- A world that has been fervently hoping for a clean break with the COVID-19 pandemic may be disappointed.
- Not everyone will agree with every target, but part of managing endemic COVID-19 requires forging a social contract that recognizes the need to control the health impact of the disease while normalizing society to the greatest extent possible.
- To help navigate this as a society, healthcare providers will need to better characterize the range of symptoms associated with long COVID.
The world, which had hoped for a clean break from the COVID-19 pandemic, would be disappointed. The epidemic is still going strong in many regions; certain countries are currently experiencing their greatest rates of hospitalisation and death, as reported by McKinsey & Company.
Endemic disease
The endgame continues to recede into the future, even in locations where it has subsided.
SARS-CoV-2 herd immunity is unlikely to be achieved in many places.
The term “endemic disease” does not imply that the disease is mismanaged.
Every year, some 38,000 Americans die in car accidents, significantly fewer than the COVID-19-related deaths of the previous year, but still a considerable amount.
We have developed instruments as a society to make road travel safer, such as seatbelts, airbags, and impaired-driving legislation.
Every road death is a tragedy, and automakers, government agencies, and others are always working to prevent fatalities.
These four imperatives, when combined, form a holistic approach to endemic management.
The new normal
Societies must define goals for what the new normal will entail and come to an agreement on them.
First, goals must take into account COVID-19’s “whole-of-society” influence.
COVID-19 has had an impact on daily activities in addition to mortality or serious sickness (learning and working, for example, and mental health). Workdays lost, business closures and school absenteeism rates should all be taken into account.
The proper measurements are likely to differ by geography: regions, where COVID-19 highlighted the health system’s fragility, may choose to prioritise avoiding overburdening their hospitals, while others may embrace a more integrated mix of economic, social, and health variables.
Second, objectives must be realistic and balanced to meet society’s various requirements.
Leaders must not create objectives that disproportionately burden the most vulnerable members of society, such as requiring low-wage frontline workers to communicate or enforce policies.
Third, through effective communication, leaders must develop the broadest possible consensus around the goals, highlighting the aims’ whole-of-society nature.
Although not everyone will agree with every goal, treating endemic disease is a necessary component of the process. COVID-19 necessitates the formation of a social compact that recognises the necessity to control the disease’s health effects while normalising society as much as feasible.
Targets will change as we learn more about what works and what doesn’t, but communication clarity and consistency will be important.
Track progress
After setting realistic, multi-sector goals, jurisdictions should keep track of their progress in an easy-to-follow, transparent manner.
Masking, physical separation, and testing requirements are examples of public-health interventions that should be implemented based on set criteria for these variables.
Metrics will have to be tracked internationally in today’s interconnected economies to understand transmission dynamics and the emergence of novel varieties, as well as to advise policy regarding travel restrictions.
This year, many countries have made significant progress in increasing their capacity to sequence SARS-CoV-2.
New initiatives like the WHO Hub for Pandemic and Epidemic Intelligence in Berlin, the UK’s plan for a Global Pandemic Radar, and the US Centers for Disease Control and Prevention’s new Center for Forecasting and Outbreak Analytics should help build on the progress made in epidemic prediction over the past year.
Finally, public communication of monitoring data must be easy and thorough.
Limit illness and death
Societies must effectively limit immediate illness, the prevalence and persistence of long-term illnesses (“long COVID”), and COVID-19-related mortality to reach a new normal in which continual COVID-19 transmission is an accepted part of everyday life. All of these things are required to minimise the impact on people’s quality of life, social well-being, and economic productivity.
The coming challenge will be divided into four areas: vaccine research and administration, scaling effective therapies, health system readiness, and the specific needs of vulnerable people.
Vaccines
The high efficacy of today’s vaccines in preventing severe cases of COVID-19 is critical to normalizing society.
Portugal illustrates the point: with 98 per cent of those eligible fully vaccinated, severe COVID-19 cases are now rare and almost all public-health restrictions have been lifted. In the months ahead, we will encounter old and new complexities in the push for vaccines: convincing vaccine-hesitant adults to get immunized; expanding immunization to younger ages as regulators evaluate filings from vaccine makers and scaling boosters across the population.
Reaching and sustaining high levels of vaccination, particularly as acute disease subsides, will require sustained and novel efforts to engage and educate consumers.
