Out of order: What’s next?

Mid-April and the only thing happening in the world—if the evening news is to be believed—is COVID-19. Where some countries are starting to show signs of recovery, parts of the United States are experiencing deaths and infections at horrific rates.

And murmuring in the background of the hand wringing and hand washing is the question of what’s next.

For the majority, this question ties to a desire to return to normal, to connect with family and friends or to return to work. I feel for everyone in this time of sacrifice, but I also feel pretty confident that normal will never be normal again.

In fact, I really hope the normal of tomorrow, next month or next year is significantly different from the normal of last year.

When I consider the question of what’s next, however, I am more interested in how—please don’t let it be if—we will apply the lessons learned not just from this catastrophe, but from the ones that came before.

I was living in the United States when the original SARS-CoV came to Toronto. From a distance, I had to watch my hometown and its citizens be ravaged by a pathogen that seemed to come out of nowhere.

Years later, back in Toronto and working for DDNews, I observed in my January 2013 commentary:

“Over the last couple of months, I have been watching reports out of the Middle East that don't alarm me so much as make my skin prickle a little. Aside from the usual strife in this region, there is a more insidious enemy that is making its presence known—a microbial presence that has killed five people in the region (as of this writing).”

MERS-CoV was something that happened over there, however, rather than in my backyard. So, much like Ebola or Marburg virus, its devastation was much less personal to me. I write that with full acknowledgement of my participation in the problem.

It is with that acknowledgement, however, that I wonder if the aftermath of SARS-CoV-2 will be different than its predecessors, whether coronavirus, flavivirus, filovirus or any other.

In a 2013 review to mark the 10th anniversary of the SARS outbreak, Rolf Hilgenfeld and Malik Peiris, then at University of Lubeck and University of Hong Kong, respectively, looked back at the learnings that arose from the SARS pandemic.

After highlighting many of the technical challenges and victories, they suggested: “However, it should also be noted that after 2005-2006, it became difficult to obtain funding for research on SARS-CoV in many countries, especially for efforts to discover new antiviral therapies.”

“Similarly, there was no incentive to further develop SARS-CoV vaccines in the absence of an overt threat to human health,” they continued. “Funding agencies and peer reviewers were probably short-sighted in this respect, but many virologists also failed to take seriously the threat of the re-emergence of SARS or of a SARS-like virus.”

As MERS was just starting to be addressed in 2013, the authors also turned their gaze forward in time, looking beyond the then-current efforts being made.

“If the current MERS-CoV outbreak is over by then, there is a danger that both funding and enthusiasm for developing these and other compounds will once again wane,” they warned, “and we will be in the same ‘drug-less’ situation when the next zoonotic transmission of a coronavirus into the human population will occur.”

Seven years later, we must be chastened.

Maybe it will be different with SARS-CoV-2.

Maybe the devastation wrecked by SARS-CoV-2 across Western Europe and North America will be enough incentive for those countries to continue to support research long after the immediate terrors have subsided.

Maybe this coronavirus will—as I have heard suggested—become a more chronic condition, akin to seasonal influenza, forcing us to harness our resources both in terms of outbreak surveillance and immunization.

Maybe the economic destabilization triggered by shelter-in-place orders and debates over what industries are essential will be enough to ensure governments and large companies will deeply invest in health infrastructure following their financial recoveries.

That’s a lot of maybes. But maybe.

Despite the huge efforts that are being made to fight this pandemic and the myriad successes arising from those efforts—none of which I mean to minimize—if what’s next doesn’t include a massive, multinational rethink of what was, then all these deaths, all this suffering will have been for naught.