March 09, 2022
Many parts of the United States, including the Philadelphia region, have lifted most COVID-19 restrictions in response to declining cases and hospitalizations. But a group of health experts have provided a reality check on what the future might hold.
In a 136-page report, the experts laid out a detailed road map to the "next normal," a period when COVID-19 becomes endemic. But with COVID-19 deaths still 10 times higher than those caused by seasonal respiratory viruses, like the flu, they emphasized that the U.S. is still far from getting "back to normal."
The report was written by 23 scientists, doctors and public health experts. Several served on President Joe Biden's COVID-19 transition team, including Dr. Ezekiel J. Emanuel, vice provost of global initiatives at the University of Pennsylvania.
Two other Penn professors – Dolores Albarracín and E. John Wherry – and Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, also are among the authors. William Hite, superintendent of the School District of Philadelphia, was among 30 other contributors.
Their report echoes the message of Dr. Anthony Fauci, the chief medical advisor to the White House – that the U.S. only can return to a sense of normalcy when the disease burden is similar to that of other viruses.
The "next normal" will arrive when the U.S. can live with the coronavirus, but without major disruptions to daily life, like the emergency mitigation measures seen during the last two years, the authors wrote.
In past years, bad seasons of respiratory viruses, including the flu and respiratory syncytial virus, have led to as many as 1,150 deaths per week without the restrictions implemented during the COVID-19 pandemic.
However, the rate of COVID-19 deaths remains much higher than that number. Some weekly death tolls have been as high as 12,000 people. Last week more than 9,000 people died from the virus, according to the U.S. Centers for Disease Control and Prevention.
"Make no mistake, the United States is far from a normal situation," the authors wrote.
The authors outlined several possible scenarios for the future. In the most optimistic scenario, annual death totals might be as low as 20,000 due to higher population immunity through vaccination and infection rates.
In a more pessimistic scenario, as many as 264,000 people could die from COVID-19 between now and March 2023. This could occur if a new variant infects about 80% of the U.S. population, with 0.1% of those infected dying.
Even in that scenario, however, the loss of life would be less than what the country has suffered in the last two years of the pandemic.
While data points to the pandemic improving, the authors warned against celebrating too prematurely. They said there is still much work to be done to protect the country not only from COVID-19, but other diseases as well.
In the report, they outlined major investments the U.S. should make to better manage COVID-19 in the future. They recommend the White House create a position on the National Security Council to advise the president on pandemic threats. They said the U.S. also should invest in a multi-drug, oral antiviral cocktail since it is expected that the virus will develop resistance to any single drug.
The authors said the U.S. needs a better system to provide easy access to testing for respiratory illnesses and quick prescriptions to antiviral drugs that target particular viruses.
The report also called for greater investments in public health. That includes creating an infectious diseases dashboard to help national, state and local leaders introduce, modify or lift public health measures. Stricter building codes for better air ventilation and more research into long COVID are needed, too.
"This report hopes to influence critical decisions that must be made to positively affect the future of U.S. security, economic and health care planning," Emanuel, who spearheaded the writing of the report, told Forbes.
The report also addressed the fatigue people are feeling in regard to the pandemic.
"Some think that we are finished with this pandemic, but, with 1,500 deaths a day – we are not," Rick Bright, CEO of the Pandemic Prevention Institute, told Forbes. "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."
The authors wanted to provide this blueprint now partly due to concerns that Russia's invasion of Ukraine will divert attention and resources from controlling the coronavirus and planning for future pandemics.
"I do think it's a worry," Emanuel told STAT. "And part of the reason to lay this out is to emphasize that that would be a huge mistake, and a really, really serious flaw."