COVID-19: What should the 'new normal' look like?

• Governments of the world continue to discuss COVID-19 policies for the future.
• Necessarily, these procedures and strategies have morphed as the pandemic has progressed.
• A recent viewpoint article in JAMA compiles some experts’ thoughts about future national policies.

COVID-19 has affected many countries of the world immeasurably. Governments are coming to terms with the fact that SARS-CoV-2 may not go away, and countries face the need to consider their national strategies and implement appropriate risk assessments.

A recent viewpoint piece in JAMA presents three experts’ opinions about what officials should focus on as countries learn to move forward with COVID-19.

Three experts penned the piece:

• Dr. Ezekiel J. Emanuel, an oncologist and bioethicist at Perelman School of Medicine at the University of Pennsylvania, who has served as special advisor for health policy to the director of the Office of Management and Budget in the White House.
• Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis.
• Dr. Celine R. Gounder, an infectious disease physician and epidemiologist at Grossman School of Medicine, New York University, New York, and a medical journalist.

Many scientists believe it is impossible to eradicate COVID-19. The authors of the JAMA article explain that “Infectious diseases cannot be eradicated when there is limited long-term immunity following infection or vaccination or nonhuman reservoirs of infection.”

For this reason, some experts are advocating for a reevaluation of goals and public health strategies moving forward. The authors of the recent article advocate for strategies that improve data collection, health response, and public trust.

What are the goals? 

The authors believe that humility is critical when creating and changing COVID-19 policies.

They note that there are multiple unknowns and that data will continue to evolve. A few key uncertainties include:

• How long immunity from vaccinations or previous infections lasts.
• Whether or not the virus will become seasonal.
• The effectiveness of antiviral therapies in preventing long COVID.
• Whether new variants, which may be more transmissible, virulent, or immune-evading, will arise.

The authors note that “[t]he goal for the ‘new normal’ with COVID-19 does not include eradication or elimination, e.g., the ‘zero COVID’ strategy.”

They explain that neither vaccines nor acquiring infection with the virus appear to give anyone lifelong immunity.

According to the long-term aspects of SARS-CoV-2, they note that nations need to look at SARS-CoV-2 in relation to the impact of other respiratory viruses. Policymakers then need to consider strategies that will help reduce the impact of these viruses overall.

The authors recommend establishing a risk threshold in line with other respiratory illnesses in years where the severity of these illnesses was high. They note that this threshold at peak weeks would help agencies know when to implement emergency measures.

It would also help healthcare systems plan what they need for surges and at a maintenance level. A risk threshold needs to consider three main factors:

• weekly deaths
• hospitalizations
• community prevalence

Considering these factors, the experts recommend several vital elements for public policy and overall health promotion.

Elements of public policy

The authors note that policymakers need to determine their goals in relation to COVID-19 and then communicate them clearly to the public. Local governments can then adapt national recommendations at the local level.

Their piece notes four main components to help respond to the COVID-19 pandemic.

Public health and infectious disease expert Prof. Katharina Hauck, a professor in health economics at Imperial College London in the United Kingdom, who was not involved in the paper, identified that these strategies focus on nations being prepared.

And when people have a prepared response, there is less need for mitigation measures, including lockdowns and mask wearing. She thinks these methods may help communities in the long run. She told Medical News Today:

“There is little doubt that the proposed measures prevent pandemic deaths and reduce the need for pandemic mitigation once an outbreak takes hold.”

“The global economic and social costs associated with closures of nonessential businesses and schools are estimated in the trillions; the mental health costs of reduced social contacts are unquantifiable. In comparison to pandemic mitigation, many societies will consider [pandemic preparedness] as bargain investments.”

She noted that COVID-19 has forced society to consider how mitigation factors affect communities, but focusing efforts on being prepared will help minimize the need and impact of mitigation factors. She explained to MNT:

“The pandemic forces us to navigate an agonizing trade-off between competing societal objectives. Society needs to put a price on life, and during a pandemic, the price is measured in terms of economically and socially costly pandemic mitigation and restrictions to personal liberties. [Pandemic preparedness] promises to alleviate that trade-off by reducing the need for pandemic mitigation.”

Effective treatment and prevention

When it comes to the actions and goals of policies, governments should seek to promote the health and well-being of the population. For example, the authors note adopting strategies to increase vaccinations, collect accurate data, and improve public trust.

Focusing more on researching and developing therapeutics to help treat people with COVID-19 is also vital.

For instance, Dr. Arturo Casadevall, an infectious disease expert at John Hopkins University in Baltimore, explained to MNT that one of the treatment options some scientists are exploring is convalescent plasma therapy. Dr, Casadevall also noted that government agencies could help improve its availability and distribution.

Therefore, efforts from the government can focus on a variety of areas to help with the prolonged impact of COVID-19. These actions can focus on being prepared for surges and improving the overall treatment of the disease.

Looking to the future

As the United States and other countries move forward into a new year, they must consider how to handle COVID-19. They must seek to look at all data and evaluate the effectiveness of policies.

The authors of the viewpoint note that the U.S. needs a strategic plan in the future to help reduce all costs associated with COVID-19. They conclude:

“Without a strategic plan for the ‘new normal’ with endemic COVID-19, more people in the U.S. will unnecessarily experience morbidity and mortality, health inequities will widen, and trillions will be lost from the U.S. economy. This time, the nation must learn and prepare effectively for the future.

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