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5 Strategies for a Post-COVID World
Pages 55-70

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From page 55...
... This hypothetical exercise outlined a situation where a new coronavirus variant that could evade vaccine-induced immunity has emerged and is spreading through the United States.1 Finally, workshop planning members commented on the needs highlighted throughout workshop discussions and the opportunities for improved pandemic and health emergency planning to ensure the global crisis that COVID-19 brought on is not repeated. VISIONS FOR THE FUTURE For a broader perspective on the current pandemic and what future pandemics may hold, two speakers provided keynote presentations that 1  Thisscenario exercise was prepared and took place prior to the detection of the Omicron variant in November 2021.
From page 56...
... The second presentation discussed public health and societal measures that can protect populations and improve outcomes the next time this type of health emergency occurs. Pandemic Preparedness: The Biomedical Research Approach Presented by Anthony Fauci, National Institutes of Health Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH)
From page 57...
... In other words, he said, researchers use strategies and tools that were successfully applied to another virus and translate those to related virus vaccine design. This strategy employs basic virology principles, assays for preclinical and clinical settings, animal models, antigenic targets, potential immune correlates, and manufacturing strategies.
From page 58...
... Building core capabilities 5. Managing the mission Lessons from COVID-19 and Opportunities to Improve Future Responses Presented by Sandro Galea, Boston University School of Public Health Galea noted that his remarks complement the biomedical research approaches outlined by Fauci and that both efforts are needed, not one over the other.
From page 59...
... For decades in the United States, we have "underinvested in what makes us healthy," he commented, and we have also made those investments inequitably.4 He shared data on racial income and wealth gaps between White and Black families in the United States from 1989 to 2016, saying that while White families have about 40 percent higher income than Black families on average, the gap in wealth is about 10-fold difference, with White families attaining much more wealth than Black families.5 This underinvestment and inequity, 4  See https://nam.edu/vital-directions-for-health-health-care-priorities-from-a-national-­ academy-of-medicine-initiative (accessed February 16, 2022)
From page 60...
... Matthew Zahn, Orange County Health Care Agency (California) , offered that from a local public health perspective, one of the greatest difficulties has been messaging the importance of comorbidities but being careful not to blame the victims.
From page 61...
... For this exercise, participants were split into two groups and given the charge to extract key pieces of information and identify critical uncertainties, including basic knowns and unknowns of the situation. Next, they were asked to build a consequence cascade that maps out possible sequences of events once cases arrive in the jurisdiction, based on the status quo and best-guess probabilities.
From page 62...
... confirmed a cluster of breakthrough infections among elementary school-aged children at a summer day camp hosted by a suburban school district in a populous state. ­Sequence analysis confirmed the spread of a new SARS-CoV-2 variant.
From page 63...
... First, participants in the group suggested setting up aggressive surveillance efforts for children, especially in congregate settings. Many in the group voiced the importance of having active surveillance among all age groups, including elder care settings, because this is a new variant.
From page 64...
... Group Two Stephen J Thomas, State University of New York Upstate Medical University, moderated the second group's exercise experience and shared the key characteristics of the future that several participants found most likely and most undesirable (which can therefore inform what mitigation strategies can be deployed to avoid this hypothetical future)
From page 65...
... They discussed whether new epidemiological trends had a basis in new pathogenesis or new mechanisms of infection or immune evasion, and how did this translate into transmission dynamics, meaning, what is the R0 of the new variant? 10 Thomas also shared the group participants' reflection on whether there is a new mechanism increasing transmission and whether it applies to increased severity and affects existing treatment strategies.
From page 66...
... Many in the group noted an immediate need for real-time research to establish evidence and causality, identify potential animal reservoirs, and determine the stability and persistence of the viral variant. The group discussions reiterated the need and opportunity to appropriate funds to One Health programs and biomedical preparedness in a meaningful and enduring way, so they have authority and resources to 11  For full table of proposed strategic actions for group two, see Appendix E
From page 67...
... Lindsey Leininger, Tuck School of Business at Dartmouth felt strongly that there is a need for a much more robust digital response, including a social media ambassador and online efforts. One of our strategic failures was failing to map out the digital information environment, resource it, and attend to it, she added.
From page 68...
... Thomas replied that this was a topic of discussion for group two as well, and said when it comes to preparedness, if nothing changes then nothing changes. We simply cannot put the national preparedness mission on the existing public health infrastructure, from the local level up to federal agencies, that has been defunded and hollowed out over the past decade, he stated.
From page 69...
... But this will require broadening our thinking, and he emphasized the need to move from a reactive to a proactive approach. Speakers shared exciting developments of plans to invest in these more proactive areas, such as strengthening capacities of local governments and creating public policies for communication, all in the context of equity and addressing issues holistically.
From page 70...
... PREPUBLICATION COPY -- Uncorrected Proofs


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