ENVIRONMENTAL CLAIMS JOURNAL 2022, VOL. 34, NO. 3, 193–207 https://doi.org/10.1080/10406026.2021.2015821
The Future Disease Burden of Pandemic Covid-19 for Individuals, Communities, and Society
Robert A. Michaels
RAM TRAC Corporation
ABSTRACT Pandemic Covid-19 has exposed tension between personal choice and public health policy. Vaccination has damped pandemic inertia in the U.S., but emergence of highly infectious variants such as delta and omicron has increased infection of fully vaccinated people. This worrisome trend justifies vaccine booster eligibility and access for all vaccinated people in a timeframe responding to waning protection. In restricting booster eligibility, US FDA and CDC statements indicate failure to consider that SARS-CoV-2 might be persistent, meaning that it might remain dormant in immune-privileged “refugia” such as the central nervous system of previously infected people, even if their Covid-19 symptoms had been mild or nonexistent. Opportunistic re-activation of dormant viruses can cause severe illness, as in childhood chickenpox producing adult shingles decades later. External re-infection is unnecessary. Consistent with the “precautionary principle,” the overriding FDA and CDC public health priority should be to prevent as many SARS-CoV-2 infections as possible, not tolerate them, assuming optimistically that they will not impose major public health and associated economic burdens in the future. We naturally have focused upon our tragic past losses. We also must focus upon the future, learning from Covid-19 to manage pro-actively the inevitable next pandemic. Introduction In the Fall of 2021, the US FDA (2021b) and US CDC (2021) expanded eligibility to receive Pfizer Covid-19 booster shots. Boosters should be understood to mean additional shots for people who were eligible for, and received, the initial full course of Covid-19 vaccination(s). Eligible people would include recipients of any approved Covid-19 vaccine(s). That is, boosters would not be “boosters” if they were administered to people who had not already received a vaccine. Neither the FDA (2021b) nor the CDC (2021) addressed the issue of whether the SARS-CoV-2 virus might persist after Covid-19 disease symptoms resolve. The issue remains unresolved and largely unaddressed (for CONTACT Robert A. Michaels RAM TRAC Corporation, 3100 Rosendale Road, Schenectady, NY 123091510, USA. (cid:1) 2021 Taylor & Francis Group, LLC
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~ example, Alpalhao, Ferreira, and Filipe 2020). The agencies, however, imposed booster eligibility restrictions that merit evaluation in the context of the hypothesis of SARS-CoV-2 persistence, re-activation, and possible future disease burdens.
Methods Assessment of the hypothesis of SARS-CoV-2 persistence, re-activation after “cure,” and possible future disease burdens is solely based upon litera-
ture research on evidence of SARS-CoV-2 invasion of privileged immune “refugia” and resulting long-term persistence. No laboratory or clinical activities were undertaken. No human research, and no associated ethical issues, were involved. No institutional review board approvals were required.
Findings
Pandemic Covid-19 has imposed a huge disease burden in the U. S. and globally. It has exposed tension between personal choice and public health policy, for example when individuals test themselves to verify that they have mounted an immune defense following vaccination or seek vaccine boosters well ahead of U. S. FDA and CDC approval of such boosters (FDA 2021a). Such tension between personal action and public agency advice may be especially acute for seniors and other immunologically compromised people. Findings regarding several inter-related issues together
support these and other personal choices, notwithstanding possibly countervailing agency guidelines, or lagging public agency approvals. Vaccination has damped pandemic inertia in the U.S., but the emergence of highly infectious variants such as delta and omicron has increased infection of fully vaccinated people (“breakthrough” infection). This worrisome trend justifies vaccine booster eligibility and access for all vaccinated people in a timeframe responding to waning immune protection. Indeed, in restricting booster eligibility initially, US FDA (2021b) and CDC (2021) technical statements indicate failure to consider that SARS-CoV-2 might be persistent, meaning that it might remain dormant in immune-privileged “refugia” such as the central nervous system of previously infected people, even if their Covid-19 symptoms had been mild or non-existent. Opportunistic re-activation of dormant viruses can cause severe illness,
as in childhood chickenpox producing adult shingles decades later. External re-infection is unnecessary. Consistent with the “precautionary principle,” the overriding FDA and CDC public health priority should be to prevent as many SARS-CoV-2 infections as possible, not tolerate them, assuming optimistically that they will not impose major public health and associated
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economic burdens in the future. We naturally have focused upon our tragic past losses. We also must focus upon the future, learning from Covid-19 to manage pro-actively the inevitable next pandemic.
