COVID-19: Science’s Next Great Stepping Stone

The coronavirus pandemic effectively brought the world to its knees: it disrupted government affairs, destabilized social infrastructure, devastated the world economy and shattered hearts worldwide. No other event in this generation has garnered the attention of the world quite like COVID-19. Melinda Gates put it succinctly: “This pandemic has magnified every existing inequality in our society.” It has caused society to reevaluate the infrastructural systems that it has put in place and has failed us during this crisis. The world has survived various catastrophic events; however, the COVID-19 pandemic has left an imprint, unlike any other global collapse, leaving many with more questions than answers. As reported by the University of Toronto’s author Chris Sasaki, “The COVID-19 pandemic… has been with us long enough to clearly expose fault lines, inequities and deficiencies in virtually every sector of society.” This experience has presented society with the opportunity to not return to our everyday routines but rather establish a “new normal.” It begs the question: How would you prepare if you knew another pandemic was imminent? Although many believe that pandemics are inevitably destructive, several organizational strategies can mitigate their disturbance. This can be shown by understanding why epidemics happen, analyzing our historical successes and failures, and fostering social change that will help prevent a future pandemic.

Why do pandemics happen?

To understand how to combat the pandemic, we must first understand the recombination of pathogens and their effect on the human body. As our understanding of microorganisms grows, our concerns and concentration turn towards potential deadly diseases. Emerging diseases are defined as illnesses that have increased in incidence during the past two decades or are likely to increase in the near future, and many of these diseases are zoonotic. (Merck). A zoonotic disease is any virus with the ability to transmit between animals and humans. Increased transmissions might be a result of the increased prevalence of the agent in domesticated or wild animals. (Merck) Small changes in the virus’s DNA enable it to transmit from animal species to humans. This was the case for COVID-19 when it was first identified in Wuhan, China. The first outbreak stemmed from animal products in a market, and its rapid transmission was due to the lack of immunity against it. The new sequence was so different that most people had little to no immunity against the new virus. Because the shift is so sudden and aggressive, it is difficult to prepare proper treatments and medication to combat the virus and accordingly, pandemics occur.

Similarly, these small changes can add up over time to create the potential for a pandemic. For example, Influenza is another possible virus that could cause a pandemic and is an excellent example of how different variations of the same virus may affect the human population. As discussed above, one-way influenza viruses change called “antigenic drift,” which is small changes in DNA. The body’s immune system recognizes minor changes in the surface proteins of influenza viruses to signalling an immune response. (CDC) The body recognizes the virus is similar to one it has seen before, and it creates antibodies that are crucial to the deterrence of infections. In essence, if one’s body has antibodies against one influenza virus, there will be a great chance that the body responds to a similar virus. This phenomenon is a theory called “cross-protection.” (CDC) Problems arise when these minor mutations accumulate and result in an antigenically different virus (further from one another on the phylogenetic tree). When this type of antigenic drift appears, the immune system may be incapable of recognizing and impeding the new influenza virus. Subsequently, one may become vulnerable to the flu infection. Antigenic drift is responsible for the reason individuals get the flu more than one time, and it has become the primary cause for a yearly flu vaccine. While minor changes in the DNA cause pandemics, so can large changes, such as “antigenic shift.” Shifts are sudden and significant changes in a virus. The results are new surface proteins that aid in transmitting the virus, most notably in transmissions with humans. This type of shift is often found in zoonotic diseases of an animal population that gain the ability to infect humans. (CDC) Although Influenza is constantly changing due to antigenic drifts, antigenic shifts occur infrequently, making them rare and unpredictable. However, increased transmission rates have helped them spread at astronomically large rates when they do take place.

Several reasons have contributed to elevated transmission rates, but many of them are a product of the lifestyle of the general public. Growth in the human population has led to extra pressure on concentrated regions of wildlife, leading to increased contact. As society grows, more space and resources are required to fulfill the needs and wants of the population. Markets and areas with high amounts of animal products can become regions of outbreaks. Climate change is also considered to influence the likelihood of pandemics. The climate changes allow specific bugs to survive the winter and permit longer transmission seasons (Merck). While changes in our environment affect transmission rates, our technological advances have granted us the ability to recognize these diseases more frequently. This led scientists to questions whether these diseases are emerging or if the world has lived alongside their presence. Improved diagnostic techniques and ease of access to technology have enabled the identification of specific pathogens. Finally, medicine and science have increased human susceptibility to foreign pathogens as the number of immunocompromised people has increased by factors such as the AIDS epidemic. (Merck) Understanding how pandemics happen is only the first step in building strategic infrastructure to combat the next pandemic. Healthcare professionals and government officials must recognize the previous successes and failures of historical pandemics.

How do different countries address pandemics?

