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Expert Interview

Infectious Respiratory Diseases: What Have We Learned From COVID-19?

July 13, 2023

Close up of thermometer, tea and medicine on the table while girl laying down in the bed in background.

With the emergency phase of the COVID-19 pandemic at an end, questions regarding what we’ve learned from the pandemic about tracking and reducing the spread of respiratory diseases are center stage. We turned to Sarah Ball, ScD, MS, MPH, a Vice President for Clinical Research and Lead Scientific/Epidemiology Advisor for Westat’s Health Sector, for answers, relying on her extensive epidemiologic experience and clinical knowledge of respiratory diseases, including COVID-19 and influenza. Here she discusses lessons learned; challenges we may face with future emerging respiratory diseases; steps needed to ensure high levels of vaccine uptake for diseases beyond COVID-19; and how the differences between COVID-19, influenza, and tuberculosis (TB) impact efforts to control their spread.

Q. What have Westat researchers and others learned about reducing the spread of respiratory diseases?

A. One important insight was the vital need for accurate and timely data to inform policy decisions so that health strategies such as wearing masks and providing vaccines can be established. We also saw the importance of strong partnerships with health systems nationwide that allowed Westat to track the effectiveness of the COVID-19 vaccines and be among the first researchers in the country and in the world to produce estimates of vaccine effectiveness. Of course, good communication is as important as good science since mitigating strategies are largely dependent on people’s actions, and people’s actions are dependent on the information they receive and understand.

Q. What challenges did you face related to tracking the SARS-CoV-2 infection?

A. Two challenges we experienced included the proliferation of at-home rapid tests and the reporting of community-based testing into the electronic health records (EHRs) of medical systems. With the use of at-home rapid tests, results, if not reported to a health system, could not be tracked.

Q. What do we need to think about now to track and respond to future respiratory diseases that might emerge?

A. The first issue that always exists with an emerging infectious disease is being able to identify its course. Will it spread or fizzle out? If it’s spreading, we will have to wait for a medical test to be developed that will confirm if someone infected is positive for the virus. If the developer of the test cannot obtain reagents and other substances required to detect the new disease, undiagnosed patients can unknowingly transmit it, complicating mitigation efforts. In addition, there might be limitations on data available from the surveillance systems used to monitor and track the disease, presenting another hurdle, and we will need to understand those limitations. We will also need to establish standardized reporting requirements for positive tests. We do have a foundation of models from our experience over the past several years to help guide future efforts.

As we know all too well from the course of the COVID-19 pandemic response, without complete data, it will be difficult to assess the cost/benefits of applying different interventions. Decisionmakers will be faced with making recommendations with incomplete information and then trying to gain the public’s trust to follow their recommendations. As if these were not enough challenges, supply chain disruptions of shipments of such things as masks, ventilators, medicines, and vaccines could further obstruct mitigation strategies.

Q. These are familiar issues we faced in the COVID-19 public health crisis. How are we better off now than in 2020? Is CDC rethinking its approaches to tracking and mitigating the spread of respiratory diseases?

A. Yes, the CDC is working on its Data Modernization Initiative that will allow it to gather data more quickly and more efficiently. It involves a comprehensive approach to surveillance of emerging diseases that addresses both technology and the sharing and use of data. Essentially, the siloed and antiquated public health data systems will be replaced with connected, flexible “response ready” systems. These will enable the rapid prediction, prevention, detection, and response to emerging diseases.

Q. With vaccine hesitancy and resistance still a concern, what can public health officials do to ensure high levels of vaccine uptake for respiratory diseases beyond COVID-19?

A. To address this concern, public health officials will need to strengthen their community engagement, improve access to vaccines—especially among adults—and communicate with the public in new and better ways about the benefits of vaccines. It will also require tapping into providers’ knowledge about why their patients are vaccine hesitant.

Q. What are some of the key differences between COVID-19 and other respiratory diseases like influenza or tuberculosis (TB), and how do these differences impact efforts to control their spread?

A. The biggest difference is that COVID-19 is a new disease while influenza and TB have been with us throughout history. We’ve had a long time to understand how TB and influenza work and how to manage them. We can use this understanding as a starting point for controlling newly emerging pathogens, which we did for COVID-19. But these diseases are ultimately different pathogens that behave in different ways and warrant different approaches to control them. Additionally, the newness of COVID-19 means that the virus that causes it is still changing as it spreads from person to person. That’s probably why in such a relatively short time we’ve seen such dramatic changes in the pathogen’s transmissibility, driven by changes to its genome. Flu and TB have been circulating for much longer so while evolution is a constant, ongoing process, they have had more time to become optimized to their environment and transmission patterns.

Q. In light of our experiences with COVID-19 as well as influenza strains and TB over the years and everything we have learned, are you optimistic about our ability to identify, surveil, and respond to novel respiratory disease?

A. We have learned a lot since 2020 that augments what we have learned over time through TB and influenza crises—not only in terms of the science of viruses and the epidemiology of disease but also about communications strategies broadly among the public and between providers and patients. Now we have in place more infrastructure for capturing and sharing data and information, with additional efforts underway at CDC and other federal agencies. We are alert to future challenges but continued emphasis and vigilance are required to ensure that this infrastructure is not only maintained but also continues to be enhanced.

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