Covid-19 disease burden
The SARS-CoV-2 virus, which causes Covid-19, as of 16 June 2021 was reported to have killed 3.82 million people globally, and infected 176.3 million (UN WHO 2021), corresponding to a 2.2-percent cumulative fatality rate. After so much tragic experience, these disease burdens naturally have focused us on our losses. However, we also must focus on the future. To
manage future risks pro-actively, we must reduce present uncertainties. Covid-19 symptom intensity, which is statistically associated with comorbidities, still eludes reliable individual prediction (Wynants et al. 2020; Kaiser 2021). The range of clinical infection and post-infection effects remains only incompletely known. A recent large study, analyzing nearly two million health insurance claims in the U.S., revealed new medical issues among nearly one in four “recovered” Covid-19 patients, including patients who had been non-symptomatic or only mildly symptomatic (FAIR Health 2021). That study illustrates that the future disease burden of
Covid-19, which is fully vested in pandemic survivors, whether or not they were infected, constitutes a major unresolved public health issue for individuals, for their communities, and for society. In the United States, the Centers for Disease Control (CDC) reported that, as of 16 June 2021, the virus had killed 597,965 people (over 0.5% of U.S. population) and infected 33,315,272 million (over 10%), corresponding to a 1.8-percent cumulative fatality rate (US CDC 2021b). The number of fully vaccinated people in the United States as of 19 June 2021 was reported to be 149,125,164 (44.9% of total population; US CDC 2021c).
Vaccination and enlightened public health policies together have suppressed Covid-19 infection, hospitalization, and death rates, although less so in states that have resisted these strategies. Pre-vaccination and post-vaccination era data illustrate great progress. For example, the number of fully vaccinated people in New York State as of 19 June 2021 was reported to be 10,084,575 (50.6% of total population; NY.gov 2021). In New York State, on 14 January 2021, the number of positive Covid-19 tests was 19,942 out of 324,671 total (Forward New York 2021), corresponding to a 6.1-percent pre-vaccination era positivity rate.
On 15 June, the number of positive Covid-19 tests had dropped to 349 out of 100,477 (Forward New York 2021), corresponding to a 0.3-percent postvaccination era positivity rate.
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The success of vaccination and enlightened public health policy may suggest that continued progress is inevitable on all fronts, though possibly with a patchy geographic pattern and uneven time course. Yet, vaccination has produced a new and increasing population of people who are being tested for Covid-19 less commonly, and whose SARS-CoV-2 status, future
health risk, and long-term disease burden, therefore, are more uncertain. A good fraction of vaccinated people have abandoned routine precautions for Covid-19 surveillance, thus reducing testing, tracing, isolation, and case detection. The data, though highly variable geographically and over time, suggest that roughly, on an order-of-magnitude basis, surveillance has dropped to a tenth of pre-vaccination levels. Specifically, in New York state, the post-vaccination era number of Covid-19 tests and positive tests on the two sample dates reported above dropped, respectively, to 0.30 and 0.02 of pre-vaccination era levels. Covid-19 test positivity dropped to 0.05 of the pre-vaccination era rate.
SARS-CoV-2 breakthrough: Covid-19 among fully vaccinated people
Available data indicate strong vaccination suppression of Covid-19 incidence. Even fully vaccinated people, however, are at risk, especially with emerging variants (Lovelace 2021): “The World Health Organization … urged fully vaccinated people to continue to wear masks, social distance and practice other Covid-19 pandemic safety measures as the highly contagious delta variant spreads rapidly across the globe.” Less certain is the degree to which vaccination also has suppressed future risk, in part because breakthrough cases, of unknown incidence, do occur (MMWR 2021b). Breakthrough has increased uncertainty about the SARS-CoV-2 status of all vaccinated people, whether infected or not.
