COVID-19: Are We Ready For the Next Big Pandemic?

Andrew Garrett ’90 had been waiting for a pandemic for years. Before the first reports of a deadly respiratory disease first started to trickle out of China, before lockdowns and nasal swabs and social distancing became the new normal, he was planning for the disease that would shut the world down.

Garrett is an expert in emergency medical response, a professor at George Washington University’s medical school, and past director of the National Disaster Medical System at the Department of Health and Human Services. He, like other public health officials, saw how lucky Americans were during the 2003 SARS outbreak and the 2009 swine flu epidemic and recognized the chaos and disruption a deadly new virus could pose.

“I knew it was going to be a problem,” he says. “I just didn’t know it was going to be called coronavirus.”

He wasn’t the only Carleton alum on the lookout. In her lab at Brown University, Amanda Jamieson ’97, an immunologist who specializes in respiratory diseases, was also thinking about the SARS outbreak and what it could have been. Presciently, she wrote about the need for more ways to treat coronaviruses after studying the responses to SARS and Middle East Respiratory Syndrome (MERS). “Recently, other CoVs have been detected in animal populations, raising the possibility that we will see a repeat of these types of outbreaks in the near future,” she wrote in that 2016 paper. We needed more ways to strengthen the body’s ability to fight these viruses off, she warned.

At the Centers for Disease Control, epidemiologist Emily Kahn ’86 was modeling possible disease outbreaks. She looked at situations like the 1918 Spanish flu pandemic and hoped we might fare better if something similar happened again. “We had vaccines; we knew things that we didn’t know back in 1918,” she says. But then COVID-19 emerged and she quickly realized that no one was prepared. “A lot of what we had thought would never happen was happening.”

Garrett, Jamieson, and Kahn are just three of the Carleton alumni who had the knowledge and foresight to predict the pandemic’s potential for global disruption. When COVID-19 finally arrived, they jumped into action, helping to manage the most significant public health crisis in over a century. Now, they’re facing a new challenge: how to learn from this pandemic to try and mitigate the next big one.

Watching a car crash in slow motion

Under the Obama Administration, Garrett was part of a team that created a pandemic playbook: a guide to help the government manage just such a situation. It included questions the government should ask about a new pathogen—How is it transmitted? Do we have ways to treat it?—and a list of pathogens that could pose a threat, including coronaviruses. Watching COVID-19 hop from Wuhan to Germany to Washington State, Garrett realized this was exactly the situation they had prepared for.

He likens seeing the COVID-19 pandemic unfold to watching a car crash in slow motion. “Once we saw the virus starting to grab hold, it became very clear very soon how this was going to end. We didn’t know the numbers, but we knew that once you have a novel virus that’s freely transmissible with no resistance in humans, that’s a pandemic.

But options were limited for public health officials. A new administration was in the White House, and no one was talking about the playbook. The number of infections was growing, and Garrett, who had left the government in 2018, realized none of the work he’d done was going to help stop this pandemic.

“When you’re talking about pandemic response there’s a lot of information that has to come together,” he says, adding that the federal government needs to align disparate agencies, direct funding to the right people, coordinate with state and local governments, and communicate clearly with the public. There’s no time to argue about politics. But that’s exactly what was happening.

As politicians fought over the severity of the disease, masking, social distancing, and school closures, Garrett acted as an advisor to the government, helping set up and manage the CDC’s quarantine of the Grand Princess cruise ship in San Francisco. But it’s one thing to study and prepare for a pandemic and quite another to actually live through one. Garrett had worked as a frontline responder during events like Hurricane Katrina, and over the course of his career he’s been deployed to more than 20 major disasters worldwide.

But he quickly realized that responding to COVID-19 would be a very different experience. People weren’t used to being directed to quarantine by the CDC—the agency hadn’t enforced an action like this in a century. People were confused and angry, and they needed a lot more than medical care. The emergency response team also had to provide access to everything else: food, information, even Amazon packages. And it didn’t have good data about how the virus spread or how to protect responders—or even how to test people. “We had so many questions and almost no answers,” he says.

A responsibility for others

At the CDC, Emily Kahn was doing everything she could to get answers as soon as possible. A CDC epidemiologist for more than two decades, she thought the agency was prepared to handle a flu-like virus pandemic, but COVID-19 caused more severe infections and was harder to treat than she had anticipated. “We didn’t know how much we didn’t know,” she says. “We thought we were more prepared than we were.”

Between 2019 and 2022, Kahn worked 14- to 16-hour days. She spent hours in meetings with colleagues, at the CDC and other agencies, to ensure everyone was operating with the same information. Every day, she gathered, cleaned, and verified data on schools across the country—what precautions they were taking, how many students were absent—to help inform the White House. She ran models to understand what strategies were curtailing disease transmission and whether they were worth the cost. If states closed restaurants for three weeks, would it save lives? Would it be worth the economic fallout?

She felt a duty to do the best she could. “We did feel responsible for what was happening,” she says. “What pushed many of us to work as hard as we did for as long as we did was just the hope that we could make things better, that we could prevent people from getting sick, prevent people from dying.”

Kahn was honored to serve, but she felt demoralized and diminished by the political response and the relentless anti-vaccination and anti-masking campaigns. “Nobody thought there would be the pushback to what we thought were reasonable defenses,” she says. She grew tired of seeing every science-backed intervention vilified by conspiracy theorists and maligned by politicians. “We watched some of our senior leaders say what we thought we should be saying and get fired for it.”

