6 Critical COVID-19 Questions We Must Answer to Move Past the Pandemic

By Jonathan Ford Hughes on May 15, 2020 FacebookTwitterLinkedInEmailShare

If there’s any cause for optimism over the response to COVID-19, it’s this: Every day, we learn a little bit more about the virus and how to put a stop to it. It’s actually quite remarkable if you think about where we were in February, compared to where we are now. Then, we weren’t even sure if survivors had immunity. Now, we’re rolling out new tests, we have a treatment option, and an accelerated vaccine timeline. 

However, we’re by no means on the other side of this pandemic. To get there, we’re going to need to come up with answers to these critical questions.

What is the actual mortality rate?

This is the literal trillion-dollar question, with the economy tanking and a record number of Americans out of work. The current mortality rates are accurate only to a degree. It’s a simple matter of data set size. The more tests we have, the more data we have, and the more accurate our projections about the infection and mortality rates become. Without knowing the actual mortality rate, how do we know if we’re overreacting, under-reacting, or getting the social distancing/shutdown response just right?

The only way to answer this question is to expand testing — a refrain that we’ve heard from researchers since day 1 of the epidemic. We’re making progress on that end. Rutgers University recently rolled out a saliva-based, rapid antigen detection test. But until we have something instant — something akin to a pregnancy test — can we safely allow people to return to work?

Furthermore, let’s say we know the actual death rate. This raises the king-kong ethical question of, how many deaths are acceptable? 

How serious is the risk to children?

Early in the response to the pandemic, many believed that children would largely be unscathed by COVID-19. And statistically, that does appear to be the case. However, the recent emergence of about 150 cases that look similar to Kawasaki disease, mostly clustered in New York, are cause for concern. Are these isolated incidences, or the early onset of a trend for the virus?

Again, knowing the answer to this question is critical for the reopening of America. Harried parents across the U.S. want their kids back in school so they can get some relief and get back to work, but is it safe for them to return? And what precautions might we have to take prior to widespread availability of a safe, effective vaccine?

Is an accelerated vaccine timetable safe?

Speaking of vaccines, we are heading into uncharted territory. President Trump’s Operation Warp Speed calls for 300 million vaccinations by January 1, 2021. For context, the record for bringing a vaccine to market is 4 years, held by the mumps shot. To hit that January 1 mark, we’re going to have to jump directly into human trials.

This raises a number of ethical questions, as well as technical ones. For one, is it right to inject millions of people with a vaccine that hasn’t been subjected to the usual rigorous FDA trial process? And more importantly, how will we be sure that it works and that there aren’t any adverse events without the usual trial phases? 

There’s a tradeoff to be made here: Save lives by bringing a vaccine to market quickly, or be methodical to minimize risk? Once again, knowing the actual death rate would make answering this question a bit easier.

What’s going on with remdesivir?

So, great. We have one effective COVID-19 drug. But just how effective is it? Unfortunately, as reported by STAT earlier this month, the jury’s out. NIH researchers elected to give patients earmarked for placebo the drug before the study was complete. The thinking was that from an ethical standpoint, carrying the study through to its designated length put more patients at risk of dying when early results seemed to indicate that remdesivir could help.

At the end of the trial, STAT notes, among those who received remdesivir, 8% died. In the placebo group, 11.6% died prior to the endpoint change. This, unfortunately, isn’t statistically significant. So, it looks like it’s back to the drawing board.

What is the extent of the mental health toll?

Are we ready for the mental health pandemic that’s likely to be on the heels of the COVID-19 pandemic? For months, people have been living in isolation, separated from their support networks of friends and families. Elements of everyday life — such as going for a walk or shopping for food — have become anxiety-provoking brushes with illness or death.

Nearly 100,000 are dead, and their friends and family haven’t had the chance to even properly grieve the loss of the people they love. Unlike cases of the virus, it isn’t as easy to measure the mental health impact. We’ll likely only gain a sense of the scope in the years to come. 

How are physicians and other healthcare workers holding up?

Burnout was a problem before COVID-19 hit. Now, many physicians have been working non-stop to keep patients alive. Others are watching their practices shrivel as elective procedures have been put on hold, and patients avoid seeking care out of fear of falling ill with the virus.

There’s been much focus on financial support for Americans at large, but little discussion about supporting American physicians and healthcare workers. We need to understand what their fiscal and emotional needs are to keep continuing their critical work.