The Coronavirus has affected each nation, yet South Korea has managed to host fascinating advancements despite the notable setbacks. South Korea’s ability to resolve minor complications before they evolved into large contagions was made possible using technology and the government’s proactive mindset. In February 2021, South Korea had managed to maintain reduced COVID-19 cases and fatalities. This continued success resulted from measures taken to defend against small outbreaks assertively, as these positive numbers were partly due to South Korea’s aggressive and restrictive response to the COVID-19 pandemic. South Korea began developing COVID-19 testing and scaled-up production while its case tolls were below one hundred. “Its continued vigilance, extensive testing and contact tracing, isolation, and treatment of confirmed cases remains a model that most other countries can only aspire to” (Bremmer). South Korea has managed to have one of the best initial reactions to the pandemic, and it was able to do so without bringing its economy to a standstill. Their greatest asset was their experience from undertaking the 2015 MERS epidemic. The South Korean citizens’ involvement in the MERS epidemic meant they were ready to sacrifice privacy and lifestyle for elevated surveillance in their communities to gain leverage on future COVID-19 outbreaks. A tracking system designed to monitor COVID-19 patients allowed public health officials to have real-time access to critical information about locations. South Koreans also had access to generous government stimulus payments. These payments included cash payments to most citizens totalling ₩11.7 trillion and another ₩50 trillion in small businesses’ emergency financing. However, while South Korea’s response was successful, some nations’ efforts did not yield many results.

Although the United States is considered global leaders in innovation, their slow response to the COVID-19 pandemic was not a failure in their harshly critiqued healthcare system. It was instead because of the lack of centralized leadership. New administration policies in April 2020 restructured responsibilities between the US’s federal and state governments, as there was an emphasis on the federal government being a “back-up” to state legislature regarding COVID-19. Due to the lack of a centralized leadership committee, the multi-faceted approach resulted in discrepancies among the national COVID-19 response. Certain states reopened their economies without accurate data to support the action, and it was ultimately those states which suffered more significant outbreaks. Drew Altman, CEO of the Kaiser Family Foundation and author of Understanding the US failure on Coronavirus, asserts that the government’s eagerness to revive the economy before the administration had a handle on the Coronavirus was detrimental to their success (Altman). In some large counties, the jurisdiction of authorities overlaps, making it an overcomplicated and troublesome affair to coordinate responses and protocol. For instance, a city may deliver a large part of the health services, but a county may control the region’s public health sector. Different combinations exist across the nation and coordinating them individually authorities’ jurisdiction ambiguity surrounding one’s role. The highlight of the US’s failure has been the citizens’ reactions. The American people are split along political lines as if “the country has both red and blue pandemics” (Altman). When this polarisation occurred, the population’s eagerness to prohibit the disease’s transmission essentially collapsed across Republican America. Altman’s essay acknowledges, “Democrats are about twice as likely as Republicans to say the worst is still yet to come on the pandemic in the US” (Altman). The US failed to capitalize on their opportunity to exterminate the Coronavirus while it was a minor threat. Due to their sluggish response, they did not have the correct services in place to contain outbreaks and attend to those who were the most at risk. The US is an example of a nation that had the means of acquitting themselves of the virus, but a lack of procedure and vision prohibited a smooth response. Unfortunately, the US is the opposite of South Korea when comparing their pandemic responses. Through examining both the successes and failures of advanced countries, characteristics of a successful framework can be highlighted.

The decisions and programs evoked by South Korea and the United States can aid leaders in creating policies that improve their ability to react to unprecedented events. South Korea’s successful proactive mindset and technological advantage are effective strategies that promote pre-existing programs. The US’s lack of centralized leadership displayed the importance of defined response roles and public readiness. Without these critical conditions, it can be challenging to mount a pandemic response. Only a few countries can achieve these requirements; however, these systems can be made available to developing nations through funding and planning. South Korea’s model for success included two philosophies: use technology to identify the nation’s weak points and to remain vigilant. This success is mainly due to the always-on disaster and safety-information system to capture risk information in real-time. The administration’s active prudence made it possible to tackle small outbreaks before they become national health concerns and supply stimulus payments in the wake of economic stagnation. In comparison, the US’s failures have highlighted apparent discrepancies in their leadership. A clear-cut definition for response roles for industry leaders and government organizations at a global, national, and local level is vital to limit confusion and turmoil. The well-defined roles and thorough procedures will help prevent delays and confusion when an outbreak occurs. Lastly, governments can keep outbreak preparedness on the public agenda. Countries such as the United States can implement standards to test the nation’s pandemic readiness. Authorities can also encourage and teach about natural disaster relief strategies and prepare the public in the case of a disaster. Heightening the public’s awareness of the threat posed by diseases and natural disasters will aid in the general public’s response to the next pandemic. By contrasting the two nations, it is easy to see that South Korea succeeded because of their structured and meticulous system while the US failed because of a lack of organization. With this in mind, how can nations build upon their existing attempts to fight the Coronavirus?

What can we do to prevent another pandemic?

