Americans have recently received mixed news on the status of the Covid-19 pandemic. Mask and vaccine requirements are dwindling while the highly contagious and now dominant Omicron b. Subvariant A.2 is spreading further. Although deaths remain relatively low, case numbers and hospitalizations are trending up 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 tell if we’re getting out of the worst of this pandemic or are destined to learn more Greek letters as variants emerge. What is the right way forward? Informed by the past two years, especially given the rapidly changing case numbers, we must remain vigilant.
As a practicing cardiac anesthesiologist, I keep patients safe by carefully monitoring blood pressure, oxygenation, and ultrasound imaging of the heart, and responding promptly to changes. Even if the patient is fine at a given moment, unpredictable changes are the norm during cardiac surgery; we must remain vigilant.
Similarly, by monitoring their vital signs and analyzing our responses, we have learned many lessons from this pandemic that will help us prepare for the rest of this pandemic and the next. Here are five ways to increase our alertness:
Think global, act local
Currently, the US sits relatively low on the list of global Covid-19 hotspots, while places like Australia, New Zealand and South Korea have recently been at the top. Even as we take steps in the US to open up based on local and regional data, we must continually monitor the horizon.
Pandemic trends in the United Kingdom and Western Europe have often revealed themselves in the United States two to four weeks later, and we may be seeing evidence of this in the surges in new cases.
We need to fund, facilitate and coordinate global disease surveillance programs. Only with global knowledge can we make smart local health policy decisions and avoid messing around with public health measures. The most strategic path from epidemic to endemic requires consistency.
The urgency of a crisis offers opportunities for rethinking that serve to break down structural, financial and psychological barriers. As patients with no known treatments struggled and died, scientists and clinicians accelerated their collaboration, converting observations on the hospital floor and discoveries in the lab into treatment modalities in record time.
At the organization I work at in New York City, Mount Sinai, we found back in 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 investigators, clinicians and data scientists came together to study coagulation and what to do about it.
By sharing real-time insights, they were able to develop a solution: an anticoagulant regimen that has proven to be a mainstay of inpatient Covid care. We must continue to codify and hardwire this seamless collaboration to preserve and strengthen the connections that accelerate innovation.
Invest in genetic analysis
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Pandemics occur regularly throughout human history and can last for years or decades, giving pathogens ample opportunity to evolve to perpetuate disease.
Remarkable epidemiological insights can be gleaned from the genetic codes of pathogens as they mutate, and we need to further translate laboratory research on this front into clinical care.
Genetic analyzes of the latest variants (Delta and Omicron) provided insights that predicted which anti-Sars-Cov-2 monoclonal antibodies would remain effective. This prompted rapid updates to clinical guidelines for prescribing antibody therapies. Global partnerships to scale up genetic analysis of patient and waste water samples must be a high priority.
Plan when and where needs arise
Typically, hospitals have a relatively small number of negative pressure rooms to accommodate dangerously contagious patients. But Covid-19 changed that calculus, requiring massive efforts to build or retrofit such spaces to keep patients and doctors 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 only need a few isolation rooms. But we now have a guide to building them quickly, what equipment to use, and how to overcome supply chain issues. The fair allocation of resources is also part of planning future supply surges. The racial and ethnic disparities in mortality rates, particularly during the first wave, reminded us of the painful human costs of structural racism and failure to address the social determinants of health.
Measure, monitor and learn
We have our hands full processing, learning from, and responding to the vast stores and ongoing streams of pandemic data. The Centers for Disease Control and Prevention just launched the Center for Prognosis and Outbreak Analysis to better predict trends and essentially guide responses and drive and institutionalize vigilance.
We also need tech giants to contribute data science resources and collaborate to develop healthcare analytics tools. Genomic, environmental, health, and wearables-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.
The same tools can and should look beyond the immediate burden of the virus on the body to the multiple burdens of society: education, social isolation, behavioral health and much collateral damage.
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 anesthetist, vigilance has a purpose: it protects patients.
Similarly, the roadmap outlined above will help us stay alert and build responsiveness to whatever lies ahead, both for the remainder of this pandemic and in light of the next.