The bad news is, yes, the U.S. is in for a second wave of COVID-19, which is expected to hit during the upcoming flu season. The good news is the nation is much better prepared for the next wave, the NIH’s Anthony Fauci told a House Energy and Commerce Committee Tuesday.
“We’ve been through a terrible ordeal. We’ve learned a lot,” he said. And as a result, the nation is much better equipped today to deal with the pandemic than it was six months ago when COVID-19 first hit.
Supplies of personal protection equipment are being added to the national stockpile, hospitals are better prepared, therapies and better tests are in the works, and vaccines could be available as early as December or January.
That doesn’t mean the next wave will be a walk on the beach. “I’m cautiously optimistic,” Assistant Health Secretary Brett Giroir said, “but we have a long way to go.” He acknowledged that concern about what’s coming still keeps him up at night.
Giroir, Fauci, FDA Commissioner Stephen Hahn and CDC Director Robert Redfield stepped carefully around the politics of the hearing – it was an oversight hearing on how the Trump administration has responded to COVID-19 – to highlight what’s been accomplished and what challenges remain in a pandemic-weary nation.
On the testing front, Giroir said that, following conversations with state public health officials, the administration set a nationwide May testing target of 12.9 million. Actual testing fell short of that goal, at 12 million, as some states underperformed. Currently, about 500,000 tests per day, or 15 million per month, are being done. Giroir said he expects the monthly total to hit 40 million to 50 million tests by fall. “Hopefully it will be much greater than that,” he said, noting that new technologies will make testing easier.
For instance, a rapid point-of-care test could be available by late fall or early winter, Fauci said. Another advance is a new laboratory test, developed by the CDC, that checks for two types of influenza viruses (A and B) and SARS-CoV-2 at the same time. Testing for the three viruses simultaneously will save public health laboratories time and resources, including testing materials that are in short supply.
Referencing comments President Donald Trump recently made about how testing increases the number of confirmed cases, committee Chair Frank Pallone (D-N.J.) said it would be reckless to slow down testing.
“None of us has ever been told to slow down on testing,” Fauci assured the committee, adding that “we’re going to be doing more testing, not less.”
The CDC’s Redfield echoed those comments, saying testing is a critical underpinning in dealing with the pandemic.
When it comes to a COVID-19 vaccine, Fauci said one will be entering phase III trials next month and others will be going into phase III one to three months later. He reminded the committee that in January, he had said a vaccine could be ready within 12 to 18 months. With the progress being made, that timeframe is still doable, and a vaccine could be available by December or January. Fauci added that having 1 billion doses of a vaccine also is feasible.
Given that development of vaccines is, on average, normally a seven-year process, the rapid pace for developing a SARS-CoV-2 vaccine is raising concerns about safety and the possibility that political pressure would be exerted to get vaccines approved before they’ve proved efficacy. “We all want a vaccine to be developed as soon as possible,” Pallone said, but the administration must make sure it is safe and accessible.
While the FDA is working with companies to ensure the right studies are done to develop vaccines, the agency will independently review applications. “We will use science and data to do that,” Hahn said.
Fauci added that the accelerated pace of vaccine development does not pose safety or efficacy risks. “There are risks, but the risks are all financial risks,” he said, explaining that the government and companies are investing in manufacturing before they know a vaccine will work. If the vaccine fails, that investment will be lost. However, it would be better to lose a lot of money than to delay the availability of a proven vaccine by several months by waiting to scale up manufacturing, he said.
Even as the government prepares for the next wave of COVID-19, it is still dealing with the first wave of infections. Fauci said the nation needs to get the pandemic under control in the next few months before the second wave hits.
“In some respects, we’ve done really well,” Fauci said. However, some areas of the country that had been flattening the community spread of COVID-19 are showing disturbing surges. “The next couple of weeks are going to be critical to address those increases,” Fauci said. He urged everyone to follow the social distancing guidelines, whether they’re participating in demonstrations or rallies.
“Getting back to normality is going to be a gradual step-by-step process,” Fauci said, as he encouraged people to avoid crowds. “This is not a suggestion – it’s a plea,” he said. If people do congregate, they should wear a mask – whether it’s in a demonstration or a rally, he added.
Another important safeguard is preparing for the flu season. Americans must embrace the influenza vaccine this year. “This single act will save lives,” Redfield said.
Back to the future
Going forward, there’s a lot Congress can do to help the nation be better prepared for a pandemic or other public health emergency, beginning with sustained public health funding. While Redfield expressed gratitude for the emergency funding Congress provided for the COVID-19 battle, he said Congress needs to provide stable support to develop public health systems, which have been under-resourced for decades.
Giroir agreed that sustainability and commitment are important for the future. The U.S. got through the early days of COVID-19, not because public health systems were in place but because people were working 24/7, he said.
Meanwhile, the lessons learned from COVID-19 can’t be forgotten when the nation is on the other side of the pandemic. “We have to establish some corporate memory,” Fauci told the committee, adding that “we forget things when we get distance from them.”
The lessons learned from Ebola just five years ago already have been forgotten, Giroir noted.
Hahn had another recommendation for Congress – provide support for the generation of real-world data. “We need to collect real-world evidence in real time,” he said.