By Tony Michuda
August 10, 2020
Physicians and epidemiologists are struggling to predict where COVID is headed next. Even so, many level headed scientists see the dark skies on the horizon. Flu season is coming.
This pandemic has battered healthcare from every angle. The six sigma lean healthcare method was exposed as health systems skated the fine line between just in time delivery method and disaster. As outpatient and elective surgeries skidded to a halt, healthcare providers were left with the low reimbursement high cost reality of overflowing emergency rooms, no PPE, and enough isolation rooms to cover less than 3% of the population.
With bio-tech companies scrambling to come up with the first effective COVID vaccine, much of the world's conversations have fantasized about a vaccine, but we need to heed Anthony Facui's warning that "the chance of coronavirus vaccine being highly effective is not great."
In reality, the flu vaccine is one of the poorest performing vaccines we have. Often times only working 59% of the time for those that get vaccinated.
And here's why.
COVID is a flu strain and like the 30 some odd pandemic influenzas before it, it's highly unstable and highly unreliable when it comes to its ability to reproduce. As a single segmented RNA genome, their core proteins are divided into different types. As they undergo high mutation rates, they often make mistakes when trying to copy itself. These small mutations in the virus are called antigenic drift and this is why flu shots are annual. Prior copies of the virus from a flu shot become outdated in teaching our immune systems how to cope and public health officials have to make educated guesses about which strains will dominate in a given year.
While antigenic drift is expected. What is unpredictable, occurs when two different virus strains infect a host at the same time and exchange genetic material. Thus creating a hybrid virus through a process called reassortment. This is what many believe lead to the deaths of so many during the 1918 pandemic.
Now before you call me Dr. Doom, let me be the first to say there's tremendous promise on the horizon, but we have to fully commit to defeating the flu once and for all in a few simple ways.
1) We need more reliable, efficient laboratory testing methods
One of the biggest issues today is the back log of lab tests for COVID19. I have spoken to countless people that waited from 4 days to two weeks for results. All the meanwhile going about their lives not knowing if they are contagious or not.
We need to inform health systems and providers of the best available diagnostic tools and eliminate unregulated testing methods coming from overseas to make a quick buck.
2) We have to stop chasing shadows.
Influenza viruses derive from two flu strains: hemagglutinin (seasonal flu) and neuraminidase (pandemic flu) or HA and NA for short. Human disease from viruses are caused primary by a few select strains: [HA 1, 2, 3, 5, 7, 9] and [NA 1,2,9].
If we can develop vaccines that protect against these select groups, we can better respond to antigenic drift and promisingly take pandemic influenza off the table. This long term antigenic memory for the correct immunogen could be our best shot at avoiding a future COVID like pandemic.
3) We have to become more self reliant on critical supply chains
For the past decade, health systems have heavily relied on just in time delivery from overseas and our most critical supplies (ppe, insulin, basic antibiotics, ventilators, and saline) we need to have more control over should import and exports or trade wars impact their delivery.
4) We don't spend enough money on respiratory influenza strains
To date, we spend roughly $40M annually on influenza. HIV we spend $1B. Both are critical diseases that require our attention, however, RO (infectious) rates for airborne transmission are far more dangerous to immediate public health as a whole and funding needs to be appropriately addressed to the CDC and Medicare.
5) The more we can slow transmission of COVID until a vaccine the better
After months and months, we all at times can become desensitized to the dangers of COVID transmission, but we have to use the best weapon we have against a respiratory virus, wear your mask!
6) Nobody is in charge of making new influenza vaccines. Nobody!
There are only four major producers: GlaxoSmith-Kline, Merck, Pfizer, and Sanofi Pasteur. During the 2002-2003 SARS epidemic, hundreds of millions of dollars were spent trying to fast track a vaccine. When the virus died out, these groups were left holding the bag. We need to designate a better business models and incentives to vaccine production globally. Our global health depends on it.
7) We need to focus on heat stable vaccinations for the developing world.
It's all bird flu. There is no such thing as a naturally occurring human influenza virus. Therefore we need to reach developing and rural areas known for being hot spots of these families of viruses. In today's globalized world, we have seen the rapid spread of a pandemic first hand.
These are all but a few of the many solutions we have towards combatting one of the worst public health crises of our generation. While we still have much to learn, I am optimistic for the future. Armed with better testing, greater infection control, and eventually a long term vaccine, I am confident we will be grateful to return to live as we know it.
In good health,