这是一个MedPage Today故事。
在白宫发布其更新新冠肺炎防备计划一个由24名公共卫生专家组成的小组发布了一份白皮书，提出了他们自己的想法，让美国进入他们所谓的“下一个”正常状态。
虽然这两个计划有很多重叠之处，但是COVID路线图小组概述了未来与新冠肺炎一起生活的其他细节和策略。
该书的作者都是知名人士，包括许多在疫情时期成为新冠肺炎权威的人。
宾夕法尼亚大学全球倡议副教务长和作者之一Ezekiel Emanuel博士今天告诉MedPage，该小组在今年年初开始制定该计划。
他说，美国已经花了一年时间制定一项战略计划。然而，在扩大疫苗接种、两种不同变种的激增和新疗法之后，该国现在处于一个非常不同的地方。
伊曼纽尔说:“我们需要为这个国家制定一个新的战略计划。”。"拥有一个跨党派的外部团体有一定的优势."
该小组确定了12个重点领域，包括:
空气质量
根据这份报告，疫情揭示了建筑物内糟糕的空气质量。
所有的公共建筑都应该对空气质量进行监控并公开分级。学校、商业建筑和大型公寓应该有MERV(最低效率报告值13过滤)，它可以捕获小颗粒，美国的每个教室和儿童保育设施都应该有MERV 13或HEPA过滤器。
疗法
预计病毒会对任何单一的抗病毒药物产生耐药性，因此有效的治疗最有可能需要两种或三种药物的混合物。
该报告呼吁一个新的“曲速”计划，通过预先购买协议和其他金融和监管激励来生产一种口服抗病毒鸡尾酒。
与白宫的官方计划一样，该报告也呼吁建立一个检测到治疗的路径，以便所有PCR或在家检测呈阳性的美国人都可以在一天内得到治疗或参加临床试验。
疫苗
官员们应该继续鼓励快速开发新型疫苗平台，包括黏膜疫苗和复合疫苗，最终目标是开发一种泛冠状病毒疫苗。
政府还应该扩大国内和国际疫苗生产的产业基础，并致力于向全世界提供疫苗。
测试/监督
报告称，检测水平还不足以提供美国病例数的全面和实时情况。
PCR和快速检测应该筛查所有呼吸道病毒，而不仅仅是导致新冠肺炎的新型冠状病毒病毒。快速检测还需要无处不在、可获得、免费或非常便宜(每次检测不到3美元)。
该报告还呼吁投资于四个全面的实时监控系统:
监测环境(废水和空气)和动物(鹿、老鼠等)中的病原体
跟踪新出现的变体
评估人群对呼吸道病毒的免疫力
跟踪住院、ICU入院和死亡情况
长COVID
美国应该有一个关于long COVID的国家研究计划，包括健康、疫苗接种和社会人口数据。
研究人员必须更好地掌握长COVID的频率，无症状或轻度COVID是否不太可能导致长COVID，疫苗对长COVID的保护效果如何，对这种疾病的潜在治疗方法以及导致或防止长COVID的免疫因素。
劳动力
该报告的作者承认，有创纪录数量的医疗保健职位空缺，医疗保健工作者的倦怠程度“非常危险”。
他们指出，人员短缺是卫生保健系统提供护理能力的主要限制。他们提议建立一个灵活的医护人员库，以便在紧急情况下部署。
股权
该报告承认疫情对有色人种、农村社区和其他得不到充分服务的群体产生了不成比例的影响，并呼吁制定解决方案和战略，以“优先考虑健康公平和减少健康差距，最终目标是建立一个公平的公共卫生系统，能够覆盖得不到充分服务和历史上被忽视的人口。”
该小组提到的其他关键领域是卫生数据基础设施、个人防护设备、公共卫生基础设施、学校/儿童保健和通信。
Will Oliver/EPA via Shutterstock
华盛顿特区联合医疗中心重症监护室的值班人员.
