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June 7th, 2021


Lessons to Learn from the COVID Pandemic -- Dr. Thomas Falasca

 

What Lessons Did We Learn from COVID-19?

 

The COVID pandemic has deluged us with adversity, but we can learn plenty from it. Here, for starters, are some lessons.

 

LESSON 1 - Vaccine Complacency

The relative success of vaccine development during the pandemic may well inspire vaccine complacency that is unjustified for several reasons.

 

First, there is no guarantee that the next infectious disease will lend itself to the rapid development of a successful vaccine.

 

Second, many deaths would occur before even a successful vaccine’s discovery, manufacture, and distribution.

 

Third, a vaccine does not replace development of tests and implementation of contact tracing. Testing gives a picture of the scope of the epidemic and contact tracing is the first step in the containment of the disease. Both are centrally important in addition to vaccine development.

 

LESSON 2 – Rapid Robust Clinical Trials

The UK, despite its difficulty containing the epidemic was able to conduct such rapid clinical trials that American companies chose to test their drugs there.1

Development of an ability to institute rapid mid-sized and large clinical trials should be a priority during this inter-pandemic period.

 

LESSON 3 – Decisions under Incomplete Information

Decisions under incomplete information are the norm, and the earlier in a situation, the more incomplete the information. Early in the epidemic, it was supposed that masks were important only for medical personnel and for civilians under high exposure, such as supermarket cashiers. As further information became available of the high infectivity of COVID, it became apparent that masking was also important for the general population.

 

LESSON 4 – Early Suppression

The COVID pandemic has demonstrated the value of early suppression of the virus. The longer the virus circulates, the more time it has for mutation and the more people it infects. The more people it infects, the greater the exposure to uninfected people.

 

LESSON 5 – Telehealth Limitations

Telehealth has greatly expanded during the pandemic. However, not all problems are equally amenable to telehealth nor are all patients. Complicated problems of medicine or surgery may not be as amenable as those of dermatology or psychiatry. Additionally, the elderly, who may live alone, have poor vision or poor hearing, and who lack technologic skills or equipment, may be a poor patient selection for telehealth.2

A significant post-epidemic problem would be the reckless application of telehealth universally.

 

LESSON 6 - Oversimplification

The epidemic has necessitated, in the interests of decreasing infection exposure and increasing patient flow, the temporary streamlining or omission of some processes and procedures. Some of these changes may be improvements that translate over to the return of normality, others may be reluctant compromises that carry over because of inertia or shameless profit.

 

LESSON 7 – Tunnel Vision about Economic Consequences

The pandemic has inspired a false perception of strict dichotomy between economic consequences and health consequences of epidemic containment measures. However, the supposition of a strict dichotomy ignores the reality that while inadequate partial containment measures favor economic protection short-term they have profound long term economic consequences as more people sicken and fail to contribute to the economy.

 

LESSON 8 – Need for Transparency

The authorities in Wuhan, China, detained and silenced in December 2019 physician Dr. Li Wenliang on charges of spreading false rumors after he reported a novel illness in his patients. Dr. Wenliang died of COVID at age 34 in February 2020.3 Avoiding economic and political consequences short-term can lead to disastrous long-term economic, political, and humanitarian consequences.

 

LESSON 9 – Age Matters … Good Health Matters More

The protective value of good health is a critical lesson from the COVID pandemic.

 

Researchers at the University of Glasgow examined the risk of death from COVID among the general population, the healthier older population, and the less healthy older population. Their robust study included 470,034 people. Although the risk of fatal COVID infection was four times higher in healthy people over 75 than all people under 65, the fatality risk was 13 times higher in those with high blood pressure, obesity, or pulmonary conditions.4

 

LESSON 10 – Aerosol Studies and More

Scientists now understand better how singing, cheering, and loud talking generate aerosols even more aggressively than coughing, talking, and breathing. This topic seems to have received insufficient study because it did not fit neatly into the categories of virology, medicine, or engineering.5 There may be many more such topics requiring identification and investigation for future emergencies.

 

LESSON 11 – Fragmented Response

An Indian friend, a geology professor who lost both parents to COVID in the surge of the last few weeks, lamented to me that the Indian Government’s response to the epidemic was severely impaired by a large population and a federal form of government. These same problems, to a lesser extent, confront us in the United States. The problems of federalism, if not large population, confronted even the framers of the US Constitution. Nevertheless, the pandemic stresses the urgency of addressing these problems, to accommodate both individual freedom and public health concerns.

 

Conclusion

Winston Churchill, in the 1940s, said “Never let a good crisis go to waste.” He was referring to the opportunity to learn from adversity, of which we have seen plenty during the pandemic.

 

Learning from the pandemic may not be inevitable. Harvard epidemiologist William Hanage expressed serious doubt when he said, “I am not sure the US has learned much at all — or what it even can learn given the federal nature of the country and the balkanized state of the health care system.”1

 

Nevertheless, overcoming the problems of complacency and fragmentation presents a valuable opportunity for learning the above lessons and for bringing to light others hidden in the dark.

 

Thomas Falasca, DO

 

 Dr. Falasca - ECMS

 

 

References

 

1 Scott, D. (2021, May 03). The US is in danger of learning the wrong lessons from covid. Retrieved from https://www.vox.com/

 

2 8 lessons the COVID-19 pandemic has taught us. (2020, November 03). Retrieved from https://www.aoa.org/

 

3 Florman, R., Atun, R., McKee, M., & Mossialos, E. (2020, May 5). 12 lessons learned from the management of the coronavirus. Retrieved June 5, 2021, from http://www.elsevier.com/locate/healthpol

 

4 Harrar, S., Hochman, D., & Kaysen, R. (2021, March 04). 15 Lessons the coronavirus pandemic has taught us. Retrieved June 5, 2021, from https://www.aarp.org/bulletin/

 

5 Tate, N. (2020, December 23). From Public to Personal: Pandemic Lessons Learned. Retrieved June 6, 2021, from https://www.webmd.com/lung/news/20201223/from-public-to-personal-pandemic-lessons-learned

 

 

 

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