It was March 2020 when the reality of the Covid-19 pandemic hit home in the U.S. When the NBA suspended its season, it seemed to give permission for other closures and stay-at-home orders, and they quickly followed. At that point, there had only been around 3,000 confirmed cases of the disease and about 60 confirmed Covid deaths.
Fast-forward two years, and the numbers are staggering. According to estimates from Johns Hopkins University, as of Wednesday there have been over 79 million confirmed Covid cases and over 960,000 deaths. Several million have been hospitalized and millions more have reported symptoms that linger for weeks or even months, with unknown consequences moving into the future.
“It’s massively higher than I thought,” says Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. “Particularly when in November 2020 the announcement came out that we had a vaccine that was 95% effective.”
Amanda Castel, a professor of epidemiology at George Washington University’s Milken Institute School of Public Health, said in an email that she’s also surprised that the pandemic is still going, compared to her initial expectation. “In retrospect, I think I was hopeful that it would be more self-limited, like the SARS pandemic.”
The worst of the pandemic is behind us, experts told Forbes, in part because the first two years provided valuable tools for the continued fight against both Covid and future disease epidemics. Ignoring the pandemic in lower-income countries, they say, could mean new variants making their way back to the U.S.
One lesson the experts didn’t expect to learn was how polarizing the response to the pandemic could be, especially as time went on. “I was surprised and alarmed to see how politically polarized Covid-19 responses have become, with some U.S. states (most recently Florida) promoting public health policies that directly oppose the science (and common sense),” Steffanie Strathdee, associate dean of global health sciences at the University of California, San Diego, said in an email.
The depth and intensity of political anger against public health officials was also jarring, says Castel. “To think that many public health leaders at the local, state and national level received death threats and lawsuits because of the evidence-based guidance they issued is appalling.”
“It’s tragic, because the outcomes of that were that hundreds of thousands of people died, who would not have died, if the response had been less political and more governed by the best science,” Wachter adds.
Wachter also says it’s hard to fathom the size of anti-vaccine sentiment based on what things looked like before the pandemic. “The anti-vax movement was previously pretty small and fringe,” he says. “And it was as likely to come from the left as the right—maybe even more likely to come from the left.”
The worst of the pandemic is (probably) behind us
“Years three and four will, hopefully, see a transition of Covid-19 from an emergent condition to an ongoing public health challenge with significantly less morbidity and mortality,” Anand Parekh, chief medical advisor for the Bipartisan Policy Center, says in an email. But not if it’s left to itself, he’s quick to add. “This would require easy access to prevention, testing and treatment.”
“I think the likeliest path will be a version of where we are now,” says Wachter. “With small surges that will not be overwhelming and be regional, partly related to seasonality, maybe partly related to vaccine status in different regions.”
The biggest unknown about this prediction, of course, is whether a new Covid variant emerges, which Strathdee warns is an increased risk if high-income countries choose to ignore the pandemic in the rest of the world. “If we don’t ensure that new medical advances such as vaccines and therapeutics reach the lower- and middle-income countries, new variants will emerge that threaten us all.”
Long Covid will have a potentially long impact
A potentially bigger challenge than surges of new infections in pandemic year three, says Wachter, are the still mostly unknown impacts of long Covid. If it turns out that, as some preliminary estimates suggest, as many as 10% to 20% of people experience lingering symptoms, “that’s tens of millions of people, and that’ll have an impact on the workforce and that’ll have an impact on economic performance.”
Long Covid will take a potential toll on the healthcare system as well, adds Castel. “Until we learn more about how to prevent and treat long Covid, we can anticipate a large burden on the healthcare system for the near future.”
“The high prevalence of long Covid stands to cause significant disability,” Strathdee says. “which affects both mental and physical health, including quality of life. I don’t think we’ve got a good handle yet on how big this problem may be.”
One major concern, says Wachter, is that unlike most respiratory diseases, early studies are warning that Covid may cause long-term health problems. A recent study said that people with even mild Covid showed more incidents of brain damage compared with those uninfected. Another finding: People infected with Covid have higher rates of heart attack and strokes. “If that turns out to be real, you’re talking about a new risk factor in almost 40% of the population,” he says. “A risk factor that may be as potent, as if people have high blood pressure or if they smoke. And that’s a very big deal.”
