COVID-19 Public Health Emergency Is Over. What Have We Learned?

It has finally happened. COVID-19 has receded from a crisis to an emergency to an afterthought for most people. Although the disease and the SARS-CoV-2 virus that causes it will be present in our lives for many years, the role that they play in the daily lives of most has changed dramatically. The end of the COVID-19 public health emergency on May 11, 2023, bookends the pandemic in the US, providing the opportunity to review our notes about what we have learned about our response to a novel respiratory virus from both scientific and societal perspectives and to consider what it means for the next threat.

Scientifically, I believe our COVID-19 response must be considered a big success. Chinese scientists shared early management strategies and published information on patient risk factors for severe disease that informed treatment strategies across the world. The virus was quickly sequenced after its initial discovery, and vaccine development was both rapid and multifaceted.

The Operation Warp Speed initiative had both successes and failures, but the successes were meaningful. Using previously developed platforms, multiple successful vaccines were developed, purchased, and administered to patients with a rapidity never seen before. Multiple novel large and small molecule therapeutics were developed and authorized by the FDA, and existing immunomodulatory therapies that save lives were studied and authorized.

Practical research networks such as Recovery were created to evaluate possible therapies quickly, with large numbers of patients enrolled as they were treated, eschewing granularity in trial design in favor of increased power to find useful therapies. These trials found both lifesaving drugs like dexamethasone and disproved suggested uses of others such as hydroxychloroquine, lopinavir-ritonavir, and azithromycin. Testing also moved quickly, with home use of rapid antigen tests becoming commonplace, paving the way for assays of other infectious diseases in the future.

Overall, despite the bumps, I do not think we have ever seen a more successful scientific response to an acute infectious challenge.

Our societal response has been much less impressive. Nothing the scale of the COVID-19 pandemic has ever occurred in a background with the force of social media dominating societal discourse and with disinformation as easily propagated as information. Successes include the widespread distribution of vaccines through newly formed networks consisting of community pharmacies, public health centers, “pop up” clinics, and even drive-through administration sites. Failures include the divergence of vaccination rates, masking, and acceptance of public health measures by political affiliations; authorization of hydroxychloroquine by the FDA before evidence was able to prove or disprove its utility; and the rise of grifters spreading dangerous falsehoods for personal profit or political points. We have also lost many people from the health care workforce, both from the sad reality of deaths from on-the-job COVID-19 infections and the burnout that coping with so many infected patients has caused.

Where does this leave us? I am both optimistic about the scientific capability that we demonstrated and worried about the long-term effects on our public health response. If the unfortunate occurrence of another serious respiratory virus occurred this year, does anyone think that our response would be a good one? Our scientific victories are impressive, but they are tempered by societal reality. As the focus fades from COVID-19, we need to study and learn from the psychology of our society’s response to dangerous infectious diseases.