Rich DiPentima of Portsmouth has served as Chief of Communicable Disease Epidemiology and Assistant Director of Public Health for the NH Division of Public Health Services (NHDPHS), Deputy Public Health Director for the Manchester Health Department and is a retired NH Air National Guard public health officer.
As we enter the fourth year of the COVID-19 pandemic it might be a good time to evaluate the policies and actions that worked and those that did not, and what these mean for confronting future pandemics.
While we are still very much remained in the COVID-19 pandemic, with 400 to 500 deaths per day in the United States, cases are down and life has returned to a new normal. There has been a great deal of both positive and negative aspects to our overall response to COVID-19, and now is the time to start the process of learning from our mistakes and building on our successes.
On a scientific, epidemiologic and technology level we made amazing and speedy progress in the development of vaccines, anti-viral therapies, diagnostic and screening testing, medical management of cases, and viral genome sequencing. We are able to quickly identify new virus variants and how to better track the spread of these variants.
On a social, political, legislative, and policy level we may have unfortunately taken steps that may limit and hinder the progress we have made on the scientific and technological levels. The vaccines and other preventive measures are only as effective as the willingness of people to accept and use them. Many states, including New Hampshire, have passed laws and are currently considering additional legislation that will severally limit, slow and impede the government’s response when the next, possibly much more devastating pandemic strikes.
States have passed laws that prohibit immunization mandates, mask mandates, limits on the ability of governors to exercise emergency protocols, limits on social distancing, the use of schools for immunization clinics, advocating unsafe and dangerous therapies, restricting the use of federal pandemic response funds and other counterproductive anti-public health policies.
On a social level, the amount of misinformation presented to the public via mass media, social media, the internet, politicians, and charlatans has caused a great deal of confusion, skeptics, and doubt among a large segment of the population.
This has resulted in many people rejecting vaccines, refusing to wear masks in large public indoor venues, not getting booster vaccines, taking unapproved therapies, not restricting activities when sick, and generally denying the existence or scope of the pandemic. All these negative political, legislative, and social actions have resulted in more preventable morbidity and mortality.
While humans were passing laws and making policies that limit our ability to protect public health, the virus continues to operate under the laws of nature which are not subject to political, economic or ideological fantasies.
The threat of a new and even more deadly pandemic is not hypothetical. It will happen, when and how severe is up to nature. Currently, there is serious concern regarding the rapid spread of the bird flu A (H5N1) virus.
There is already an epizootic (epidemic among animals) across the globe involving both wild waterfowl and domestic birds such as chickens, ducks and turkeys. There has also been spillover of the virus from birds to mammals including bears, foxes, otters, seals and mink.
In 2022, over 6,000 wild bird cases were identified in the U.S. (CDC). Nearly 50 million domestic birds including chickens, turkeys and ducks have been killed to prevent the spread of the virus. While this virus is not yet easily transmitted from birds to humans, since 2003 there have been 868 human cases identified with 467 deaths, a case fatality rate (CFR) of 53%. (WHO, NETEC)
The COVID-19 CFR is about 1% (CDC COVID Tracker). As this virus continues to spread there is the ongoing possibility that it could meet other viruses in a mammal, exchange their genetic material, and create a new virus that is much more easily transmitted from birds or other mammals to humans. This is exactly how pandemics begin.
Imagine a respiratory virus that can easily spread from person to person by those without any symptoms with a CFR of 53%.
Considering the above scenario, even one where the CFR is much lower than 53%, say 10% or 20%, the consequences would be catastrophic. The good news is that we do have a vaccine for the current A(H5N1) virus. The bad news is that there are not nearly enough doses available to vaccinate everyone in the U.S. And there is always the possibility that the virus that does emerge will not be covered by the current vaccine.
As a result, in either case, it will take time to either produce more of the existing vaccine or develop, test, and produce a new vaccine. Time that we may not have.
And even if the vaccine were to be available in the needed quantities how will the legislative, policy, and social limits created as a result of COVID-19 limit the ability to quickly and effectively protect the public?
Will people react differently when there is a virus circulating with a 20% CFR that infects children and healthy adults than they did with COVID-19? Will people get vaccinated at the level necessary to control the pandemic? Will people wear masks in public indoor settings? Will policymakers adjust and implement the necessary social distancing mandates needed to control the pandemic? Will laws prohibiting public health measures need to be repealed to allow for immunization, mask, and other mandates?
These are the vital questions that need to be considered now before we face the next more deadly pandemic. We must learn from the mistakes of the COVID-19 pandemic.
If not, we are doomed to repeat and continue them with very serious consequences.