strong incentives for the timely reporting of uniform data by states and localities to a central, open-access data repository, which is essential for an effective response.
6) We know how to reduce the spread of airborne viruses like Covid.
Inexplicably, the World Health Organization and the Centers for Disease Control and Prevention had been very reluctant initially to embrace the reality that the SARS-CoV-2 virus, like most respiratory viruses, could spread through the air by microscopic particles and remain suspended and travel beyond a close group of people, otherwise known as airborne transmission. This viral transmission can be reduced through the use of high quality N95 or KN95 respirators, by being outdoors and, when indoors, by increasing ventilation and improving indoor air filtration. The federal government needs to provide incentives to local governments to update their building codes to require better indoor air quality.
7) Vaccines reduce serious disease, but are unlikely to prevent transmission. New therapeutics are needed.
Vaccinated people are far less likely to get seriously ill or die from Covid than those who are unvaccinated. Many people also benefit from boosters. While the vaccines have reduced the risk of hospitalization and death, we need to develop vaccines that induce broad-spectrum and long-lasting immunity to protect against rapidly mutating viruses. We also need to develop additional monoclonal antibodies, treatments necessary for immune compromised individuals who don’t respond well to vaccines, and broad-spectrum antiviral medications to inhibit the replication of a wide range of viruses.
8) Responses should be tailored to local circumstances.
Over the last three years, the virus sometimes spread nationally and other times was limited to a few regions of the country. Viral surges repeatedly erupted in some areas but not others. The appropriate public health response should be modulated and based on viral prevalence, vaccination rates and other circumstances at the local level. Federal coordination is important, but we should rely on locally nuanced responses.
9) School should not be interrupted or placed online except in rare circumstances.
In-person education can continue during a respiratory pandemic like Covid, even before a vaccine is developed. Among other things, this would require: improved indoor air quality by opening windows and using better HVAC and enhanced filtration systems; managing how lunch and other group activities are conducted; testing for infections; and wearing high-quality masks during surges. When vaccines become available, teachers and students should be prioritized, although as some countries showed, schools could reopen without vaccines by employing those other public health interventions. In the most severe outbreaks or those particularly deadly for children, closing schools temporarily may be necessary.