伊曼纽尔指出，至于白宫的报告，该小组同意许多观点，在某些方面，主要观点没有什么不同。然而，有一些领域，如监视，他和小组认为应该包括更广泛的干预。
例如，根据该小组的说法，可能成为病毒重要宿主的动物应被纳入监测范围，群体免疫和确定细胞免疫是否能长期持续也应如此。
还需要升级和收集家庭新冠肺炎测试的数据，可能通过整合二维码或其他类似于高科技公司部署的患者参与工具。
“这个路线图重新想象了美国如何与COVID一起生活，这需要达到并维持下一个正常状态，并允许大多数人回归日常生活的常规和乐趣，”该组织写道。
该报告承认，美国还没有完全达到这一水平。流感和呼吸道合胞病毒(RSV)的总死亡人数每年可达到60，000人以上的峰值，相当于每天165人死亡或每周1，150人死亡。然而，目前的COVID死亡人数仍然是这个数字的15倍左右，2月份每周有17500人死亡——“这个数字仅次于心脏病和癌症的现代杀手，”他们指出。
考虑到群体免疫，该小组勾画了三种可能的未来情景:
他们乐观的设想是20%的发病率和0.03%的感染死亡率(IFR)，年死亡率在10，000到30，000之间
他们的中间方案预测每年约有30，000至100，000人死亡，发病率为40%，IFR为0.05%
他们的悲观设想是80%的攻击率和0.1%的IFR，每年总共有100，000到300，000人死亡
他们写道:“即使是悲观的预测，也比美国2021年经历的大约475，000人的年死亡人数少得多。”
总的来说，该报告得出结论,“下一个”正常状态可能是对病毒出现之前生活的改善。
该组织写道:“随着更多的远程工作和更少的通勤，工作与生活之间可能会有更好的平衡，这是一个快速开发高效疫苗和治疗方法的平台，更好的室内空气质量，更少的各种呼吸道感染，以及更有效的监测，以预测和应对新的病毒威胁。”
“通过创建本报告中概述的一些工具来实现这一更好的目标将需要大量资源。但封锁造成了数万亿美元的经济损失，没有人能对COVID失去的近100万美国人的生命进行估价。
他们补充说:“现在花费数百或数千亿美元来保护美国免受哪怕是一小部分的损失，可能是美国历史上最好的投资之一。”。
对伊曼纽尔来说，这种心态至关重要。
“即使像COVID这样的疫情是百年一遇，这种投资也是高回报的，”他说。“我们需要更像企业一样思考。这是将为社会带来更多回报的资本投资。”
What the 'new normal' of living with COVID might look like
Less than a week after the White House released itsupdated COVID-19 preparedness plan, a group of 24 public health experts issued a white paper with their own ideas for moving the nation into what they call the "next" normal.
While there's quite a bit of overlap between the two plans, the 132-page document by theCOVID Roadmap Groupoutlines additional details and strategies for living with COVID-19 in the future.
Among its authors are high-profile names, including many who've become authorities on COVID-19 during the pandemic.
The group began working on the plan at the start of the year, Dr. Ezekiel Emanuel, Vice Provost of Global Initiatives at the University of Pennsylvania and one of the authors, told MedPage Today.
The U.S. has gone a year with one strategic plan, he said. However, after expanding vaccination, surges of two different variants, and new therapies, the country is now at a very different place.
"We needed to have a new strategic plan for the country," Emanuel said. "Having an outside group, which is bipartisan, has a certain advantage."
The group identified 12 key areas of focus, including:
Air Quality
According to the report, the pandemic revealed the poor air quality inside buildings.
All public buildings should have their air quality monitored and publicly graded. Schools, commercial buildings, and large apartment complexes should have MERV (minimum efficiency reporting value 13 filtration), which captures small particles, and every classroom and childcare facility in the U.S. should have either MERV 13 or HEPA filters.
Therapeutics
The virus is expected to develop resistance to any single antiviral drug, so effective therapy most likely will require a cocktail of two or three drugs.
The report calls for a new "Warp Speed" program with advanced purchase agreements and other financial and regulatory incentives to produce an oral antiviral cocktail.
Like the official White House plan, the report also calls for a test-to-treat pathway, so that all Americans who have a positive PCR or at-home test can be treated within a day or enrolled in a clinical trial.
Vaccines
Officials should continue incentives to rapidly develop novel vaccine platforms, including mucosal vaccines and combination vaccines, with the ultimate goal of developing a pan-coronavirus vaccine.
