The USA was hit hard by the COVID-19 pandemic. What insights have been made, what actions have been taken, what are the new strategies and how is the country preparing for the next one?

The world has suffered immensely over the past three years as leaders have navigated their way through a never-before-seen health crisis. In the United States of America alone, by April 2023, more than 104 million COVID-19 cases had been recorded and 1.12 million Americans had lost their lives. As part of another unfolding crisis, at least 140,000 U.S. children were left orphaned by the pandemic, according to estimates.

Good medical response and a somewhat confused public health response. Initially it was treated like influenza, and the U.S. political response was not effective.”

In assessing America’s overall approach to the pandemic, Dr. William Haseltine, founder, chairman and CEO of Human Genome Sciences, and a scientist known for his research on HIV and cancer said, “Good medical response and a somewhat confused public health response. Initially it was treated like influenza, and the U.S. political response was not effective.”

 

William Haseltine, founder, Chairman and CEO, Human Genome Sciences. Photo: The Aspen Ideas Festival

 

Prepare, prepare, prepare

After three years, the worst of the COVID-19 pandemic may be over worldwide, but most scientists know that a COVID variant, or an even more lethal virus, could surface without warning. There is no time to waste in assessing what worked in combatting the coronavirus and what could have been done better.

For the future, those in research, healthcare and government in the U.S. are stressing a basic strategy: prepare, prepare, prepare. That means stockpiling drugs, vaccines, and personal protective equipment (PPE), developing more medications to treat viruses, creating new supply chains, and having the ability and resources to quickly mobilize personnel.

While some lessons are clear, that does not mean changes will be easy.

“Everyone now is more aware of the dangers of viruses, and we learned of deficiencies in the public health service,” says Haseltine. “But to know the problems is not necessarily to solve them.”

Stronger to move forward faster

Dr. Dawn O’Connell, Assistant Secretary for the U.S. government agency Administration for Strategic Preparedness and Response (ASPR), said in an interview with news outlet Axios that she is striving to apply lessons learned during the pandemic “to make sure the U.S. Department of Health and Human Services (HHS) is better positioned and stronger to move forward faster with whatever comes next.”

At the administrative level, among the efforts so far has been the decision in 2022 to make ASPR an Operating Division within HHS, which means that ASPR takes the lead on medical and public health preparedness in responding to disasters and other public health emergencies. “This move enables ASPR to mount a coordinated national response more efficiently and effectively during an emergency and gives the agency greater operational capabilities,” states O’Connell.

In addition, the U.S. Congress provided funding to investigate domestic manufacturing, so the nation would not be as dependent on overseas supply chains for critical equipment.”

The Strategic National Stockpile is a critical component in the U.S. response infrastructure, continues O’Connell. “We’ve been able to restock the Strategic National Stockpile so it will have PPE ready and available to go for anything that might come,” she says. “In addition, the U.S. Congress provided funding to investigate domestic manufacturing, so the nation would not be as dependent on overseas supply chains for critical equipment.”

In terms of funding in the next fiscal year, ASPR is seeking 4.3 billion USD in discretionary money from the federal budget, an increase of more than 642 million USD. Included in that is 400 million USD in new funding for pandemic preparedness and biodefense.

Agencies also are anticipating the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA) by Congress before the end of the 2023 fiscal year. The newest version could add more accountability to preparing for pandemics and improve coordination among government agencies.

Problem will continue if it’s not addressed

Some are concerned, however, that new procedures will not get past the planning stages. “Hopefully, some lessons will not be just observed, but learned,” says Dr. Gigi Kwik Gronvall, an immunologist and Senior Scholar at the Johns Hopkins Center for Health Security and associate professor with the department of Environmental Health and Engineering at Johns Hopkins University.

“Lessons learned do not mean solutions will be forthcoming,” notes Haseltine.

One of the biggest problems with the U.S. pandemic response was the delay in providing tests, Gronvall says. Rather than authorizing private labs to develop a test for the virus, the government initially chose to rely on its own test, but the number of tests produced was inadequate for the demand.

The days when people didn’t need a diagnosis are long gone. We’ve reached a different space, and we expect tests to be available and useful.”

“That problem will continue if it’s not addressed,” she says. “People need to know if they are potentially infected. The days when people didn’t need a diagnosis are long gone. We’ve reached a different space, and we expect tests to be available and useful.”

Exploring new supply chains is critical, because of the problem of multiple countries relying on the same handful of sources, she agrees.

 

Left: Gigi Kwik Gronvall, immunologist and Senior Scholar, the Johns Hopkins Center for Health Security and associate professor, the Department of Environmental Health and Engineering, Johns Hopkins University. Photo: Larry Canner. Right: Dawn O’Connell, Assistant Secretary, the US government agency Administration for Strategic Preparedness and Response (ASPR).

 

Vaccines are not the only answer

Since COVID may be here to stay, other treatments besides vaccines also need to be developed, according to Haseltine. “I can understand why people like vaccines,” he says. “They are easy and quick, but vaccines are not the only answer to this type of tricky virus.”

While vaccines provide some protection from these new, lethal viruses, eradicating them is difficult and the USA and the rest of the world should focus more on creating effective anti-viral drugs. “Currently there is only one drug to treat COVID. The world is now inhabited by a new, dangerous variation of a virus that is at least two or three times as lethal as influenza, and it is recurring,” says Haseltine. “Effective anti-viral drugs are now allowing HIV-positive people to live near-normal lives, for example, even though the virus cannot be cured.”

Because COVID mutates more quickly than anticipated, vaccines rapidly become ineffective for the latest variants. Neither vaccines nor previous infections provide complete immunity, adds Haseltine. “Through anti-viral drugs, the virus can be controlled, but those require time and intense research to develop. It’s a solvable problem, but we’re not solving it.”

Protective measures

Another critical area under review is improving measures to protect people, mostly the elderly, in assisted living facilities and nursing homes during outbreaks.

“In the long-term care environment, there were a lot of deaths before the vaccine,” says Patricia Jackson, President of the Association for Professionals in Infection Control and Epidemiology (APIC). “We have to build the infection-prevention work force and make sure they are properly trained.”

Among the areas that are being evaluated for care facilities are cleaning practices, testing protocols, and ensuring staff have sufficient protective equipment and can recognize symptoms of COVID or other viruses and quickly separate residents from other people.

Someone needs to take charge to make sure each step is done correctly so they can prevent infections.”

“Someone needs to take charge to make sure each step is done correctly so they can prevent infections. APIC also has gone on record urging the development of more diverse supply chains and ensuring health care workers have the next generation of PPE,” says Jackson.

 

Left: Patricia Jackson, President, the Association for Professionals in Infection Control and Epidemiology (APIC). Right: New York City, USA, 2 May 2020.

 

Opportunities to learn from our mistakes

Long-term and more difficult problems that need addressing include correcting the misinformation that arose about the virus, Gronvall says, and cracking down on illegal animal markets worldwide. “Animal markets in China and other countries keep a variety of animals close together in cages with minimal sanitary measures, making it easy for viruses to spread among animals and eventually to humans,” she says.

More effective strategies for responding to pandemics will continue to evolve, continues Gronvall.

“It’s going to be the same way it was after 9/11 [the Sept. 11 2001 terrorist attacks]. Major changes took a while to happen after that. We have time, we are going to have future disease threats. We definitely will have more opportunities to learn from our mistakes.”