A coordinated system to fight infectious diseases requires “different norms, processes, and structures from those used when providing our medical services.” (Mckinsey) The streamlining of decisions is critical, leaving our most trusted directors to make fast yet rational decisions in the face of adversity. These requirements pose a significant dilemma for our current epidemic-management system: Our future pandemics plans are not used and practiced until it is too late, allowing for critical errors that may have been avoided. A theory presented by Mckinsey & Company in their article, Not the last pandemic: Investing now to reimagine public-health systems, demonstrates how authorities can redefine their “break glass in case of emergency” model into an “always-on” system (Mckinsey). Their article argues that it is impossible to expect the new protocol to function efficiently under challenging times if the framework is never exercised. A system built on a principle of active preparedness can be consistently tuned and rededicated so that a mechanism is in place to combat outbreaks when they start. Several institutions have already used similar systems in different scenarios that help with viral identification and have the “always-on” attribute that would help with constant coverage. The first is the exact mechanism used to combat fast-moving outbreaks such as COVID-19 currently, and the second is to address slow-moving outbreaks such as HIV. Active preparedness can be established through our ability to build cross-sector partnerships — this is something that can prove to be more challenging during a real crisis. From our COVID-19 experience, governments can maintain their information-sharing practices between major outbreaks and then ramp them up when outbreaks start. Similar to South Korea’s MERS program, an “always-on” network enables leaders of multiple sectors to communicate and share real-time data concerning zoonotic diseases. With the rise of animal-human transmissions, twenty-four-seven surveillance is needed more than ever to notify scientists and government officials of potential exposures.

An always-on system targets infectious diseases during a pandemic, but more systems can help prevent a pandemic. Universal healthcare (UHS) is one primary strategy that governments can take to slow the spread of a future pandemic. It is believed that just over half of the American population receive some form of healthcare insurance from their employers, but many still find themselves without sustainable insurance during the worst pandemic in this generation’s history. (King et al.) The pandemic has caused extreme job loss and a national lack of income, as families are forced to make tough decisions regarding their health. In a recent study, The Commonwealth Fund found that 68 percent of adults said the out-of-pocket costs they might have to pay would be important in their decision to get care if they had symptoms of the Coronavirus (Collins). Without proper access to healthcare, it becomes complex to coordinate accurate data and responses as many individuals are not tested or return to their normal lifestyle too quickly. This inherently prolongs the pandemic and damages the already unstable economy. Governments are already issuing billions of dollars to defer testing costs for uninsured individuals and have constituted laws that limit cost-sharing associated with COVID-19. These efforts could have been consolidated elsewhere if the establishment of a Universal Healthcare System was in place. By establishing a UHS, governments would already have policies protecting the uninsured and impoverished so that testing and prices and extra payments could be deferred or covered under their Medicare act. In theory, patients are more likely to discuss their genuine symptoms if they are not subconsciously obsessed with the price tag that comes with their physical well-being.

Even with the addition of a Universal Healthcare system, a growing number of people will still reject treatment in defence of their civil liberties and misguided ideologies. In the last decade, vaccine hesitancy or “anti-vax” sentiment has become a severe issue for healthcare professionals. On social media and even within the professional community, vaccine hesitancy has established fear and doubt about vaccines and their effects on citizens’ lifestyles. The World Health Organization recognizes it as one of the major threats to global health (Godlee). Noni MacDonald defined vaccine hesitancy as delay in acceptance or refusal of vaccination despite availability of vaccination services. (MacDonald) It is a worldwide phenomenon (Thomson) and extends to all cultural beliefs, health education and languages. Due to its complexity, there are no definite responses to reduce unfounded skepticism (Thomson), and the only current solution is data-driven evidence that eliminates doubt and misinterpretations. Thus, better science education could help curb the spread of a possible future pandemic. If the general public understands the science and reasons behind the safety procedures put in place, it will dissuade them from breaking protocol and foster an environment of support. Furthermore, citizens who receive a base education about viruses, antibodies, and vaccines will know about future vaccinations and the procedure associated with manufacturing and testing them. While education and awareness are not immediate remedies to these issues, educating and training the public to be conscious of scientific data enables professionals to offer strategies that tackle each epidemic. Inherently, this allows the public to have confidence in their elected officials, and it permits them to make informed autonomous decisions centred around accurate information.

In unison with strong and effective leadership, precise medical agendas and legal frameworks can forcefully deter a potential pandemic. Integral parts of a nation’s ability to remain attentive and assertive against lethal pathogens that threaten their population lie in understanding why pandemics happen, rationalizing our mistakes and ensuring social change to support our future. The Coronavirus pandemic has laid the foundation for the future generation of politicians, doctors and scientists to establish enhanced and effective policies. “We long to return to normal, but normal led to this… we MUST grapple with all the ways normal failed us.” (Ed Yong) The fundamental principle should be to bypass crucial mistakes that limited society’s response to the Coronavirus pandemic. Our current medical schemes are restricted in times of urgency. Hospitals are confined to regulations that cannot accommodate the public as many patients are left defenceless against dangerous diseases and extortionist insurance companies. Consequently, our governments, healthcare officials and society must face the reality that with unprecedented times comes unprecedented changes. As long as our world remains attentive and prudent in its defence against the next pandemic and implements suitable corrective systems, our world will change for the better. If the next pandemic is to be overcome, our society must adopt new actions after this time of uncommon crises.

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Bachelor + Masters Student at UBC

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