Following the Biden administration's new National Covid-19 Preparedness Plan, a number of public health experts have released a roadmap for the "next normal" of living with Covid-19. It highlights various prevention, mitigation, and treatment strategies—and outlines three scenarios the country may face in the near future.

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A roadmap for the 'next normal'

On Monday, the COVID Roadmap Group released the 136-page report, which features insights from dozens of high-profile experts on living with the SARS-CoV-2 virus as a continuous threat. The group has been working on the plan since the beginning of 2022, according to Ezekiel Emanuel, vice provost of global initiatives at the University of Pennsylvania and one of the authors of the report.

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According to Emanuel, the increasing availability of vaccines, new therapies for treatment, and the repeated surges driven by new variants has put the United States in a very different place than it was a year ago—and a new plan is needed to address the current state of affairs. "We needed to have a new strategic plan for the country," Emanuel said. "Having an outside group, which is bipartisan, has a certain advantage."

"It's an attempt to have a more disciplined approach to dealing with this crisis, providing a vision for what 'next' might look like," said Luciana Borio, one of the authors and a senior fellow for global health at the Council on Foreign Relations.

The group's report identified 12 key focus areas:

1. Broaden focus to major respiratory viral illnesses

The authors advised that the United States widen the scope of its focus beyond Covid-19 to "major respiratory viral illnesses like flu and RSV infection, with the interim goal of reducing annual deaths below the worst influenza season in the last decade."

2. Establish an infectious diseases dashboard

According to the authors, the country should establish and maintain an accessible "transparent infectious diseases dashboard to guide both the public and policymakers at the national, state, and local levels on the introduction, modification, and lifting of public health measures," among other objectives.

3. Testing and surveillance

According to the authors, PCR and rapid tests should screen for all respiratory viruses, and rapid tests should be ubiquitous, accessible, and either free or less than $3 per test.

The report also calls for an investment in four comprehensive, real-time surveillance systems that can:

• Monitor pathogens in the environment and animals
• Track emerging variants
• Assess population immunity against respiratory viruses
• Track hospitalizations, ICU admissions, and fatalities

4. Air quality

In the report, the authors called on the Environmental Protection Agency and the Occupational Safety and Health Administration to "develop standards to improve indoor air quality and protect workers from inhalation exposure."

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Specifically, the authors recommended all public buildings have their air quality monitored and publicly graded. In addition, the authors said schools, commercial buildings, and large apartment complexes should be required to install MERV 13 filtration, and every classroom and childcare facility in the country should be required to install either MERV 13 or HEPA filters.

5. Vaccines and therapeutics

The authors called for a new "Warp Speed" program that would use advanced purchase agreements, along with other financial and regulatory incentives, to produce an oral antiviral cocktail.

The report also states that officials should continue using incentives to rapidly develop novel vaccine platforms, including mucosal and combination vaccines. In addition, the authors urge the government to expand the industrial base for domestic and international vaccine manufacturing, with the goal of improved worldwide vaccine distribution.

6. Global investment

According to the authors, the United States has "both a moral imperative and economic and health incentives to support other countries' public health efforts" to lower the spread of the virus.

7. Long Covid

The report calls for a national research program on long Covid that includes health, vaccination, and sociodemographic data and allows researchers to better understand the chronic condition.

8. Equity

The report calls for solutions and strategies to "prioritize health equity and the reduction of health disparities, with the end goal of building an equitable public health system capable of reaching underserved and historically neglected populations."

9. Health care workforce

The authors recommended expanding and supporting "the public health and health care workforces through improved wages, health benefits (including mental health), tuition assistance, loan forgiveness, and safe working conditions." Additionally, they suggested creating a pool of flexible health care workers who can be deployed in emergencies.

10. Biosecurity and pandemic leadership

According to the authors, the country should establish a new federal post "responsible for preparing for, monitoring, addressing, and coordinating responses to and communications about any biosecurity and pandemic threats." The authors added that this post should also helm efforts to combat medical misinformation.

11. Communication

The authors advised that the country implement a "communication and behavioral intervention infrastructure to increase vaccination, testing, and treatment, especially among vulnerable groups."

12. Schools and childcare

According to the report, schools and childcare facilities should be closed only when "all other community mitigation measures fail," an effort that includes establishing programs and policies to enable these facilities "to remain open and safe for in-person instruction and care without the need for special public health mitigation measures."

3 possible future scenarios

The authors also outlined three possible future scenarios—accounting for population immunity—that the country may experience in the near term with Covid-19:

• In their optimistic scenario, in which immunity holds up and the virus doesn't evolve to something more virulent, the authors predict a 20% attack rate with a 0.03% infection fatality rate (IFR), for an annual mortality range of 15,000 to 30,000.
• In their intermediate scenario, the authors predict a 40% attack rate, with an IFR of 0.05%, leading to around 30,000 to 100,000 deaths annually.
• In their pessimistic scenario, if immunity thins and a more virulent variant emerges, the authors predict an 80% attack rate with a 0.1% IFR, for a total of 100,000 to 300,000 deaths per year.

"We're not going to normal 2019," Emanuel noted. "There are things that are going to be better. Our surveillance system better be better. Our indoor air quality system better be better. Our willingness to put up with [for] short periods of time—and around certain vulnerable populations—having special public health precautions. All of that should make a big difference in the mortality." (Branswell, STAT News, 3/7; Fiore/Henderson, MedPage Today, 3/7; Albarracín et al., "Getting to and Sustaining the Next Normal: A Roadmap to Living with Covid" report, 3/7)