As the reported cumulative incidence of Covid-19 in the United States is in the range of 10% (US CDC 2021b), the preponderance of vaccinated people (roughly 90%) never contracted it. If breakthrough is rare, as reported by CDC (MMWR 2021b), then the causative SARS-CoV-2 virus likewise may have a low prevalence. If breakthrough is common, however, the issue of its potential clinical significance becomes paramount. Concern about persistent, dormant, and/or latent SARS-CoV-2 most essentially arises from the unknown risk of breakthrough. The concern is exacerbated by rapid viral adaptation to Covid-19 vaccines, emergence of increasingly infective variants, such as the delta variant, that reduce vaccine
effectiveness, and the possibility of eventual evolution of vaccine-escape strains that will necessitate booster vaccinations. Breakthrough implies viral penetration of multiple layers of immune defense, not just antibodies. Although breakthrough might involve
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Table 1. Breakthrough incidence: Covid-19 among fully vaccinated people. Assumed
Avsascucmineed Observ Population efficacy CovidPopulation ID size (percent) cases US CDC: “CDC incidence” data reported from 46 U. S. s Vaccinated 101,000,000 0.80 10, 101,000,000 0.90 10, Unvaccinated 227,239,523 0.80 33,400, 227,239,523 0.90 33,400, New York Yankees7, 11, 12 Bronx6 50 0.80 50 0.90 all sites6 300 0.80 300 0.90 Kentucky Nursing Home8, 10 vaccinated 75 0.80 residents 75 0.90 vaccinated health 58 0.80 care employees 58 0.90 Notes. 1. U. S. infection rate (IR). IR ¼ 33,400,000 ¼ 10.18%. 2. Expected cases among vaccinated people (Exp ). E vax 3. Expected cases among unvaccinated people (Exp unv 4. Covid-19 incidence. Incidence ¼ observed Covid-19 c For Yankees, vaccinated fraction was (cid:4)85 percen assuming 100-percent vaccination (would be higher 5. Incidence. For US CDC section, incidence/“CDC by definition. 6. D&B (2021). 7. Enriquez (2021). 8. MMWR (2021a). 9. MMWR (2021b). 10. Rabin (2021). 11. Stieg (2021). 12. Wu (2021). emergence of vaccine-resistant varia sons. Vaccine inactivation might oc (Shammas 2021). Vaccinated individ suppressed (Couzin-Frankel 2021), m petent immune response. Vaccinated vaccine protection excessively, perha Such concern might seem misplac (MMWR 2021b) recently reported b per million (0.01%; see Table 1). Thi under-reporting due to surveillance untary, was based upon 10,262 case people. However, if breakthrough is rare consistently. However, nine ca Yankees coaches, support staff, and 2021), and 18 cases were reported nursing home (MMWR 2021a, Rabin
ved Expected Covid-19 Incidence -19 Covid-19 Observed/ incidence4 /CDC s1 cases2, 3 expected (percent) incidence5 states and territories, 1 January—30 April 20219 ,262 6,680,000 0.0015 0.01 1.00 ,262 3,340,000 0.0031 0.01 1.00 ,000 26,720,000 1.25 15 1.00 ,000 30,060,000 1.11 15 1.00 9 1.8 5.0 18 1,772 9 0.9 10 18 1,772 9 1.8 5.0 3 295 9 0.9 10 3 295 18 3.6 5.0 24 2,372 18 1.8 10.0 24 2,372 4 0.8 5.0 7 679 4 0.4 10 7 679 0 cases (2021.06.05)/328,239,523 population (2019.07.01) Exp ¼ total cases (cid:2) (1 (cid:3) vaccine efficacy). vax ). Exp ¼ total cases (cid:2) (vaccine efficacy). vax unvax cases/population size ¼ (column 4 value)/(column 2 value). nt10. Breakthrough incidence is conservatively calculated assuming <100% vaccinated). C incidence” ¼ 1.00 because numerator ¼ denominator
ants, it also might occur for other reaccur, possibly due to improper storage duals, possible those who are immunemight fail to mount a timely and comd individuals also might challenge their aps during prolonged indoor exposures. ced because breakthrough is rare. CDC breakthrough incidence of just 102 cases is “CDC incidence,” with acknowledged
being passive and reporting being voles among 101 million fully vaccinated s as rare as CDC reported, it should be ases were reported among New York players (Enriquez 2021; Stieg 2021; Wu among residents of a single Kentucky n 2021; Table 1).
