5 Lessons Learned in Pandemic Year 2

Photo: SJ Objio / Unsplash

One million Americans have died from a virus that was unknown to humans just a couple of years ago. Covid became the third leading cause of death in the U.S in 2020. Ask yourself, what would you say to someone if they told you in just over two years, a virus too small to see with the naked eye but brutal enough to kill a population the size of Delaware would sweep through the nation?

As leaders in one of the largest healthcare systems in the United States, we would say: this would be a travesty of epic proportions.

It has been over 26 months since this unrelenting virus forced the federal government to declare a national emergency, and most recently the Biden administration extended the national emergency due to the ongoing risk posed by Covid. Cases are again increasing throughout the United States, averaging 100,000 per day but nowhere near the peak seen in January of nearly 1 million cases due to the Omicron variant. Hospitalizations are also slowly creeping up and newer subvariants like BA.2.12.1 are gaining more of a foothold, accounting for nearly 47 percent of new cases in the U.S.

It has been a challenging couple of years to say the least. Here are 5 things we’ve learned in year two of the COVID-19 pandemic.

One, we started 2021 with great excitement over the increasing availability of Covid-19 vaccines but have now entered 2022 with persistent and, perhaps, increasing vaccine hesitancy — especially towards booster doses with only 30 percent of the nation’s population boosted. With the high likelihood of additional booster doses needed, this does not bode well for the nation’s Covid vaccination campaign which ranks eighteen in the world for booster doses administered per 100 people. We must do more to encourage people to remain up-to-date with Covid vaccinations.

Two, the arrival of outpatient Covid-19 therapeutics has been a gamechanger and has decreased the risk of experiencing severe outcomes or dying from Covid. To-date, five monoclonal antibodies have received FDA Emergency Use Authorization starting in June 2021 and two oral anti-viral pills, Paxlovid and Molnupiravir, were authorized in late 2021. While supply has improved, access to the anti-viral pills remains a challenge. The Biden Administration has recently announced plans to increase access and availability; this must be a priority.

Three, availability of rapid, at-home Covid tests greatly improved over the last year. Also known as ‘antigen’ tests, most give results within 15–30 minutes. A federal website was launched to help Americans obtain free Covid tests. The downside to at-home rapid testing is that results are not regularly or consistently reported, hence, giving an undercount of true prevalence of the virus and case positivity rates. The upside is that individuals can now test for Covid in their homes as soon as symptoms appear or if there’s been an exposure and, if positive, get connected to outpatient treatments, including the oral anti-viral pills, through the Covid-19 Test To Treat Locator.

In addition to personalized testing, we have a newish tool, waste water surveillance testing. And while still in its infancy stages, it has the potential for real impact as an early warning system. Upfront investment and expansion of wastewater surveillance testing now will likely pay in dividends when it comes to bio-preparedness in the future.

Four, public health shifted from the collective “us” to the individual “me.” That is not the ethos of public health but pandemic fatigue. With rapidly changing public policy, including the lifting of the mask mandates on public transportation by the court, risk calculation has shifted towards individual preferences and risk tolerance. We must continue to let science and data, not personal preferences, lead public policy decision making.

Five, communicating the real-time science behind all the data continues to be challenging. We have heard confusion over vaccine guidance from countless people. What does it mean to be “up-to-date” with Covid vaccination (which includes booster doses for those eligible) when having received two doses of a primary mRNA vaccine series or one dose of the Johnson & Johnson vaccine is still considered “fully vaccinated”?

We have come a long way since early 2020; unfortunately, with the heavy human toll of 1 million deaths in the U.S. from Covid-19. As health care leaders who have worked continuously to stem the Covid-19 tide in New York City, we understand that people want to put the pandemic behind them and move forward with their lives.

However, doing so requires work on the part of institutions (i.e., better ventilation systems to reduce risk of viral spread); better public policy by government (i.e., paid sick leave and free access to healthcare services) and individual action (i.e., staying up-to-date with vaccinations). We hope year 3 of the Covid pandemic is the last, but we know there is still more work to be done.

This piece was co-authored by Syra Madad, DHSc, MSc, MCP, Infectious Disease Epidemiologist; Adjunct Faculty at Boston University’s Center for Emerging Infectious Disease Policy and Research; Fellow, Harvard Belfer Center for Science and International Affairs; Senior Director, System-wide Special Pathogens Program NYC Health + Hospitals and Andrew B. Wallach, MD, FACP, Ambulatory Care Chief Medical Officer, NYC Health + Hospitals and Associate Professor of Medicine, NYU Grossman School of Medicine.

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Syra Madad

Syra Madad

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Dr. Syra Madad is an internationally recognized public health leader and epidemiologist in infectious disease and special pathogens preparedness and response.