Tough questions of pandemic will be solved with generosity

Co-operation promotes answers, Kevin Keough says.

During this pandemic, officials have applied the tried-and-true mechanisms of public health to manage the problem: quarantine, isolation, contact tracing and testing.

The first two lines of defence against a new virus such as SARS–COV2, the cause of COVID -19, are quarantine and isolation. They have been used effectively for a millennium or more.

In this pandemic, they have saved countless lives and our critical care systems. But in this modern, interconnected world, their use rapidly generates major widespread negative consequences such as the breakdown of the economy, delays in health-care delivery and increasing challenges to mental health. Of course, the same negative consequences would have occurred, likely with worse impact, in the absence of the containment measures.

So, a challenge for society is to generate modifications to quarantine and isolation that enable positive effects while avoiding the negative consequences such as severe economic setbacks. This presents a formidable or wicked problem, but it should not be beyond solution in the 21st century. It is likely that changes in how these measures are applied will result from the inevitable evaluations that will follow the resolution of the current crisis, but we need to have a more profound consideration of the issues that will emerge just from hindsight.

There are deep questions for scientists, humanists and policy-makers embedded in the challenge. Collectively, we should be able to dissect this problem and find effective solutions that respond to the challenge.

Some processes will be improved by having better-resourced public health systems and more fully equipped critical care systems.

More resilient plans for emergency isolation in hospitals that allow for non-urgent but important treatments to continue could be developed. There could be new ways to protect health care and other essential workers. Can we develop better ways to estimate risk and apply these in management systems? Are there ways to ensure more fulsome compliance with public health measures especially as initial fear abates?

It should be possible to develop timely targeted risk-based implementation and withdrawal of measures to hold epidemics in check, but these will likely require new targeted research. It should be possible to have a larger armament of therapeutics that might be tested quickly against a new virus. We could have well-developed, ethically acceptable risk-based clinical trial methodologies on hand for testing of drugs and vaccines. Could we develop broad-spectrum vaccines that would act against a range of strains of a virus or even against a range of viruses?

There will be a need for more public-private partnerships to ensure that therapeutics are made and delivered quickly. Using artificial intelligence to forecast and inform early decision-making is essential. The company Blue

Dot and the Public Health Agency of Canada, for example, have such systems, but they could be refined and adapted to internal country use.

Tracking systems need improvement through technology. There are cellphone-based systems now being used, but they need refinement. Serious consideration of how these can be reconciled with privacy concerns is needed.

And what about those who do not use these technologies? There are myriad questions, and finding answers will be expensive, but consider the costs of not having them on hand when the next pandemic occurs. And there will be a next time.

We can expect that answers will come from the new Centre for Pandemic Preparedness and Health Emergencies Research recently announced by the federal government. There are exceptional opportunities for collaboration across research disciplines and across civil society to reach a new model for dealing with novel infectious diseases. Fear and generosity have propelled society to interim success in handling the current pandemic. One hopes that as fear dissipates, generosity will remain so that new solutions for such thorny questions will be found.