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Breakthrough cases among the Yankees correspond to an incidence in the order of 10%. According to Dun & Bradstreet (D&B 2021), the Yankees have 50 employees in the Bronx and 300 at all sites combined. The breakthrough infection incidence would be 9/50 (18%, or 180,000 per million) if only Bronx employees are counted, or 9/300 (3.0%, or 30,000
per million) if all Yankees sites are counted. A risk of 3.0 to 18% may be considered reasonably good medical odds (82%–97% success rate), say, for individuals facing surgery. In the world of public health, however, 30,000–180,000 per million is a huge risk for a potentially fatal disease. It is a risk that deserves high-priority regulatory risk management, and aggressive risk communication. It is a risk that should supersede politics. The actual Yankees breakthrough risk may be higher than the order of 10-percent. Vaccination of Yankees employees was reported to be (cid:4)85% (Stieg 2021), but was conservatively assumed to be 100%. Also, employees became breakthrough cases in mid-May of 2021, soon after completion of the full vaccination series (one-shot), and a two-week waiting period. Thus,
the breakthrough incidence reported in mid-May translates to a risk incurred over roughly one month. It would be higher if translated to an annual (12-month) risk, and higher still if translated to a lifetime (assumed 70-year) risk. The Yankees constitute a young, occupationally active population. Risks to older populations, such as nursing home residents, might be higher. A Kentucky nursing home with 83 residents, 90% of whom (75) were vaccinated, experienced a Covid-19 outbreak traced to an unvaccinated health care employee (MMWR 2021a; Rabin 2021). As Table 1 shows, that outbreak included 18 breakthrough cases among 75 vaccinated residents, corresponding to a 24-percent (or 240,000-per-million) breakthrough
incidence. Four of 58 vaccinated health care employees also became breakthroughs, corresponding to a 7-percent (or 70,000-per-million) breakthrough incidence in this younger population. The CDC (for example, 2021a) has been obtuse regarding infection risks to vaccinated people, and opaque regarding possible long-term effects thereafter. CDC has suggested that breakthrough is rare and generally insignificant clinically (MMWR 2021b). Indeed, one might take comfort that eight of the Yankees’ nine breakthrough cases were non-symptomatic or only mildly symptomatic (Enriquez 2021). Non-symptomatic Covid-19 cases, however, still might have the potential to produce long-term effects. The premise that vaccination has solved the problem therefore seems pre-
mature, given that breakthrough cases have been reported to occur more commonly than reported, that increasingly infective variants are emerging, and that no assurance exists that breakthroughs tend to be clinically insignificant in the long term.
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One difference between CDC’s breakthrough risk estimate and my own inferred from the Yankees and the Kentucky nursing home is that CDC’s numbers predominantly arose from passive surveillance and voluntary reporting. The Yankees numbers in contrast arose from active surveillance including aggressive testing, with follow-up viral genetic sequencing (“analysis of variants”). The Yankees also constitute a small sample, so I
cannot be confident of the quantitative accuracy of my comparison of the Yankees experience with CDC’s larger database. Even so, if nine fully vaccinated members of the Yankees, 18 fully vaccinated residents and four fully vaccinated health care employees at a Kentucky nursing home became breakthrough cases, one cannot be confident in CDC’s assurances that breakthrough is rare.
