If you have gotten this far in this blog (and not cheated and jumped over a few (can II blame you???), you certainly don’t need another 10 minutes on immunology and its paradoxes. So allow me to suggest some personal and public health thoughts for you to ponder.

 

1. We are in a brutal evolutionary struggle between humans and microbial pathogens. The pathogens evolve much faster than we adapt. A new pathogen emerges, on average, every 4 to 5 years. Covid-19 has been bad, but the larger danger comes from a novel influenza that has a high fatality rate and is highly transmissible before the development of symptoms. There is a 1% yearly probability of an influenza pandemic that could cause six million deaths or more.

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2.  About 75% of new emerging diseases are zoonotic (originating in animals). Humans amplify that threat in a variety of ways. Our appetites are insatiable for animal protein (e.g., pigs, cows, and god forbid, wet-markets). Deforestation is bringing humans into more frequent contact with wildlife such as bats (spreading infection). It has been well documented now that popular house pets (dogs and cats) can contract and transmit the coronavirus. Scientists in the “Predict” program have discovered 1200 animal-borne diseases over the past several years and estimate there may be 700,000 more we don’t know about.

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3. The world is “a little blue marble” and spreading disease to and from our borders in places such as Brazil, South Africa, or Britain can, as we are seeing with the coronavirus, lead to genetic variants that evade immunity, vaccine, and become potentially deadly. Fighting diseases in one country is not as effective as them being fought “everywhere.”

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4. The U.S. government failed to provide early and adequate support for testing and contact tracing with SARS-CoV-2. It failed in a timely manner to effectively distribute medical supplies and equipment, standardize epidemic data, and enforce rational triggers for stay-at-home orders and school closings. Such errors resulted in an inadequate response to the COVID-19 pandemic (and unspeakable death). We cannot allow such errors in adherence and commitment to public health guidelines to occur again.

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5.  A large number (perhaps a majority) of Americans failed to take relatively minor preventive steps such as mask-wearing and social distancing. Part of this was because of a president who consistently played down and politicized the public health crisis. But the problem runs deeper than political ineptitude and resistance to commonsense measures. Epidemiology and public health dictate the necessity of demographic assessments of age, comorbidity, socioeconomic factors, and basic living conditions in a pandemic or for that matter, any health-related issues. How would the U.S. have behaved if political and societal actions had been more closely aligned and sensitive to these epidemiologic factors and risk of death? It requires conscientious, organized, astute, and empathetic governing to assess specific and generic risks to protect humanity.

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6.  Finally, calibrating our responses and responsibilities to the urgencies and dangers we face as a society, will protect the public health and improve the well-being of humankind in general. Attention to climate change, pollution, farming, deforestation, wildlife, health, precision health, disease prevention, and providing adequate federal planning, resources, and funding for the next pandemic is our only hope for a better future.

 

It is estimated that there are 380 trillion (1038) viruses residing in environmental ecosystems throughout the world. Let us all hope and pray that the bioscience, applications of immunology, genetic science, AI technologies, and mostly our personal and societal efforts will meet and defeat this public health challenge of infectious disease pandemics and will help humanity create a better place in which we and future generations all can live.