IEM Health Reflects on COVID-19 Pandemic Response

Three Years of COVID-19: IEM Health’s Dr. Rashid Chotani and Team Reflect on Pandemic Hardships, Progress Made and Lessons Learned since COVID-19 First Swept the Globe

This year, the world is three years beyond the start of the COVID-19 pandemic. Although humanity suffered great losses, there has also been incredible scientific progress in dealing with the virus.

Dr. Rashid Chotani, IEM Chief Medical Director, was a leading figure in  IEM Health’s response to COVID-19. Dr. Chotani and the IEM Health team were pivotal in providing reporting and tracking services, modeling and projections, vaccination and treatment sites, and program management and guidance to state and federal response teams.

As COVID-19 is seemingly now endemic, Dr. Chotani and the IEM Health team reflect on the past three years of COVID-19 response as well as the progress made, and lessons learned. Read our team’s thoughts below:

Q: How do you feel about the progress that has been made three years after the onset of the pandemic?

On March 11, 2020, when the World Health Organization declared COVID-19 a pandemic, we had seen other coronavirus outbreaks such as SARS (2003) and MERS (2012) but had no idea that SARS-CoV-2 would cause such unprecedented devastation. COVID-19 has been one of the worst pandemics in centuries – an estimated 20 million people have died worldwide, making the COVID-19 pandemic among the biggest killers globally for each of the past three years. At least 1.1 million Americans died from SARS-CoV-2, with a reported 102 million cases. Both figures are likely to be an underestimate.

However, even among all of this great hardship, we have to look at the incredible scientific achievements that were accomplished during a raging pandemic; namely the vaccines, therapeutics, testing and surveillance modalities. COVID-19 served as an incubator for scientific discoveries but also highlighted some social and societal determinants.

The scientific discoveries and the technologies developed, specifically the mRNA vaccines, have revolutionized the vaccine industry and will help quickly develop other vaccines against current and emerging infectious diseases. We also learned that wastewater surveillance can be used to detect the viral load and implement targeted intervention to specific areas.

Socially, we learned how to cope with the loss of loved ones, the fear of acquiring the disease, isolation for an extended period of time, and how to study and work remotely, among many other things. All of these changes led to the desire of getting things back to “normal.” The nuances as a consequence of the pandemic also had profound mental effects on adults as well as school aged children, resulting in an increase of moderate or severe depression cases. Today, we have a better understanding of how to deal with some of the social issues experienced, and how we need to be proactive in dealing with them.

From the societal perspective, we learned that we as a society were ignoring health disparities among the black, brown, and rural communities. The pandemic exacerbated these disparities, causing more disease and deaths among these populations. Moreover, we also learned that our public health infrastructure was not up to par to deal with such a catastrophe and was past due for extensive upgrades and modernization.

Three years later, we now have greater awareness and understanding about how pandemics begin and evolve, and how important it is to control and prevent outbreaks before it is too late.

Q: The COVID-19 pandemic is unprecedented. How has it changed how public health officials approach public health challenges?

There were multiple challenges faced by the public health officials. The most critical realization was that the U.S. public health infrastructure did not have the capability or capacity to deal with this unprecedented pandemic – we were just not prepared. These challenges stemmed from not having the appropriate tools and staff. We realized that our data systems were fragmented and not integrated between the various federal and state agencies, and were also severely underfunded to address this catastrophe. This was particularly frustrating as we had dealt with the 2009 influenza H1N1 pandemic and at the end had realized that our nations readiness level was not appropriate. Public health officials also realized that the pandemic had been politicized and as a result, polarized the nation against previously uncontroversial practices. When there wasn’t a unified message being delivered by public health officials or infectious disease epidemiologists, politicians took the lead. This resulted in misinformation and disinformation which spiraled into extreme public distrust. This has culminated in countless negative health effects, including decreases in overall childhood vaccination rates, refusal to get vaccinated, and continued infections and virus variants. The mistrust in public health, if not corrected, can lead to harmful consequences when dealing with another outbreak, epidemic or even the next pandemic.