Possible long-term SARS-CoV-2 persistence in infected people
People may be unlikely to protect themselves after vaccination, and unaware of mild breakthrough infection. If SARS-CoV-2 persists in “refugia” where it cannot be detected even if present, then dormant virus populations and/or latent infections invisible to routine surveillance may contribute to explaining decreases in post-vaccination Covid-19 positivity
rates. People harboring invisible SARS-CoV-2 would be unaware, and unlikely to take protective precautions. In this scenario, the potential future clinical significance of possible long-term persistence of the virus, both in recovered Covid-19 patients and in fully vaccinated people who become infected (or re-infected), must be deemed uncertain. Recurrence of infection effects is known to occur with many other viruses, such as Herpes simplex type 1 (HSV-1), which causes “cold sores,” and Varicella zoster, which causes chicken pox and shingles. People infected with HSV-1 may harbor dormant, potentially infective virus in
nerve cells in the skin indefinitely (Mayo Clinic 2021a). After a case of HSV-1 infection, HSV-1 opportunistically may emerge from dormancy and cause cold sores repeatedly, at times of disease, malnutrition, or other stress. Likewise, after a childhood case of chicken pox, V. zoster persists in an inactive state in nerve tissue near the brain and spinal cord (Mayo Clinic 2021b). It may reactivate as shingles in adults decades later. The possibility that coronaviruses (Desforges et al. 2019), and SARSCoV-2 in particular (Petri 2020), might persist in previously infected people and in breakthrough cases suggests that the legacy of pandemic Covid-19
might be greater than we know. This concern would be enhanced if persistent SARS-CoV-2 eludes detection via routine surveillance, which it might do if restricted to immune-privileged places such as the brain (Desforges
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et al. 2019, Petri 2020). In that case, the disease burden that we see might be the visible tip of a predominantly invisible iceberg. This scenario might seem alarmist. However, the hypothesis of clinically significant SARS-CoV-2 persistence seems credible given experience with HSV-1 (Mayo Clinic 2021a), V. zoster (Mayo Clinic 2021b), and many other viruses (Boldogh, Albrecht, and Porter 1996; Traylen et al. 2011),
possibly including human coronaviruses (Desforges et al. 2019). The possibility of such long-term health consequences should trigger application of the “precautionary principle,” in which conservative assumptions, even if thought unlikely to materialize, are made in the interest of being protective.
Eligibility and access to covid-19 booster vaccination
Two issues together suggest the need for unrestricted booster eligibility (and access). Variants, such as the current delta and omicron variants, are being selected strongly to exploit personal immunological weaknesses (for example, Goldman 2021). Progressive viral adaptation has produced increasing susceptibility to SARS-CoV-2 infection and increasingly frequent breakthrough infections (infections among fully vaccinated people; Kustin et al. 2021; Scheepers et al. 2021). Booster vaccinations would counter these trends by enhancing levels of circulating antibodies, which otherwise wane
naturally with time. In conjunction with other immune system components, such as T cells and memory B cells, boosters therefore would accelerate immune response and thereby strengthen protection against possible SARS-CoV-2 infection. The biological plausibility of SARS-CoV-2 persistence after “cure” is suggested by its ability to affect both the animal central nervous system (CNS; de Melo et al. 2021) as well as the human CNS (Meinhardt et al. 2021). SARS-CoV-2 is a human respiratory virus and, like other human respiratory viruses, appears to be an opportunistic human CNS pathogen (Desforges et al. 2019) that can cross the blood-brain barrier (Boldrini, Canoll, and Klein 2021). Consistently, the virus is strongly associated with Covid-19 symptoms affecting memory, commonly including “brain fog.” The CNS is an immune-privileged refuge (Petri 2020), which could facili-
tate viral evasion of otherwise robust immune surveillance.
