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We are just about at a year for the COVID-19 pandemic. After a year COVID has infected more than 115 million people and caused over 2.5 million deaths, with over half a million in the US alone. Pandemic fatigue has definitely set in, but with the rollout of various vaccines we can also see the light at the end of the tunnel. But there appears to be a strong consensus among experts that just because this pandemic ends, as all pandemics eventually do, that does not mean our concerns are over. They may just be getting started.

Dr. Mike Ryan, head of the World Health Organization (WHO) Emergencies Program warns that COVID-19 may have just been a “wake-up call”. This was a once-in-a century pandemic, but it may not be another century before the next one hits, and the next one could be far worse. What has changed?

The most obvious factor is simply that the human population has grown. Infectious diseases spread when animals congregate in large numbers. World population is now approaching 8 billion, and that population is increasingly global. Our rising population also brings other important factors. Producing enough food to feed the world includes raising large numbers of animals in close quarters, and they represent breeding grounds for viruses and infectious agents that can jump to humans.

Further, humans are increasingly encroaching onto natural habitats, raising the probability of a virus going from a non-human reservoir into the human population. That is likely what happened with COVID-19, although the exact path has not yet been proven. SARS-CoV-2, the disease that causes COVID-19, is endemic in the South Asian bat populations, and likely came from that source through wet markets and intermediate species.

There are potentially thousands of viruses in the world that have the potential to become the next pandemic, and SARS-CoV-2 is far from the worst of them. Rolling the “pandemic dice” has a good chance of producing something far worse than COVID-19, which is what Ryan and others are referring to with their warnings. The CDC keeps an eye on “Viruses of Special Concern”, such as those likely to produce the next flu pandemic. Other organizations also have published lists of potential severe pandemics, which include things like Ebola and Zika.

In addition to the direct health effects of the pandemic, it has been incredibly disruptive to life and economic activity. A study published in October estimated that the cost of the pandemic to the US was $16 trillion. At the same time the IMF estimated that world-wide lost productivity alone could cost $28 trillion. A generation of students may have effectively lost a year of education. Life expectancy in the US was decreased by 1.13 years due to COVID-19, disproportionately affecting minorities and the poor.

Once the vaccines have effectively ended the pandemic (although SARS-CoV-2 will likely remain with us, like the flu), it will be tempting to try to forget it and return to pre-pandemic normal life. But really, that will not be possible, nor should it be our goal. We need to adapt to a world where pandemics are increasingly likely.

One adaptation, which is the most hopeful thing to emerge during this pandemic, is that health science continues to advance impressively. We not only developed and deployed multiple vaccines within a year of discovering the virus, some are based on an entirely new vaccine platform – the mRNA vaccines (such as the ones developed by Pfizer and Moderna). Because sequencing and making DNA and RNA is now a mature technology, it took only weeks to sequence the genome of the SARS-CoV-2 virus, and only days to make the mRNA vaccine once the companies were handed that sequence. It then took months of clinical testing to prove the resulting vaccines were safe and effective – but there clearly is an opportunity here to fast track new vaccines, using a now-proven platform, without having to reinvent the clinical science each time. Quickly producing vaccines in response to new pandemic will likely prove to be one of our most important tools in the future.

We also need to take concrete steps to reduce the probability of new pandemic viruses from emerging. This may include changing practices at factory farms, and regulating wet markets. But we also need to carefully consider development practices that encroach on natural habitats, and habitat destruction in general.

The political challenge, as we have seen, may prove to be the most difficult. Preparedness is critical – we need to put in place, and maintain, a pandemic response infrastructure that can monitor for the emergence of new diseases, and respond effectively. This needs to be a global effort. It should be incredibly obvious now that something that happens on the other side of the planet can have devastating effects at home.

Finally, on the personal and societal level there needs to be permanent changes in culture. We have collective acquired some new skills during this pandemic, and we should not discard them once the pandemic is over. This includes mask-wearing. It should be a simple matter now, and culturally normal and expected, that anyone with cold or flu-like symptoms should remain isolated, but if they have even minor symptoms and need to be in public they should wear a mask and socially distance.

Further, working from home when sick or exposed should also be accepted as normal and responsible behavior. We can all Zoom now, and this should remain if not the default then at least an option for attending meetings and class when necessary. The pandemic also exacerbated and thereby helped reveal socioeconomic disparities. The “digital divide” now has public health consequences, and as we plan infrastructure investment it is clear that making sure everyone can attend class from home should be a priority.

In a way, we need to adapt in the same way our immune systems adapt. Once exposed to an infectious agent, our immune systems remember them so that they can respond more quickly and vigorously at the next exposure. Similarly, our world needs to respond more quickly and vigorously to the next pandemic. We must have pandemic-memory, even if we want to forget the past year.

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Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.