Public health experts sketch a roadmap to get from the Covid pandemic to the ‘next normal’

A new report released Monday charts a path for the transition out of the Covid-19 pandemic, one that outlines both how the country can deal with the challenge of endemic Covid disease and how to prepare for future biosecurity threats.

The report plots a course to what its authors call the “next normal” — living with the SARS-CoV-2 virus as a continuing threat that needs to be managed. Doing so will require improvements on a number of fronts, from better surveillance for Covid and other pathogens to keeping tabs on how taxed hospitals are; and from efforts to address the air quality in buildings to continued investment in antiviral drugs and better vaccines. The authors also call for offering people sick with respiratory symptoms easy access to testing and, if they are positive for Covid or influenza, a quick prescription for the relevant antiviral drug.

The 136-page report was written by nearly two dozen experts, a number of whom have advised the Biden administration on its Covid-19 policies. Thirty other experts contributed to the report, entitled “Getting to and Sustaining the Next Normal: A Roadmap to Living with Covid.”

“It’s an attempt to have a more disciplined approach to dealing with this crisis, providing a vision for what ‘next’ might look like,” said Luciana Borio, one of the authors and a senior fellow for global health at the Council on Foreign Relations.

Its publication comes at a critical time, when the combination of declining case counts, deep-seated Covid fatigue, and a dangerous and unprovoked war instigated by a nuclear power threaten to push control of the virus and planning for future pandemics to the far back burner.

“I do think it’s a worry,” Ezekiel Emanuel, vice provost of global initiatives at the University of Pennsylvania and another of the authors, said of the risk that Russia’s attack on Ukraine will drain attention and funding from the Covid response. “And part of the reason to lay this out is to emphasize that that would be a huge mistake, and a really, really serious flaw.”

The report suggests the U.S. response to Covid-19 should transition from one directed solely at this single disease to one where prevention, mitigation, and treatment efforts are focused on Covid as one of a number of respiratory viruses, including influenza.

The authors sketch out three scenarios the country may face in the near future with Covid-19 — one optimistic, one pessimistic, and the third midway between the two. Which will come to pass will depend on how well immunity to the SARS-2 virus — immunity acquired through vaccination or infection — holds up and whether mutations to the virus make it more infectious and/or more lethal.

In the optimistic scenario, where immunity holds up and the virus doesn’t evolve to trigger more severe disease, it’s possible that annual Covid deaths could be kept to between 15,000 and 30,000, the experts predict. At the other end of the scale, if a more virulent variant emerges and immunity wanes — leading to a substantially higher attack rate in a given year — the death toll could be nearly 10 times that of the optimistic scenario, they warn. In the intermediate scenario, they estimate that between 30,000 and 100,000 people could die from Covid annually.

The group suggests the country should aim to keep the annual death toll from respiratory infections like Covid, flu, and respiratory syncytial virus to about 60,000 a year — roughly the number of deaths that influenza causes in a bad flu season.

Can one add Covid — currently the worst of the respiratory pathogens — to the existing mix and still keep deaths to that pre-pandemic worse-case level? Emanuel said improvements the group is calling for — things like better indoor air quality — will help to reduce the toll of influenza and other flu-like illnesses as well as Covid.

“We’re not going to normal 2019,” he noted. “There are things that are going to be better. Our surveillance system better be better. Our indoor air quality system better be better. Our willingness to put up with [for] short periods of time — and around certain vulnerable populations — having special public health precautions. All of that should make a big difference in the mortality.”

A key piece of the puzzle that needs to be addressed is the quality of indoor air, Borio insisted. “In a way, it’s a little bit like training for a long marathon. You have to start somewhere. And we should start. We shouldn’t just put this in a it’s-too-hard box, because it really isn’t.”

She too fears that as the pandemic appears to be easing, attention will wane on efforts to better prepare the country to deal with the ongoing challenge of Covid and to be ready for the next infectious-disease crisis.

“It’s one thing for a private citizen to move on and decide they’re going to travel and enjoy their summer,” Borio said. “But the government can’t do the same. The government has to still continue to monitor for emergent variants and continue developing the important vaccines and therapeutics.”

Correction: An earlier version of this article misspelled Ekekiel Emanuel’s surname.