5 lessons COVID-19 has taught us for the next pandemic

The pandemic that launched the nation’s first and most ambitious experiment to slow the spread of COVID-19 — stay-home orders for 7.6 million Bay Area residents — is easing.

It’s left behind shattered lives, economic upset and widened racial inequities, but also valuable lessons which could strengthen our future response to outbreaks of deadly contagion.

“Despite these enormous hardships, we have so many reasons for hope and a better future now,” said Dr. Dan Lowenstein, executive vice chancellor and provost of UC San Francisco.

A year ago, Bay Area health officials did the unthinkable: They pushed us into isolation, ordering that people leave their homes only to “obtain or perform vital services.”

With merely five deaths and about 245 confirmed infections in the region, it seemed a heavy-handed step that upended our lives.

But their instincts proved prescient. In a matter of weeks, the Bay Area was swept by its most dire public health crisis in a century. In the year since, the pandemic has claimed more than 5,780 lives here, with more than 426,000 confirmed infections.

“Every single bed was filled…It was horrendous,” recalled Dr. Paul Silka, medical director of emergency medicine at Regional Medical Center in the heart of East San Jose, which was so overwhelmed with COVID-19 patients last spring that a refrigerated truck was parked outside ready to serve as a makeshift morgue.

Now, Bay Area deaths have fallen from a peak in late January of 75 deaths in a day over a seven-day period to 18 at the start of this week.

“The chaos has gone away,” said Silka.  “But no one can ever take away the experience from those who went through it.”

As we emerge from the nightmare, those fighting on biomedicine’s battlefield offered a list of lessons learned, many of them surprising and specific. For instance, we need a more diverse supply chain for things like gloves, gowns and masks, said Dr. Joshua Adler, vice dean for clinical affairs at UC San Francisco. The broader lesson is that it is now time to prepare for the next pandemic.

The man vs. microbe war is far from over, experts warn. But if we adapt, we will be defined not by the virus, but our response.

Lesson: Time is of the essence.

The race to create a vaccine has been stunning. But many lives were also saved by California’s early and aggressive stay-home measures.

Our statewide order came four days ahead of New York’s, and followed several days of increasing restrictions. During that time, New York’s COVID-19 cases multiplied to 15,168 — 10 times the 1,536 cases in California at the time.

Even within California, a few days made a big difference in slowing the exponential spread of infection. The Bay Area’s stay-home order took effect on a Tuesday; Southern California’s took effect on a Friday, along with the rest of the state, but was largely ignored in the southland until Monday, according to UCSF infectious disease expert Dr. George Rutherford.

“That one-week difference was was huge,” he said. “It basically meant Southern California had many more chains of transmission to deal with. In general, they’ve never recovered from it.”

Lesson: We need direction from the top.

“When there’s no leadership at the federal level, the responsibility is pushed out to the state. And then at the state, it becomes quite political and it’s pushed down to the county level,” said Dr. Sara Cody, Santa Clara County Health Officer.

“So you get like this extraordinary patchwork,” she said. “A ‘county, by county, by county, by county’ approach — all across the country — is not the most successful way to fight a pandemic.”

In hospitals, as case counts climbed, doctors were on their own to strategize the best approach to care, recalled Dr. Peter Chin-Hong, a professor of medicine and infectious disease specialist at UCSF.

“We were sharing with each other on Twitter, because nobody was telling us what to do. We came up with our own first guidelines… I’d click on the (federal) website” for information, he said, “and it wasn’t there.”

Nurse Liz Thurstone, who works in Regional’s COVID-19 ward, recalled the dark early days. “We just put on our helmets and dug into the frontlines… We’d try something, to see what stuck. We’ve come a long way.”

Lesson: You can’t manage what you don’t measure.

The California Reportable Disease Information Exchange (CalREDIE) was not built to handle the volume of data about COVID-19 cases, hospitalizations and deaths, so many local officials scrambled to conduct their own tallies.

“Modern data systems hadn’t been built that standardized the collection, reporting and sharing of data,” said Cody.  To understand the spread of the virus, “we had to build a lot of infrastructure that didn’t exist.”

Similarly, the data problems experienced by California’s troubled early vaccine rollout left the state uninformed about how many doses were available, and where they were needed. Some local health departments and hospitals lacked access to the federal technology platform. Others discovered that their reporting of daily inoculations wasn’t automatically uploading to the state’s registry, which created delays.

Lesson: Accelerate and coordinate research.

COVID-19 taught us that clinical trials can be launched more quickly, said Dr. Annie Luetkemeyer, professor of infectious diseases at UCSF.

“I’ve gotten a clinical trial up and going in 11 days, which has never happened before,” she said. “I really hope that will continue… let’s cut out some of the stuff that’s getting in the way.”

But they need to be coordinated; early on, too many small studies repeated each other, she said.

We’ve learned that findings can be published more promptly. Scientists are now uploading preliminary versions of their papers, or “preprints,” to public repositories, such as medRxiv.

“Do we really need to wait for a conference to present life-saving data? I don’t think we’re going to do that anymore,” Luetkemeyer said. “There are a lot of things from the pre-COVID world that I’m happy to let go of.”

Lesson: An ounce of prevention.

Finding the cause of an outbreak is challenging, especially if it stems from a brand new pathogen. Global screening could catch the next pathogen.

“We need more vigilance in terms of how we monitor and detect infections, and then, importantly, communicate about it, so that there can be global preparations,” Nobel Laureate Jennifer Doudna, professor of biochemistry & molecular biology at UC Berkeley, said during a UCSF webinar earlier this month.

This can be done through new genomic technologies, which identify pathogens and could be used to construct a ”real time” network that tracks emerging viruses throughout the world, according to Doudna and Joe DeRisi, professor of biochemistry and biophysics at UCSF and co-president of the Chan Zuckerberg Biohub.

“Where’s the next big one going to come from? I wish I knew,” said DeRisi. “There’s really no great way to predict, other than to create systems that are going to let us watch how the viruses around us change and move.

“If we don’t do that, we ignore the signs at our peril,” he said. “We just are doomed to repeat the mistakes of the past.”