How Should Our COVID-19 Response Evolve?

Americans have received mixed messages recently on the state of the Covid-19 pandemic. Mask and vaccine mandates are waning, while the highly contagious and now-dominant Omicron b. A.2 subvariant continues to spread. Although deaths remain relatively low, case rates and hospitalizations are trending upwards in most states.

At the same time, we just marked the tragic milestone of one million American deaths from Covid-19.

Only future history books can say whether we are emerging from the worst of this pandemic or are destined to learn more Greek letters as variants emerge. What is the right path forward? Informed by the last two years, especially in light of fast-changing case counts, we must remain vigilant.

As a practicing cardiac anesthesiologist, I keep patients safe by carefully monitoring blood pressure, oxygenation levels, and ultrasonic imaging of the heart, and responding promptly to changes. Even if the patient is doing well at a particular moment, unpredictable changes during cardiac surgery are the norm; we must remain vigilant.

In a similar fashion, we have learned many lessons from this pandemic by monitoring its vital signs and analyzing our responses lessons that will help us prepare for the remainder of this pandemic and the next one. Here are five ways to bolster our vigilance:

Think Globally, Act Locally

Currently, the U.S. is relatively low on the list of global Covid-19 hotspots, while places such as Australia, New Zealand, and South Korea have seen recent spikes. Even as we take steps in the U.S. to open up based on local and regional data, we must continuously monitor the horizon.

Pandemic trends in the United Kingdom and Western Europe have frequently presaged in the United States two to four weeks later, and we may be seeing evidence of that in the new case upticks.

We must fund, facilitate, and coordinate worldwide disease surveillance programs. Only with global knowledge can we make intelligent decisions for local health policies and avoid playing whack-a-mole with public health measures. The most strategic pathway from epidemic to endemic requires consistency.

Break Down Siloes

The urgency of a crisis presents opportunities to think in different ways that serve to break down structural, financial, and psychological barriers. As patients were struggling and dying with no known treatments, scientists and clinicians accelerated their collaborations, converting observations on the hospital floors and discoveries in the lab into treatment modalities in record time.

At the organization where I work in New York City, Mount Sinai, we noticed as early as March 2020 that an unusual number of patients were developing life-threatening blood clots. It was remarkable how quickly basic and translational science researchers, clinical trialists, clinicians, and data scientists came together to investigate the clotting and what to do about it.

By sharing insights in real-time, they were able to develop a solution: a treatment regimen of anticoagulants that has proven to be a mainstay of inpatient Covid care. We must continue to codify and hard wire these seamless collaborations to preserve and strengthen the connections that speed innovation.

Invest in Genetic Analysis

Pandemics happen with regularity throughout human history and can last for years or decades, giving pathogens ample opportunity to evolve to perpetuate disease.

Remarkable epidemiological insights can be gained from the genetic codes of pathogens as they mutate, and we need to continue translating laboratory research into clinical care on this front.

Genetic analyses of the latest variants (Delta and Omicron) provided knowledge that predicted which Anti-Sars-Cov-2 monoclonal antibodies would retain effectiveness. This drove rapid updates in clinical guidelines for prescribing antibody therapy. Worldwide partnerships to expand genetic analyses of patient and wastewater samples must be a high priority.

Plan to Surge When and Where the Need Arises

Typically, hospitals have a relatively small number of negative-pressure rooms to house dangerously infectious patients. But Covid-19 changed that calculus, demanding massive efforts to build or retrofit such rooms to keep patients and clinicians safe. The Mount Sinai system alone built more than 500 negative-pressure rooms from March to May 2020, when we had thousands of patients with Covid-19 in our hospitals.

Today, we need only a small number of isolation rooms. But we now have a playbook for building them quickly, what equipment to use, and how to navigate supply chain issues. Future surge planning also includes assigning resources equitably. The racial and ethnic disparities in mortality rates, especially during the first wave, reminded us of the painful human cost of structural racism and failures to address the social determinants of health.

Measure, Monitor, and Learn

It is all hands on deck when it comes to processing, learning from, and acting on the massive stores and ongoing streams of pandemic data. The centers for disease control and prevention just launched the center for forecasting and outbreak analytics to better predict trends and guide action essentially, advancing and institutionalizing vigilance.

We also need technology giants to contribute data science resources and collaborate to evolve health cares analytical tools. Genomic, environmental, health record, and wearable-derived data and metadata can provide real-time decision support, as artificial intelligence and machine learning tools evolve to the next level of augmented intelligence.

These same tools can and should look beyond the virus' immediate toll on the body, to the multiple tolls on society: education, social isolation, behavioral health, and many collateral injuries.

The original seal of the American society of anesthesiologists, founded in 1905, shows a lighthouse guiding a ship to safety, with the motto "Vigilance." For the cardiac anesthesiologist, vigilance has a purpose: it keeps patients safe.

Similarly, the roadmap outlined above will help us maintain vigilance and build responsiveness to whatever lies ahead, both for the remainder of this pandemic and in the face of the next.