COVID: The predictable, unpredictable pandemic

A great deal of what has happened in the last year with COVID- 19 was both predictable and preventable. In fact, some infectious disease researchers did predict more than five years ago that a coronavirus could cause a global pandemic.

Still, the unexpected transmissibility of the virus combined with its ability to spread by asymptomatic carriers caught our global public health community largely off- guard. After one year of living amid COVID- 19, there are important lessons we have learned and those we still need to master to get this pandemic under control in 2021.

Public health officials and researchers for decades have cried out into the wilderness about the underfunding of and lack of infrastructure for public health. Watching the consequences of those decades of neglect in 2020 was heartbreaking. These failures were no surprise to many in our public health and health care systems who knew how truly fragile our nation’s health is.

Yet to see handwashing and face coverings take on such prominence in our daily lives is refreshing and not likely to disappear soon. Wearing face coverings more regularly, especially when feeling under the weather, and more people pursuing careers in medicine and public health will remain in vogue long after we reach herd immunity. Globally, we have gained an appreciation for public health and hygiene that was long overdue and I expect will remain for many years to come.

We have learned that if the global scientific community decides to marshal all its resources to solve a particular scientific challenge, it can do so — and with unprecedented success and speed. Developing not one but three COVID- 19 vaccines in under a year is something that most early last year doubted could be done.

Our scientists and laboratories, our pharmaceutical industry and our entire global supply chain can unite to solve global- scale problems when we rally around a common goal. One hopes that it won’t take another global catastrophe for the world to unite around other global causes such as clean water or climate change.

Yet for all we have learned about public health and infection control to stop the spread of COVID- 19 in the last year, the fight against this virus ( and others lurking in animal populations in the world) is far from over. As we closed out our first year living with COVID- 19, the virus began to show it could fight back with a vengeance with the appearance of a new variant with super- spreading capability. We should expect that this virus will continue to mutate ( hopefully not too much) as it finds new human hosts and continues to challenge our immune systems — and our health systems, as well.

Today, we are fighting to overcome our lack of health care infrastructure and coordination to engage in a speedy vaccine rollout nationwide. Our state- bystate system of managing and monitoring public health absent a strong, clear federal strategy and playbook has plagued us ( pun intended) tremendously.

We cannot continue to operate our health care systems with overflowing ICUs and burned- out health care providers. 2021 will bring tough choices, as we have seen in other countries, about lockdowns and economic tradeoffs. No one can predict how durable our immunity to COVID- 19 will be. But we need to know so we can make longterm plans for ongoing vaccination and health care delivery under less strenuous circumstances.

COVID- 19 may have been the first global pandemic in more than 100 years, but we know it will not be the last.

Many of the improvements and advances we have made this year will strengthen our public health systems for years to come. We cannot predict when the next pandemic will happen or when this one will end, but we do know much more now about what we need to do to control it.