To Get to a ‘New Normal,’ Public Health Must Focus on All Respiratory Viruses

In recent years, the U.S. has accepted as many as 35,000 hospitalizations and 3,000 deaths per week from influenza and respiratory syncytial virus (RSV) alone.

We believe that hospitalizations and deaths are the appropriate metric for assessing control measures for respiratory viruses. Health systems can use projections to plan for year-round and seasonal hospital bed and workforce needs. Forecasts of hospitalizations and deaths linked to respiratory viruses could help public health officials and the general public plan for when to wear high-quality masks, switch to remote work or school, or avoid certain indoor activities, much as weather forecasts nudge people to carry umbrellas.

The U.S. is currently averaging almost 150,000 hospitalizations and 12,500 deaths per week just from Covid-19. That’s four times as many hospitalizations and deaths as from influenza and RSV in a bad year. Some think that suppressing hospitalizations and deaths to levels seen in bad pre-pandemic years is too ambitious. Some will be horrified the country didn’t do more to suppress illnesses and deaths from viral respiratory infections in years past. But these numbers provide a place to start debating goals.

Once the goals have been agreed upon — both national and local — the U.S. needs to build a comprehensive, representative testing and real-time reporting system for all illnesses caused by respiratory viruses.

Every person in the country should have access to free testing and paid sick and family leave, empowering them to isolate when contagious and to seek prompt treatment. Rapid antigen tests, which exist not only for SARS-CoV-2 but also for influenza and RSV, and could be combined into one test strip for use at home. Labs, too, should routinely test for a panel of the most common respiratory infections in all patients presenting with relevant symptoms.

Positive results from either home- or lab-based tests should automatically link to treatment ranging from monoclonal antibodies and Paxlovid (nirmatrelvir and ritonavir) for Covid to Tamiflu (oseltamivir) or Xofluza (baloxavir marboxil) for influenza, as well as access to enroll in clinical trials. The U.S. government should accelerate the development and production of such therapies, making them widely available at low or no cost. Better measuring the burden of viral respiratory illness may lead to better understanding of what new antiviral therapeutics are most urgently needed and more closely link point of care diagnostics to appropriate treatments. An extra benefit of this approach would be reducing the overuse of antibiotics, which are effective only against bacterial infections, not viral ones.

Specifically, genetic sequencing should be conducted on a larger and more geographically representative proportion of respiratory infections as well as breakthrough infections among vaccinated individuals regardless of the severity of these infections. Results of all genomic sequencing should be uploaded into global databases in real time, facilitating a more global understanding of the emergence and spread of novel variants.

Earlier recognition and characterization of new variants of respiratory viruses would allow state and local health departments and systems to mobilize resources proactively ahead of a surge and inform research and development on new vaccines and therapeutics.

The most proactive way to stay ahead of future variants would be to develop a universal coronavirus vaccine that protects against known coronaviruses as well as oral, intranasal, and transdermal administered vaccines that improve both access and immune responses.

Finally, the United States must strengthen its national, state, and community public health workforce to respond and serve effectively and visibly and to address both persistent problems and evolving emergencies.

The Covid-19 crisis has created a unique opportunity for the U.S. to build a stronger, more proactive, and more prepared public health system. While vaccines will continue to be a crucial tool to control illness and death from viral respiratory infections, they must be complemented by a strong public health infrastructure, real-time data, testing, treatment, air ventilation and filtration standards, and clearly guided non-pharmaceutical interventions. By investing in a broad public health response that is both strategic and coordinated, the U.S. has an opportunity to build a foundation for establishing and returning to a “new normal” with Covid-19 and stemming future health emergencies altogether.

Céline R. Gounder is an internist, infectious disease specialist, and epidemiologist at the NYU Grossman School of Medicine and Bellevue Hospital and host of the “Epidemic” podcast. Rick A. Bright is an immunologist and virologist, CEO of the Pandemic Prevention Institute at The Rockefeller Foundation, and former director of the Biomedical Advanced Research and Development Authority. Ezekiel J. Emanuel is a physician, vice provost for global initiatives, and co-director of the Healthcare Transformation Institute at the University of Pennsylvania. All three served on the Biden-Harris transition team’s Covid-19 advisory board.

This article first appeared in STAT on January 20th, 2022, and is reposted with permission.