Predicting the next COVID-19: What we've learned 3 years later

What will the be the future of COVID-19 and will there be another pandemic?

That was the big question of the South by Southwest panel "COVID, Mpox, Disease X, What's Next?" last week.

Three years ago, Austin, the United States and the world shut down. Schools went on spring break and didn't return in person until August. Businesses shut down. People started working from home and trying to educate their children and grandchildren from home.

Since that time more than 1.1 million people have died from the disease in the United States, more than 93,000 in Texas and 1,802 in Travis County.

Is COVID-19 as a pandemic over?

We went from the panic phase to the neglect phase, said Dr. Matthew Hepburn, an infectious disease specialist and the senior advisor to the director of the White House's Office of Science and Technology Policy for pandemic awareness. "We have all been through a collective trauma. We want it to end," Hepburn said.

It isn't really over. Instead of it being a COVID-19 pandemic, it's an endemic, meaning something that is frequently around like the flu. We will continue to have new variants emerge, said Hamilton Bennett, the senior director of vaccine access and partnerships at Moderna, which produced an mRNA vaccine for COVID-19.

"It will look like a seasonal flu, with the severity of the variants being less and less," Bennett said. "We have gotten really good at responding to variants," she said.

What's next and will it be a fungus like in "The Last of Us"?

Maybe not a fungus as in the HBO show inspired by the video game, but "in most of the sci-fi movies, it's always a pandemic that is getting us, and frankly, they're not wrong," Hepburn said.

He's now in charge of predicting and preventing the next pandemic. He also worked on the swine flu outbreak under the Obama administration.

There are all kinds of respiratory viruses and other diseases that are being tracked. "Some of them are going to be as bad as COVID-19, and some of them are going to be worse disease outbreaks," Hepburn said.

Others will stay isolated and not emerge as a global pandemic, Hepburn said, but the office he works for will still have to follow all of them.

What will be different with the next pandemic?

Both Bennett and Hepburn said we now know what to do. We have the science to create vaccines very quickly, in a matter of months and then ramp up production to create 30 billion doses in a year. Before, it took 10 to 15 years to develop a vaccine.

Now, with mRNA technology, once the disease is isolated, we can adapt that technology to encode for that disease and create a new vaccine quickly, Bennett said.

Life after COVID-19: 'You have to pivot:' What Austin's medical community has learned from COVID

What is the biggest challenge in preventing the next pandemic?

It's fatigue. Hepburn remembers after H1N1 swine flu in 2009, people had the sense that they were glad that was over and they could go on about their every day business. They wouldn't have to worry about a pandemic again. Fast forward 10 years ,and we had COVID-19, which was worse than swine flu, and unimaginable to many people 10 years before.

"The challenge we collectively have is can we keep the well-oiled machine going," Hepburn said. That means looking for the next disease and preserving our ability to ramp up vaccine production quickly and on a massive scale.

We have to keep public attention about infectious diseases and continue funding to prevent them.

One thought that keeps them up at night is this idea some people have that: "We did this for COVID-19, but we will never do it again," Hepburn said. "We have a lot of headwinds around 'I don't want to think about infectious diseases.'"

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Was Mpox a first post-COVID-19 test?

In many ways Monkeypox, now called Mpox was a test. We didn't respond as quickly as we could have, and this was a disease for which we already had a vaccine, but just not enough of it, Hepburn said.

"There was some inertia to get the response started," Hepburn said. One of the biggest factors was we rely on state, city and county public health entities to roll out programs and these are the same government bodies that lost a lot of employees during the pandemic because of burnout, Hepburn said. "We couldn't just snap our fingers and address Mpox right away and that should be the standard."

The reaction from the community, though was reassuring. Personal responsibility and changing behaviors slowed that virus down while the health department rolled out vaccines.

Dealing with Mpox:Austin, Travis County leaders declare monkeypox a public health emergency

What are we doing well when it comes to disease prevention?

We learned from COVID-19 to stay home if you are sick or have been exposed. That collective responsibility has continued into other diseases such as the flu.

COVID-19 also really changed the game because it has at-home testing that can be done to make sure you don't leave the house sick.

The pandemic also taught us the importance of volunteering for clinical trials, of which tens of thousands of people did. It also had us discussing more about health equity, and vaccine and clinical trial equity.

Learn more: When will COVID-19 be over? How Austin doctors, scientists predict the future of pandemic

Do we need to know exactly how COVID-19 started to prevent the next outbreak?

The two prevailing theories are: COVID-19 is something that escaped a lab or COVID-19 is something that came from an animal disease crossing into humans.

Hepburn said we have to protect against both scenarios because both could happen.

Technology can help both of those scenarios: using technology to keep pathogens in labs and protecting lab workers as well as monitoring spaces where animals and humans interact such as testing poultry workers for new infections, for example.

"It's important to monitor the right spaces," Bennet said. "There are spillover events all of the time. Most of the time it will appear as a common cold or asymptomatic."

But we have to be prepared for when those spillover events aren't the common cold or asymptomatic, she said. "We can probably move faster," she said.

"It's all about speed," Hepburn said. "If you can stop it at two cases that's better than 200 cases."

What's the future for mRNA technology?

"If we made a vaccine in less than a year, why can't we make it in 30 days?" Hepburn asks. "If we can make it in 30 days, can we make it in 10?"

Can we create a lab in a shipping container instead of in a building the size of a football field? If we can do that, we could drop that shipping container lab into an area with an outbreak. Then we can quickly swab a person in an infected area to figure out the makeup of the disease; we can develop the mRNA vaccine that mimics the disease and then get shots in arms on the ground before it spreads somewhere else.

MRNA vaccines are already being developed for malaria, respiratory syncytial virus and cytomegalovirus, a disease that causes birth defects.

There is a possibility for mRNA vaccines to be used in HIV, rare diseases and cancer on an individual level.

"If we can make it in a box, can we have it in a hospital?" Hepburn asks. "On Monday the hospital can make an individual vaccine for cancer for six people and on Tuesday it can make a vaccine for something else."

Hamilton assures, "We are at an age with mRNA vaccines and therapeutics, it's what can't we do?"

This article originally appeared on Austin American-Statesman: Will there be another pandemic? Here's what scientists said SXSW