Public health and emergency management officials also realized the critical importance of strategic stockpiling, medical logistics planning, and supply-chain management. Last but not least, public health officials realized that “public health emergency power laws,” which were designed with bioterrorism in mind, were not ideal for a pandemic. The national security threats posed by the 9/11 era and subsequent anthrax attacks allowed expansive powers to executive authorities during an emergency to provide quick and rapid response to a crisis involving scientific uncertainty. The unprecedented challenges brought on by the pandemic, mixed messages, political divide, and mistrust in the public health authorities and the government made things extremely difficult at the state and county levels for public health professionals to respond efficiently. The public health power laws need to be revisited and revised to reconsider the right balance among executive authority, empowering officials, protecting individual rights, and ensuring democratic accountability.

Q: Reported cases, hospitalizations, and deaths have been steadily decreasing. As the country transitions from the emergency phase, what remains a priority? What else should we be doing to prevent returning to early pandemic numbers and trends?

While the virus is not gone and is still causing cases, hospitalizations and deaths, the amazing strides in developing vaccines and therapeutics has indeed loosened the COVID grip on the nation. However, COVID-19 is still a major factor in our lives and remains a concern for millions of Americans who are immunocompromised and/or elderly or with multiple underlying diseases or co-morbidities. We still have the vaccines and the antiviral medications, such as Paxlovid, but one main line of defense, the monoclonal antibodies, has been deemed ineffective for the current circulating strain and the U.S. Food and Drug Administration (FDA) has revoked their emergency use authorization (EUA). Another line of defense, the preventive antibody Evusheld, which was effective against previous strains, may be ineffective against some variants, including the XBB.1.5 variant that is currently dominant in the US. Thus, there is an urgent need to develop new and affective treatments for the vulnerable. The vaccines are indeed providing protection against severe disease and have shown to decrease hospitalizations, however, they have not been effective in preventing the infection altogether. Thus, more work must be done on improving the vaccines. The critical issue is to prevent infection and not to scramble to modify or develop new vaccines as new variants emerge. We need to focus on developing a pan-coronavirus vaccine.

We are still learning and need to learn a lot more about COVID, especially the lingering symptoms that some who have been infected deal with in the long-term. These lingering symptoms are also known as “long-COVID.” The fatigue, headache, palpitations, and shortness of breath, among other symptoms that have been reported, are debilitating to a point that individuals can no longer work or live their lives as they did before infection. According to the U.S. Centers for Disease Control (CDC), some people, especially those who had severe COVID-19, experience multi-organ effects or autoimmune conditions with symptoms lasting weeks, months, or even years after COVID-19 illness. Multi-organ effects can involve many body systems, including the heart, lungs, kidneys, skin, and brain. As a result of these effects, people who have had COVID-19 may be more likely to develop new health conditions, such as diabetes, heart conditions, blood clots, or neurological conditions, compared with people who have not had COVID-19. More research needs to be done to better understand the long-term effects of COVID-19 and medical measures for the population that is suffering from long-COVID.

We also need to develop better and more effective surveillance strategies to understand the endemicity of the pathogen. With the introduction of home testing kits, it is very difficult to access the disease burden in a community as these results are largely not reported. One efficient methodology that has been deployed recently, although not fully developed, is wastewater surveillance to detect the viral load so health departments are aware of the disease burden in various communities.

Q: IEM Health was pivotal in supporting pandemic response initiatives. Could you talk about a some of the related work that IEM has been involved in recently?

IEM Health’s support to states didn’t end with the closing of vaccinations, infusions, testing or the alternative care sites (stand up hospitals). Federal and state governments spent billions of dollars on medical equipment and supplies in response to the COVID-19 pandemic and much of it was still being delivered after the needs for these had subsided. The equipment and material didn’t disappear when the pandemic ended and remained stockpiled in state and local warehouses. There were even fewer plans for post-COVID than there had been for pre-COVID.

Medical supplies such as PPE and Saline have expiration dates, which was compounded by limited use commodities and equipment purchased under Emergency Use Authorizations (EUA) which have since expired and resulted in massive amounts of unusable supplies and equipment that no longer meets U.S. standards for domestic use. Hand Sanitizer is one of the best examples of this, where pallets of expired or unusable hand sanitizer accumulated in warehouses that do not meet standards for storing hazardous waste.

