S2.1 Pandemic, the new normal

We have been worried about a global pandemic, something akin to the Spanish flu of 1918, for some time. Whether SARS or Ebola or the new coronavirus, there are always possible pandemics lurking on the horizon. We have dodged the bullet on avian bird flu and swine flu, although that may have had as much to do with luck than with successful intervention from the health system. Is the new coronavirus “the one?” The unfortunate reality is that we live in a time when “the one” is a foregone notion and we will always live with the threat of epidemic or pandemic on the horizon. No innovation currently in the works will completely remove that threat. Here, I outline a few, brief thoughts on what we can be relatively certain about concerning the next pandemic(s): 

1. There will be other outbreaks of varying severity with a handful reaching pandemic levels after this current outbreak of coronavirus.
2. Many will originate from Asia. This is due to varying reasons including population density and proximity of animals, including birds and other livestock, to people.
3. Pandemics will likely be a strain of influenza or a similar virus that is spread through respiratory droplets. Although a bad disease, Ebola was much easier to contain than Tuberculosis or the Coronavirus for which respiratory precautions must be taken and spread is much more difficult to contain. 
4. Pandemics will likely begin by a known virus mutating to behave in new ways, recombining with another virus to spread or evade the immune system by a different mechanism, or gaining the ability to jump from species to species. In particular the ability to transmit to humans and then transit from human to human will be a likely feature. 
5. Those with comorbidities will be hit the hardest. Underlying heart disease, lung pathology, cancer, diabetes, and other health problems all make fighting the infection and maintaining homeostasis more difficult. Long comorbidity lists will generally be predictors of lower chances of survival. 
6. Isolation and low population density will be protective. Especially during the period of an epidemic or pandemic where not targeted treatment exists, preventing human to human transmission is critical. One of the easiest ways to prevent human to human transmission is to be in a community with a low population density and with a low volume of influx from the outside. 
7. Vaccines or targeted therapies will take many months to affect the population. In the meantime containment measures and supportive care as well as screening similar therapies for efficacy will be critical in mitigating the effects. As always, wash your hands, cover your mouth when you cough or sneeze, and …did we mention wash your hands? 
8. Hospitals and other healthcare settings will be high risk places where disease is readily spread. This can be limited by the correct preventative measures and precautions, but the simple fact that many of the known cases will come through the hospital means the risk will always be high. Healthcare workers and their families will be at greater than average risk of contracting the disease. 
9. In advanced stages the flow of goods, including food and water may be affected. Our lives today are enabled by trade from all corners of the world. Our medications, food, clothes, and everything else come from many miles away and require many people to get to us. In the advanced stages of a pandemic, food scarcity, loss of power, water shortages, and medication shortages may all be realized. Having an emergency supply of food, water, and other vital supplies including medications for chronic diseases will be essential. 
10. Recovery will take years. Similar to recovering from a World War, the loss of human power and faith in economic and political systems will require years, not months to rebuild.