Richard Bucala, MD, PhD, and colleagues take a page from the history of influenza to propose a five-step process for managing COVID-19. The authors look at the similarities between the emergence of influenza outbreaks and the COVID-19 pandemic and offer a “call to arms based on science and history.”
The commentary, “Managing COVID-19 going forward—the lessons from history,” appeared in the Quarterly Journal of Medicine, which is published by the Association of Physicians of Great Britain and Ireland, the world’s oldest medical society.
In addition to Bucala, Waldemar Von Zedtwitz Professor of Medicine (Rheumatology) and Professor of Pathology and of Epidemiology (Microbial Diseases) and chief, Rheumatology, Allergy, & Immunology in the Department of Internal Medicine at Yale School of Medicine, the authors are Gerald Friedland, MD, Professor Emeritus of Medicine and Epidemiology and Public Health, and Frank Snowden, DPhil, Andrew Downey Orrick Professor Emeritus of History. Snowden is the recent author of the highly acclaimed Epidemics and Society, which was published in 2019.
Like COVID-19, influenza is caused by a respiratory virus that evolves in both animals and humans, and “both infections require a level of human activity and interconnectivity that did not exist before the 20th century, with its densely populated cities, modern agricultural practices and networks of international commerce and travel,” the authors write. “Seasonal influenza was the result of the linkages we call globalization, and we have managed it well by combining viral surveillance, vaccination and public health measures, with only occasional ‘breakthroughs,’ as with the 2009 H1N1 pandemic.”
COVID-19 is no different, the authors say. “Coronaviruses have long existed in human and animal populations, causing mostly minor colds.” They add: “Just like seasonal influenza, but more debilitating and lethal, the COVID-19 virus and future variants can be faced down with the same measures that have worked for influenza.”
Their five-step process calls for global viral surveillance, vaccines, antiviral drugs, reimagined cities, and global equity.
Global viral surveillance: “The positioning of unified virus surveillance and sequencing capabilities, coordinated internationally, would cost little while providing time to identify new variants and produce countermeasures. It has worked for the flu.”
Vaccines: “Like influenza, COVID vaccines will have to be tailored to the latest viral strain. Fortunately, we have had a very lucky break with the RNA vaccines, which are simple to engineer and will become less costly and easier to produce and distribute.”
Antiviral drugs: “Beyond the deployment of antiviral drugs to reduce disease, computational modeling and antibody engineering make possible the prepositioning of variant-specific antibodies, whose efficacy can be predicted, to protect those at greatest risk to outbreaks of new variants—everywhere in the world.”
Reimagined cities: “Epidemiological and historical studies have demonstrated that crowded cities and disadvantaged populations are the front lines in the battle against pandemics. Human vulnerability to such infections correlates with poverty, dense living and working conditions and poor access to health care. It is time to reimagine urban land use.”
Global equity: “Much of the scientific infrastructure exists and would need only expansion and reinforcement. But there is the significant final and perhaps a most challenging concern of global inequities and disadvantaged populations, where the costs of urban and rural restructuring would require sustained political will and commitment shouldered by the more advanced economies.”
The Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.