States with limited emergency logistics and warehouse capacity suddenly found themselves literally swimming in medical supplies and equipment that had to be accounted for and disposed of or repurposed.

A few examples of post COVID 19 support that IEM Health provided is listed below:

• Managing and disposing of Federally provided direct support from the Strategic National Stockpile.
  • In response to requests from Governors, FEMA as the lead federal agency authorized HHS to issue Field Medical Stations (FMS) for temporary treatment facilities, but states found themselves ill prepared to manage and account for the HHS federal property. This equipment includes numerous items including hospital beds, temporary negative pressure systems, ventilators, bi-paps and medications. IEM Health logisticians have led efforts to identify sources of these items and developed, planned for, and managed their proper disposal under federal and state guidelines. The MEDLOG’s found themselves working with federal and state officials to source, account for, document, disperse and dispose of massive amounts of COVID emergency procured items.
  • The federal procurement, accountability and reimbursement rules are difficult to comply with. As a result, IEM Health logistics experts with federal disaster response and property management experience became ESSENTIAL consultants and advisors to states who were now managing supplies which were provided under multiple federal programs including ARPA, Direct Support, FEMA PA, and state procured.
• Identifying and consolidating COVID-19 logistics lessons learned and solutions.
• Assisting clients in understanding storage and commodities management requirements for future disasters.
• Planning for the future and managing COVID-19 inventories while supporting current responses (such as Mass immigration and Asylum Seeker shelters).
• Recommending development of new, more responsive logistics organizations capable of supplying the massive amounts of supplies and equipment needed for a future pandemic response and managing the drawdown.
• Inventorying and segregating massive amounts of commodities.
• Developing logistics response packages for future pandemics and emergencies.
• Developing and implementing tracking systems.
• Disposing of millions of dollars of hazardous waste generated by expiration of commodities such as hand sanitizer and medications.
• Re-building state agency vehicle fleets to replace fleets worn out during the COVID-19 emergency, recommending new, more efficient fleet makeups to better meet the needs of a future disaster.
• Developing new Standard Operating Procedures and guidelines for managing, accounting for and operating a vehicle fleet which improves fleet readiness and includes critical capabilities such as mobile command posts and communications vehicles.

Q: What are some challenges that lie ahead and how can IEM Health help address them?

A big challenge is to be better prepared for the next pandemic, including be able to keep track of and predict possible infectious disease outbreaks. Most of the infectious diseases have a zoonotic origin. What we need to look out for is the phenomenon called “spillover.” Spillovers occur when animal viruses jump species and infect humans. These spillovers were considered rare, but in recent history, we have been encountering them more frequently. Infectious disease epidemiologists must be provided with the tools and resources to identify these spillover viruses before they become highly infectious and a bigger threat to humans.

Other challenges that lie ahead are to implement better pandemic planning, including develop a pan-covid vaccine, new therapeutics, more accurate testing and a robust disease and genetic serotype surveillance, as well as no-traditional surveillance modalities. IEM Health has the capability and capacity to assist federal, state, or local health departments to develop procedures, protocols, and policies, as well as to provide critical subject matter experts to deal with naturally occurring viruses as well as accidental or man-made viruses.

Based on our past experience and the current post-COVID work, there need to be better logistics controls over the supplies and the supply-chain for materials, equipment, and medical countermeasures. IEM Health can lead in developing pre- and post-pandemic plans for materials, equipment, and medical countermeasures as well as how to manage medical countermeasures and other supplies that have an expiration date during a crisis.

Q: Is there anything else that you would like to add (or highlight)?

COVID-19 is here to stay and has become endemic. New strains will evolve. It will be our due diligence to assure that that none of these new strains cause another pandemic or a major epidemic. Most of the U.S.’s population has resumed their pre-pandemic lives, but there is a significant number of our population that is still vulnerable. We need to make sure that that this vulnerable population has access to boosters, treatments and testing. As I have mentioned earlier, as a nation we need to increase our efforts to rebuild our healthcare infrastructure that can serve as a safety-net to any and all infectious disease threats. After all, the most important thing is to make sure that Americans are safe and healthier.