The tool kit for the next disease surge
Health experts agree that Covid-19 is likely to be around for a long time, and it’s also not going to be the last pandemic. The past two years, they say, have provided a lot of insight into what needs to be done to prepare for the next deadly disease surge.
When it comes to respiratory viruses like Covid, “We need to keep good-fitting N95 face masks, HEPA filters and good old soap and water,” says Strathdee.
“Masks should have been consistently recommended early on in the pandemic, as other countries did,” Parekh agrees. Castel concurs. “Masks are simple to use, relatively easy to obtain, and have proven to be effective in both protecting the wearer and those around them.”
Another key tool for combating future epidemics is testing, Wachter says. “We clearly made a terrible error early on in not working hard to get good tests out there more quickly,” he says. “And particularly, I think we were very late on home testing, both developing them and distributing them.”
One crucial factor that emerged to combat Covid, says Esther Krofah, executive director of FasterCures and the Center for Public Health at the Milken Institute, was research collaboration between scientists, companies and governments to produce vaccines and therapeutics quickly. That’s something she hopes doesn’t go away. “We need to ensure we build sustainable infrastructure to continue such collaboration,” she says, “and move forward efforts to change the culture in medical research to align with the urgent needs of patients.”
Experts do suggest rethinking one of the most contentious aspects of the pandemic response: school closures. “One of the real lessons learned is the negative impact of school closures on kids,” says Wachter. “And I think it will influence our response the next time.”
“Virtual schooling, while necessary intermittently, will need to be more closely considered in the future taking into account the virus’ epidemiology, risk to students and staff, and considerations for childcare/parental workforce,” says Parekh.
Hospitals need to be better prepared for future surges
Covid-19 hit hospitals extremely hard, overworking doctors and nurses to the point of burnout during pandemic surges, as intensive care units and other departments were pushed to capacity and beyond. This means that hospitals will need to work on building their surge capacity, experts say.
“Stockpiling and distributing critical medical material, deploying surge medical staff and ensuring that healthcare systems through federal grants are exercising their response plans are all critical,” Parekh says.
A major challenge for hospitals, says Wachter, will be getting extra capacity in place without breaking the bank. “Nobody’s going to be able to afford to keep a lot of excess bed capacity available, or a lot of excess nursing and doctor capacity,” he says. However, what hospitals can do is better stockpile equipment and protective clothing for healthcare workers. “The things that are not wildly expensive but you do want to have in the basement.”
In addition to better preparing for surges, hospitals also need to be better at identifying threats early so public health measures can be put in place, says Strathdee. “Public health departments and hospitals need to be better equipped to conduct surveillance, which includes systems for timely reporting.”
Castel encourages closer communication between hospitals and public health officials. “Hospitals are often sentinel sites and the first place that persons infected with these illnesses seek care, therefore they must have the capacity to work closely with public health to assist in the timely detection of emerging infectious diseases.”
“An effective response to a pandemic requires three things: political leadership, national unity and timely resources,” says Parekh. Those first two have been hard to come by since 2020, with one expert confiding to Forbes their concern that political polarization “has significantly impaired the ability of public health authorities to enact countermeasures in the future.”
Another challenge that health experts have seen during the course of the pandemic isn’t just politics but also apathy. “On May 24, 2020, the New York Times covered its whole front page with a story headlined: ‘U.S. Deaths Near 100,000, An Incalculable Loss.’ It listed names of the dead, as the paper did after 9/11. In December 2020, shortly before vaccines became available, we approached 300,000 dead, though the Times did not (and still has not) run a similar story,” Krofah says. “I’m afraid we have become numb to these numbers.”
Wachter notes that if a new surge of Covid comes in the next few months, it may be hard to galvanize a public response. “Everybody is so cognitively over this,” he says. “And the idea that you would have to hunker down again? It’s going to be awfully hard to convince people to do that.”
Other experts agree that separating politics from public health is going to be essential in order to move forward in combating future epidemics. A crucial aspect of that is rebuilding trust in institutions, repaid in kind with clear communication rooted in science. But it’s also, several say, something that has to happen between people’s everyday interactions with each other.
For Castel, what’s needed is that sense of community seen early in the pandemic when “neighbors volunteered to help older, more vulnerable people get groceries, or to make masks, or to donate food to overworked medical personnel,” she says. “Without this sense of community, we would not be where we are today and I can only hope that if faced with another pandemic, that we would all come together again in a united effort to protect and support each other. “
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