The government should also expand the industrial base for domestic and international manufacturing of vaccines, and aim to deliver vaccines around the world.
Testing/Surveillance
Testing is not at the level needed to provide a full and real-time picture of case counts in the U.S., the report stated.
PCR and rapid tests should screen for all respiratory viruses, not just SARS-CoV-2, the virus that causes COVID-19. Rapid tests also need to be ubiquitous, accessible, and free or very cheap (under $3 per test).
The report also calls for an investment in four comprehensive, real-time surveillance systems:
Monitor pathogens in the environment (wastewater and air) and animals (deer, rats, others)
Track emerging variants
Assess population immunity against respiratory viruses
Track hospitalizations, ICU admissions, and fatalities
Long COVID
The U.S. should have a national research program on long COVID that includes health, vaccination and sociodemographic data.
Researchers must get a better hold on the frequency of long COVID, whether asymptomatic or mild COVID is less likely to lead to long COVID, how well vaccines protect against long COVID, potential treatments for the condition and immunological factors that predispose to or protect against long COVID.
Workforce
The authors of the report recognize that there are a record number of healthcare jobs unfilled and that burnout among healthcare workers is "dangerously high."
They noted that staffing shortages are the main limitation to the ability of the healthcare system to provide care. They proposed creating a pool of flexible healthcare workers to deploy in emergencies.
Equity
The report acknowledged the pandemic's disproportionate impact on people of color, rural communities, and other underserved groups, and calls for solutions and strategies to "prioritize health equity and the reduction of health disparities, with the end goal of building an equitable public health system capable of reaching underserved and historically neglected populations."
Other key areas the group cited were health data infrastructure, personal protective equipment, public health infrastructure, schools/child care and communications.
As for the White House report, there are many points the group agrees with, and in some ways, the primary points aren't that different, Emanuel noted. However, there are some areas, such as surveillance, that he and the group believe should include more extensive interventions.
For instance, according to the group, animals that can be significant reservoirs for the virus should be included in surveillance, as should population immunity and determining whether cellular immunity is durable for a long period of time.
There is also a need to upgrade and collect data from at-home COVID-19 tests, possibly through incorporating QR codes or other patient engagement tools similar to those deployed by high-tech companies.
"This roadmap reimagines how America may live with COVID, which requires getting to and sustaining the next normal, and allows for the return of the routines and joys of everyday life for a majority of the population," the group wrote.
The report acknowledged that the U.S. isn't quite there yet. The combined death toll from influenza and respiratory syncytial virus (RSV) can peak above 60,000 per year, which translates to 165 deaths per day or 1,150 deaths per week. However, the current COVID death toll is still about 15 times that, with 17,500 deaths per week in February -- "a toll exceeded only by the great modern killers of heart disease and cancer," they noted.
The group sketched out three possible future scenarios, taking population immunity into account:
Their optimistic scenario sees a 20% attack rate with a 0.03% infection fatality rate (IFR), for an annual mortality range of 10,000 to 30,000
Their intermediate scenario predicts a 40% attack rate, with an IFR of 0.05%, for some 30,000 to 100,000 deaths annually
Their pessimistic scenario sees an 80% attack rate with a 0.1% IFR, totaling 100,000 to 300,000 deaths per year
"Even the pessimistic forecast projects significantly fewer annual deaths than the approximately 475,000 that the nation experienced in 2021," they wrote.
Overall, the report concluded that the "next" normal can be an improvement over life before the virus emerged.
"There is likely to be a better work-life balance with more teleworking and less commuting, a platform for rapid development of highly effective vaccines and therapeutics, better indoor air quality, fewer respiratory infections of all kinds, and more effective surveillance to anticipate and respond to new viral threats," the group wrote.
"Getting to this better place by creating some of the tools outlined in this report will require significant resources. But lockdowns cost trillions in economic activity, and no one can put a price on the nearly one million American lives lost to COVID.
Spending tens or hundreds of billions now to protect the United States from even a fraction of that toll could be one of the best investments in American history," they added.
For Emanuel, that mindset is critically important.
"Even if a COVID-like pandemic is once in a century, these kinds of investments are high return," he said. "We need to think more like a business. This is capital investment that is going to generate more return to society."