Public-sector policies, private-sector practices, and shared cultural values must create incentives for all of the above and make clear that immunization is a shared societal norm that is needed to effectively live with endemic COVID-19.
Moreover, as we transition from a heroic, one-time effort to stand up an infrastructure that put billions of doses in arms to a more routine program of booster vaccination, healthcare providers must integrate and institutionalize COVID-19 vaccinations into their broader ongoing operations.
Treatments
When people do get infected, effective treatments become critical.
As they arrive, new and proven therapeutics and care practices must be incorporated into the standard of care, especially in communities at higher risk of COVID-19 infection and death and those with historical challenges in accessing high-quality care.
New treatments are also needed for long COVID.
To help navigate this as a society, healthcare providers will need to better characterize the range of symptoms associated with long COVID and develop tailored therapeutics and innovations that improve recovery and limit disability after infection.
Health systems
Some of the darkest periods of the last 18 months were distinguished by overburdened health systems and healthcare personnel forced to make hard judgments.
These times were also marked by significant second-order health consequences, as the number of deaths from other causes rapidly increased.
To better manage future outbreaks, care-delivery systems must establish surge plans that can be activated swiftly to expand care capacity in response to local or regional outbreaks, as well as expected seasonal swings, while still meeting non-COVID-19 care needs.
To effectively manage endemic COVID-19, it is also necessary to catch up on preventative and elective care that has been ignored or delayed due to the virus.
Vulnerable populations
The final critical element of limiting death from COVID-19 is outreach to those who are most at risk.
Some groups, whether because they live in crowded settings, suffer from socioeconomic disadvantage, or have limited access to healthcare, have been disproportionately affected by the pandemic to date.
As the level of public attention focused on COVID-19 wanes, societies must be careful to avoid strategies that place a disproportionate burden on the most vulnerable.
Equity should be woven into all of the interventions to limit illness and death.
Any approach to living with endemic COVID-19 must have tailored strategies for outreach to these communities, and programs to ensure access to the vaccines, treatments, and care that can best keep them safe.
Slow transmission
In a state of endemicity, the slower transmission reduces the direct health burden of COVID-19, minimizes the likelihood that new variants arise, and mitigates the likelihood that epidemic outbreaks lead to societal disruption.
In this new normal, we can expect four approaches to become a regular part of daily life: ubiquitous testing; safer interactions in workplaces, schools, and recreation and entertainment locales; and rapid response to transmission hotspots.
Widely available and rapid testing can help individuals and societies take the steps needed to limit further transmission. Who bears the cost of sustaining this infrastructure will likely be one of the next-order questions to arise.
Over time, infrastructure improvements can continue to reduce the risk of transmission in indoor spaces.
Lastly, when local outbreaks occur despite widespread safer interactions (and they will), societies must have the rapid-response infrastructure in place to limit exponential transmission. While case investigation and contact-tracing capacity have been overwhelmed at some points during the pandemic, they can play critical roles in responding to more localized outbreaks.
Collaboration across the public sector, private sector, and care-delivery system—including the use of common communication platforms and data sharing where possible—will be critical for responding quickly and containing hotspots.
While many jurisdictions deployed these approaches too late on the upslope of COVID-19 to have the desired impact, they have a critical role to play on the downslope.
The four strands for addressing endemic COVID-19 as a whole will necessitate a major cultural adjustment. Every stakeholder will play a vital role:
- Governments will be able to achieve consensus on goals, communicate effectively, and create the appropriate incentives.
- Employers are likely to play a more prominent role, establishing regulations for their workplace and assisting their employees in navigating the changes.
- Health systems can find the correct balance between competing needs and prepare for outbreaks and surges that are unavoidable.
- Individuals can question their convictions over the previous 18 months and adopt new behaviours.
The expenditures will be significant since these imperatives will necessitate long-term investment, but the benefits of enabling normal economic activity will be enormous. To address chronic COVID-19, leaders must align incentives so that appropriate investment is undertaken across industries. The attitude transition is perhaps the most difficult of all, as we gradually recognise that COVID-19 is not a fad that we can forget about, but rather a structural transformation in how we live that necessitates lasting changes in behaviour. However, if we are to fully recover our lives, now is the time to begin constructing.
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Source: McKinsey & Company