Her frustration and exhaustion grew. So when she was offered a job outside of the CDC, Kahn took it. To this day she holds immense respect for her colleagues and for the work they did together. “I do still believe that we did much more right than wrong,” she says. But she also acknowledges that the CDC didn’t account for the unpredictability of human behavior or for the political aspects of a pandemic response. The CDC has long struggled to make their data meaningful and understandable for policymakers, and the pandemic brought that into focus. Since then, she says the agency has invested heavily in policy experts and has gotten much better at modeling their data.

But she no longer believes that a smooth, science-based response to a pandemic is possible. “There’s not much that happened in this pandemic that makes me hopeful that we will respond better as a society, or even as an agency, to the next pandemic,” she says. She hopes that insight will be factored into future planning as public health experts prepare for the next disaster.

Garrett agrees that understanding human behavior will be key for future responses. “We always just assumed that if we had a vaccine, people would want it,” he says. But that just wasn’t the case.

Moving forward, officials will have to spend a lot more time thinking about how to deliver public health messaging through voices people trust, he says. In the past, Americans might have felt comforted to hear from the CDC or the president, but in today’s highly polarized society, that may not be the case. “We can’t just assume that what we organize as resources are going to be the ones that the public wants,” he says. “We can’t assume that people are going to do what we tell them or ask them to do.”

Living with the virus

Amanda Jamieson finds coronaviruses fascinating. They can jump from animals to humans, they can infect almost any animal—which is unusual—and they include a huge range of viruses. Just a small change in biology means that while one coronavirus might cause little more than the common cold, another will trigger severe infections.

It’s a good thing Jamieson continues to be enthralled because, chances are, SARS-CoV-2 isn’t going to be the last one we see. “I think this is going to be a continuing problem,” she says. COVID-19 was the third pandemic caused by a coronavirus in just 20 years. That means Jamieson will be studying and responding to these viruses for many years to come.

Over the course of her career, Jamieson has focused on a number of pathogens, including the viruses and bacteria that can cause pneumonia. But her method for studying immune responses to those pathogens is particularly useful for studying SARS-CoV-2. Jamieson takes a holistic approach. In addition to looking at how the lungs fight infections, she also examines how other bodily systems are affected while the lungs are responding to a pathogen. No system in the body operates independently, she notes. They’re all interconnected and constantly responding to each other. “Your body isn’t just your lungs,” she says, if you focus on one organ and ignore everything else, you won’t get a full picture of what’s going on. For example, her work has shown that lung infections can drastically affect the time it takes for a skin wound to heal.

The hope is that by understanding that interconnectedness, scientists can better understand how pathogens affect so many disparate systems. How can a virus in the lungs cause blood clots, memory problems, or heart attacks? It’s a set of questions that’s become urgently important since 2020. “Unfortunately, long COVID is a perfect example,” she says. Long COVID patients report a wide variety of symptoms from trouble sleeping and depression to chest pains, diarrhea, and changes in the ability to taste and smell. Symptoms can last for months or even years after the infection is gone. Scientists aren’t sure why.

One intervention Jamieson is interested in is bolstering host tolerance: essentially helping the body cope while the immune system fights off an infection. “In order to survive an infection, you can’t just clear the pathogen,” she says. You have to be able to tolerate the damage that’s caused by your own immune response too. One way that the immune system responds to the SARS-CoV-2 virus is to release a slew of cytokines. These tiny proteins, which regulate inflammation, may also be the culprits behind some long COVID symptoms, though scientists are still learning about how these systems work and how they can go awry. If researchers can find a way to support the body and keep it from creating this out-of-control inflammation, patients may be able to fight off the infection without experiencing all of the side effects created by their overactive immune system.

Jamieson is also investigating how SARS-CoV-2 impacts coagulation, both in the short- and long-term. The systems that regulate our blood are highly complex. Too much clumping or coagulation could lead to blood clots. Too little causes bleeding disorders like hemophilia and wounds that won’t heal properly. The SARS-CoV-2 virus seems to affect both of the pathways that control this important titration, causing small clots both during the first part of the disease but also other clotting disorders that linger on in long COVID patients. “It’s something that happens to some extent with other respiratory infections, but it seems much more severe and common with SARS-CoV-2,” she says.

Jamieson was working on those problems well before COVID-19, and she’ll continue that work well after the memes about lockdown toilet paper shortages have been lost to history. She believes that better air filtration systems are crucial and has started working with a company that manufactures a surface coating that will catch viruses and deactivate them so they can’t spread as easily through the air. In some ways, the changes the pandemic brought have been transitory. The initial funding bumps from the National Institutes of Health haven’t been sustained and while the number of students in her virology class doubled during the pandemic, Jamieson hasn’t seen much increase in interest in her work. But she believes the pandemic has had a lasting influence on public attitudes. “I do think that has really raised awareness of the importance of respiratory infections and the fact that this could happen again,” she says. “Pandemic preparedness is something that’s on people’s minds now more than it was before.”

What’s more, the pandemic precipitated some major advances in how we understand coronaviruses, how we study them, and how we create vaccines. Jamieson says we have a wealth of information about SARS-CoV-2, and she hopes that those techniques can now be used to study other viruses like influenza.

Like Garrett and Kahn, she has no illusions that COVID-19 will be the last or even the worst pandemic we might face. It’s a challenge we’ll have to live with and learn how to manage. Hopefully, with more research and the lessons of the COVID-19 pandemic, our immune systems, governments, schools, and societies will be a little stronger, a little smarter, and have a lot more support the next time around.