Discussion
Breakthrough infections may be attributable to three main causes: (cid:3)1. failure of vaccinated people to mount a competent immune response, (cid:3)2. exposure of vaccinated people to variants resistant to received vaccinations, and (cid:3)3. ability of the virus to bypass immune surveillance that otherwise
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would be competent to prevent infection. The last posited cause is of most concern in the present context. SARS-CoV-2 is a respiratory virus that can infect the olfactory nerve following nasal inhalation exposure. As an airborne infectious agent, SARSCoV-2 also might be able to infect the optic nerve following airborne exposure of unprotected eyes. Neurons of the olfactory and optic nerves
might represent “express trains” to the brain, which means that neuronal exposure might be possible by bypassing the blood-brain-barrier, which might otherwise be competent to prevent it. The neuronal pathway to the brain, though well-documented for nerve signals, is by no means certain for viruses. Axons of nerves are surrounded by a protective fatty sheath, which might constitute an effective barrier to viral penetration. The virus still might travel through axons via streaming neuronal cytoplasm, but eventually such virus particles would encounter dendrites leading to a synapse. Nerve signals can be transmitted across synapses, but virus particles might be blocked.
Foreign agents detected in body fluids might be attacked by white blood cells, which can engulf them via the process known as phagocytosis (“cell eating”). Liquids can be consumed via a similar process, known as pinocytosis (“cell drinking”). Such processes might enable SARS-CoV-2 viruses to enter cells, though not necessarily nerve cells. They would then encounter another barrier to infection. Viruses are not competent to reproduce without marshaling RNA and/or DNA of a host organism. To reproduce and infect a host, SARS-CoV-2, which is an RNA virus, would have to be incorporated into host ribosomes. The issue of whether olfactory or ocular nerve exposure can produce brain infection clearly is uncertain as described above. Though uncertain,
the more general hypothesis of SARS-CoV-2 persistence (Jacobs 2021) in infected people is more than speculation, as it is evidently biologically plausible. Many viruses are persistent if they invade one or more of the body’s immune-privileged “refugia,” which are not limited to the CNS. That is, in people who contract Covid-19, the issue of SARS-CoV-2 persistence might depend primarily on whether the virus entered an immuneprivileged location. It might depend only secondarily, if at all, on whether the infected person had experienced severe symptoms, or any symptoms. Persistent viruses, shielded from effective immune surveillance, can reemerge opportunistically. This is especially likely to happen when people become weakened physiologically by malnutrition or with other illnesses,
or immunologically with aging. Reemergence of persistent viruses does not depend upon new exposure or external re-infection. Re-activation of long-dormant viruses also can cause severe illness (Petri 2020). Examples include childhood chickenpox (Varicella zoster). The
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chickenpox may have been “cured,” but the virus may persist, and cause shingles many decades later. Likewise, people “cured” of Ebola still may harbor the virus and may initiate Ebola outbreaks years later (Liverpool 2021). Public health policy in the United States has been influenced by nonpub-
lic health factors, such as the political need to return to normal (Moghadas et al. 2021). Science Magazine Editor-in-Chief Holden Thorp (2021) recently opined: “The CDC has been occupying a gray zone somewhere between the very different worlds of science and politics.” The public should have confidence that CDC guidance is based upon public health, not pandemic politics. CDC, for unspecified reasons, recently (1 June 2021) recommended against post-vaccination antibody verification testing (CDC 2021d): “Antibody testing is not recommended to assess for immunity to SARS-
CoV-2 following COVID-19 vaccination.” FDA likewise has recommended against such antibody testing (US FDA 2021a ). CDC may have had purely public health reasons for making this recommendation, such as the expectation of only marginal benefit to be derived from such antibody testing, but the cited CDC web source fails to assure that politics is uninvolved. Regarding non-pharmaceutical interventions such as masking, distancing, contact tracing, isolation, and testing: CDC likewise should provide public health guidance that demonstrably is based upon public health reasons, not
political reasons. As an agency that formulates public health policy, CDC also cannot mediate personal medical risk tradeoffs. Only individuals can formulate their personal health policy.
