Rick Bright, Others Offer Advice for Holding Back Another COVID-19 Surge

COVID-19 cases are soaring in China, Hong Kong, the U.K. and parts of Europe. At the same time, the U.S. focus is transitioning from developing vaccines and therapeutics to dealing with endemic COVID-19. The Demy-Colton Virtual Salon, Getting to the Next Normal: A Roadmap for Living with COVID, explored what we can expect in the near future.

“The challenge is two-fold: the virus keeps throwing curveballs, and the public is done with the virus even though it isn’t done with us,” Michael Osterholm, Ph.D., director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said. “What we’re seeing in Europe is a harbinger of things to come here.”

Looking at China, which recently – again – enacted large-scale quarantines, “We’re seeing a highly vulnerable population that has little immunity,” he said. “We’re also seeing that some vaccines – namely Sinovax – aren’t as effective as others. Who you vaccinate matters. Hong Kong, for example, vaccinated relatively few of its elders, so it’s seeing higher death rates now.”

Health experts also are coming to believe that a mix of vaccine types may be more effective than just one type at conferring longer-term immunity. “The immune response made against the first strain of the virus doesn’t neutralize the new variants as well as against the first strain, so there is some antibody escape,” Rick Bright, Ph.D., CEO, Pandemic Prevention Institute, the Rockefeller Foundation, said. However, “The T cell protection from the vaccines and from prior infections remain robust over time, even as the virus evolves. We are gambling with time, as the virus changes in new ways. We can’t be overly confident the vaccines will hold.”

Therefore, Bright advises companies and regulators to be nimble to enable a swift response when needed. That entails learning more about waning immunity, virus evolution and “staying on top of the technology. We can’t look the other way. This virus is ready to surge again, so we must bolster our efforts to hold it back.”

Panelists also advocated expanding the COVID-19 surveillance program, which Bright called “an unfilled gap.” The Rockefeller Foundation is trying to close that gap by strengthening existing surveillance structures to identify early signals and – importantly – to share the data so scientists and public health officials have better knowledge of what’s happening.

“Variants are the Achilles heel,” Bright said. “The world is being blindsided and is reacting inappropriately. We have the technology to know and understand what’s happening to the virus, where it’s going and its impact, but the data is siloed in different formats and contexts so it’s hard to make sense of it.” Data standardization is necessary.

Bright also advocated moving awareness of COVID-19 emergence farther upstream by looking not just at data from COVID-19 tests but also conducting wastewater and air sampling.

“Most are surprised we could pick up the omicron variant in the New York public wastewater before it was discovered and made known in South Africa,” Osterholm added. “We’ve seen that time and again, including with the H1N1 influenza pandemic in 2009.” The message from that experience, he said, is that “Travel bans don’t work…in the era of modern travel.”

To minimize the spread, Ezekial Emanuel, M.D., Ph.D., vice provost for global initiatives, University of Pennsylvania, advised improving building ventilation systems as a first step. “SARS-CoV-2 is airborne. So, bring outdoor air in, improve the HVAC systems of sealed buildings, and if you can’t improve an HVAC system, put in a HEPA filter.” This will help reduce respiratory pathogens and allergens in the air, as well as – potentially – the SARS-CoV-2 virus. “There are funds in President Biden’s American Rescue Plan that schools can use for this purpose.”

Emanuel also suggested grading public buildings on indoor air quality and posting the results prominently, just like food inspectors do for restaurants.

New vaccines and therapeutics also should continue to be developed. “It’s a pay now, or pay later scenario,” Osterholm said. “What we invest now will pay an amazing return,” in terms of healthier populations, which results in less money paid out for disability and health care, for example. Congress is debating the new expenditures, but it’s not just a question of whether to pay the extra funding, but where that funding comes from. “The states are enjoying a surplus of revenue,” he pointed out.

“Now isn’t the time to stop investing (in pandemic preparedness),” Bright agreed. “We’re not even through the crisis and already are beginning to neglect it. This pandemic cost so much because we didn’t invest earlier.”

Some of the new, exciting technologies that can help minimize the next pandemic include more accessible, lower-cost testing, second-generation vaccines that are stable at room temperature or normal refrigeration, needleless vaccines and drugs that can be used in combination therapies without the risk of treatment resistance.

“So far, government funding for COVID-19 has gone largely to the big multinational companies. It’s time now to look at smaller, innovative companies and accelerate their approaches into our arsenal,” Bright said.

The way clinical trials are conducted at the NIH also needs improvement, Emanuel pointed out. “We need to break down the narrow academic mind frame and change the paradigm of how to do research in a public health crisis.” For example, opening up clinical trial enrollment to everyone who tests positive for COVID-19 could get innovative therapies to people sooner and also create a large, real-world sampling. Medicine has advanced through empirical approaches, and physicians need the ability to use that approach now, even as the biological data is being gathered and assessed, he said.

COVID-19 is a moving target and there are many questions to which no-one has answers. “We need accelerated research programs to get those answers quickly,” Bright insisted, citing the unknowns involving the implications of the cytokine storm, lectin pathways, complement systems and other factors in disease severity and in the development of long COVID.

To return to normal, Emanuel said, COVID-related deaths should be below 165 per day in the U.S. “Right now, we’re far from that, with the average daily deaths above 1,000.” Meeting that goal depends upon population immunity, whether natural or through vaccination, as well as a range of public health measures to reduce transmission.