Discussion in the international scientific community about the possibility of new or emerging viruses with the ability to unleash a pandemic date back to the 1990s, gaining momentum with the advent of SARS in 2003 and the H1N1 flu in 2009. The World Health Organization (WHO) and several governments started making plans for such an eventuality, yet when the novel coronavirus pandemic struck, no one was adequately prepared. Even powerful countries we would expect to lead the battle against the coronavirus proved weak. They were taken by surprise in the first wave and underestimated the virus’ strength and transmissibility in the major economic and cultural centers of our interconnected world. They also failed to predict that a new and especially contagious virus, combined with low levels of immunity in the population, would trigger a second, more dangerous wave with the advent of spring, as had been the case with the Spanish flu in 1918.
It has become abundantly clear as the pandemic unfolds that serious adjustments are needed in public health policy for the containment of such outbreaks, as the mistakes and oversights of various governments – such as that of the United States – contributed to the spread of the virus.
The SARS-CoV-2 pandemic should not have come as any surprise, though, as several epidemics over the past two decades had heralded its advent: SARS, MERS, Swine flu, H1N1, Zika, Ebola, West Nile virus. It is also a near certainty that we will have to deal with more epidemics in the future – perhaps of even greater frequency and scope – if we do not start seeing ourselves as a link in the chain of nature rather than a dominant force over the environment. The modern way of life, in combination with the ongoing destruction of natural habitats (pushing animals, like bats, into closer proximity with people) and climate change, is facilitating the spread of viruses between different animals and their subsequent transmission to people. Animal-transmitted diseases will only become more frequent.
SARS-CoV-2 was probably around for years, if not decades, before making the jump to humans, yet despite advances in genetic technology, we have still not mapped the chain of transmission. It is, therefore, essential that national and international programs are strengthened for monitoring viruses that could trigger the next pandemic by jumping from animals to humans. It is also essential that the tracing, monitoring and management of epidemics – big and small – is also improved with stronger and more reliable public health structures. A recent example is the United Kingdom, where a strong and well-run epidemiological and laboratory surveillance system (which serves as a paradigm for many other countries and is able to provide a genetic analysis of 10% of all cases) allowed the new SARS-CoV-2 variant to be detected swiftly.
The pandemic has demonstrated the vital role of strong national health and primary healthcare systems in managing such emergencies. If we want to be prepared for the next crisis, we need to build a well-functioning public health system that is equipped with all the necessary technological tools, with continuous training for medical workers, proper communication between the different tiers of healthcare and strict protocols for well-organized hospitals.
In the meantime, until the population achieves immunity, either by contracting the coronavirus or being vaccinated against it, public health safety measures like sanitization, mask-wearing and social distancing are instrumental to its containment. Creating a culture of protection of individual and public health must be a priority for every country, not just as regards the current pandemic, but also for protecting the global population against other diseases. It is no accident that outbreaks of viral gastroenteritis nosedived in 2020 or that the seasonal flu is expected to have a much smaller impact as a result of safety measures. If some of the protocols adopted during the pandemic – in the food and drinks industry, in sports, etc – remain once it is over, the benefits would be significant.
The unprecedented global mobilization for developing a vaccine demonstrated the value and efficiency of collective action from biotech firms, pharmaceutical giants, international public health organizations and governments. On a societal level as well, however, the overwhelming majority of citizens have acted responsibly, with empathy and a sense of solidarity. Only when we act as a community can we deal with such grave threats.
The pandemic is testing our humanity – citizens’ and governments’. From March to October, 61.3% of deaths from Covid-19 in Belgium were of elderly people in nursing and retirement homes. The Belgian authorities appear to have dropped the ball in implementing timely laboratory checks and protocols. Moreover, most of the care home residents who became ill were not transferred to hospital. Similar phenomena were witnessed in other countries, marking a dark chapter in the history of the civilized world.
When a society faces such a crisis that demands a spirit of collective responsibility and action, it is our duty to convince the naysayers with scientific arguments. Apart from scientific fact, however, getting people on board also requires complete transparency. The pandemic has loudly confirmed transparency as a cornerstone of public health, demonstrating that all scientific and epidemiological data need to be available to everyone and instructions need to be sincere and clear.
Essentially, SARS-CoV-2 has reminded us what a pandemic means. A pandemic does not end from one day to the next; it expires gradually. The appearance of epidemiological diseases – and their eradication – is the result of a confluence of biological, environmental, geographical, climatic and even social, political and economic factors. It is not easy, therefore, to predict the duration or evolution of the current pandemic. We do know that when we try to prevent viruses from spreading with the kind of measures we’re implementing right now they tend to become more contagious. This is an evolutionary process demonstrated by the various variants. In time, though, the most likely development is that a balance will be achieved between virus and human-host that will result in more people being infected, but with milder symptoms.
We have learned a lot since the outbreak of the pandemic: what containment strategies are more effective, the value of laboratory checks and tracing and better treatments for patients in Covid-19 clinics and ICUs. We also have a much better understanding of seemingly simple questions. Take airborne transmission, for example: Our knowledge of how it works proved extremely limited but we have made progress that would have taken decades to achieve otherwise. There are also the efforts for developing vaccines and treatments that have opened up new paths in biotechnology and medicine.
These are legacies in experience and knowledge that will prove valuable nor just in the next pandemics, but also in the management of many infectious and other diseases.
Athanassios Tsakris is a professor of clinical microbiology, head of Athens Medical School’s microbiology lab and vice rector at Athens University.