Conclusions More than speculation, the issue of possible SARS-CoV-2 persistence meets
the standard of a plausible, biologically credible hypothesis that merits further investigation. Its potential clinical importance also merits application of the “precautionary principle” to prevent serious credible, even though uncertain, public health consequences. FDA and CDC, perhaps more focused on the safety of the Pfizer vaccine than on the uncertain long-term danger of SARS-CoV-2 infections, failed to do this. The Agencies’ overriding public health concern should be to prevent as many future SARS-CoV-2 infections as possible, which requires maximum safe expansion of eligibility for Covid-19 boosters. Covid-19 is not a disease that should be tolerated,
even among people vaccinated against it, under the optimistic assumption that such infections will not impose major public health and associated economic burdens in the future.
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Vaccination has stemmed the grim pandemic trends of increasing Covid19 incidence, hospitalization, and death. However, prospects for future management of Covid-19 are complicated by possible long-term persistence of SARS-Cov-2 in people who were infected, and in vaccinated people who become infected. In both, the future health risk and disease burden for
individuals, communities, and society will depend upon the clinical significance of remnant SARS-Cov-2 virus in people who contracted Covid-19 and, among vaccinated and (as appropriate) boosted people, the incidence and clinical significance of breakthrough. Uncertainties around SARS-CoV-2 breakthrough and the clinical significance of breakthrough leave open the possibility of vastly underestimated future Covid-19 health risks and disease burdens. These unknowns must be addressed forthwith toward managing future SARS-CoV-2 risks and disease burdens proactively. Health agencies at all levels, including U.N. WHO and U.S. CDC, and in all countries, will be challenged to develop and dissemin-
ate state-of-the-art knowledge and wisdom objectively. That is, science must supersede politics in health agencies. Of course, politics is intrinsic to pandemic management. Accordingly, governments must resolve scientific, economic, and other possibly competing interests toward effective policy making. They must value scientific input from all sources. To protect and enhance credibility, confidence, and compliance with agency public health policy guidance, governments must avoid confounding their own political roles with health agencies’ scientific roles. The SARS-CoV-2 virus is more than a tragedy. It is an example of
existing and emerging viruses that can and will cause future epidemics and pandemics. The response of health agencies and of governments to the Covid-19 pandemic must be evaluated in detail to inform and improve preparations for, and responses to, the inevitable next pandemic.
About the author
Dr. Michaels is President of Schenectady, New York-based RAM TRAC Corporation, and a toxicologist specializing in assessment and management of risks to public health potentially posed by environmental contaminants. Over the past decade he has been involved with many issues, including: effects of lead (Pb) on children’s health in Flint, Michigan ; effects of perfluoroalkyl substances (PFAS) near Saint-Gobain Performance Plastics in
Hoosick Falls, New York and near Chemours Fayettevllle Works in North Carolina ; and Hudson River PCB dredging by General Electric . His interest in virology and immunology began during a brief but intense stint at the Neurovirology Laboratory at the Mt. Sinai Medical Center in New York
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City. Dr. Michaels has a strong reputation for objectivity, having served national and international Fortune 500 clients; Federal, State and Municipal governments; and public interest organizations such as the Natural Resources Defense Council (NRDC). Dr. Michaels consulted for the U.S. Congress Office of Technology
Assessment (OTA) on Love Canal (New York). For years he chaired the State of Maine’s Scientific Advisory Panel. For 20 years he chaired the Certification Review Board of the Academy of Board Certified Environmental Professionals (ABCEP). “Dr. Bob” also has been Secretary of NFPA’s Committee on Classification and Properties of Hazardous Chemicals, Board Member of the National Association of Environmental Professionals, and Member of the Editorial Advisory Boards of SpringerVerlag and Cambridge University Press scholarly journals. He earned his doctorate at SUNY/Stony Brook in 1979, and in 2004 was awarded ABCEP’s Kramer Medal.
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Michaels, RA. The future disease burden of pandemic Covid-19 for individuals, communities, and society. Routledge, Taylor & Francis Group, Environmental Claims Journal, 34(3): 193-207, https://doi.org/10.1080/10406026.2021.2015821, 16 December 2021, in print 31 July 2022;