“COVID is not going to be the last pandemic, biosecurity threat, or public health emergency,” the report authors say, noting that the U.S. remains a long way from stamping out the virus or treating it as an endemic condition.

According to the report, COVID’s weekly death toll is still almost 10 times the level of weekly deaths caused by other respiratory diseases such as the flu, which U.S. health authorities accept as normal. But even when COVID no longer warrants “emergency mitigation efforts,” the report warns against “collective amnesia” of lessons learned during the pandemic.

The U.S. will have to adopt permanent changes to prepare for the next viral outbreak. Here are four steps the report’s authors highlight to help the U.S. get on track for living with COVID in “the next normal.”

Boost support for vaccines

The speedy development of effective COVID vaccines is an often underappreciated success, the report authors say. The U.S. “developed, manufactured, and tested COVID vaccines in record time,” which likely saved millions of lives. But despite inoculation’s proven success in lowering COVID hospitalization and death, the U.S. continues to struggle with low vaccine uptake.

Only 65.1% of the U.S. population have received two doses of a COVID vaccine, and only 28.9% have received a booster dose needed to provide greater protection against new COVID variants, like Omicron. In contrast, 86.6% of Singapore’s population have received two doses, and 64.4% are boosted.

The new road map points to “misinformation and distrust” as major factors behind low vaccine uptake in the U.S. and calls for “changing media laws and regulations to eliminate algorithms that preserve misinformation bubbles” as well as “making [internet] platforms responsible for the misinformation they house.”

The road map also calls for the U.S. Department of Health and Human Services to partner with private-sector manufacturers to expand domestic U.S. vaccine production, to prepare for the next pandemic. The report says “new or modified vaccines will not help if they cannot be produced quickly at mass scale.”

Improve indoor air quality

Indoor transmission was a key cause of COVID’s rapid and often uncontrolled spread, the report says, with many so-called superspreader events—where COVID passed quickly between scores of people—occurring inside confined venues. Yet “the quality of indoor air has not only failed to improve in recent decades, but by some measures has worsened,” says the report.

The road map calls for the U.S. Environmental Protection Agency to fund and mandate improvements in indoor air quality throughout the country, especially in schools and federal buildings, through the installation of high-quality ventilation systems. In some cases, that would mean subsidizing individual households to upgrade their air conditioning units.

The road map says improving indoor air quality will become a critical public health intervention for controlling not only COVID but other respiratory illnesses, like the flu, as well. Improving indoor air quality would also have spillover effects long after the pandemic ends, the report says, by reducing health care costs associated with low air quality, such as asthma.

Treat long COVID as a long-term problem

Mounting evidence suggests that even mild cases of COVID can lead to long-lasting conditions in patients. The lingering consequences of so-called long COVID include fatigue, “brain fog,” hair loss, and depression. For those who suffer from “long COVID,” returning to normal life can be difficult, if not impossible.

Supporting long-COVID patients will itself be a long-term health issue for the U.S., requiring new policies to offer support and resources to those suffering from the condition—including recognizing long COVID as a disability. One scientific survey found that half of long-COVID patients have cut back on work schedules; a quarter have stopped working entirely.

Long COVID “needs to be elevated to a national priority on par with vaccines and antiviral therapeutics,” the road map says, and the report authors call for a new task force to lead a “whole-of-government” response to mitigating long COVID’s effects.

End school closures

School closures are a politically fraught issue in the U.S., with opponents arguing that closing schools is overly detrimental to child development. The authors of the new road map appear to agree.

“Pandemic school closures cause such significant and enduring harm to children that far more should be done to avoid them,” the report says, citing slowed academic gains among students and additional burdens on working parents.

The report’s authors argue that “with vaccines widely available and infection-based immunity soaring, school-based quarantines for COVID—never popular or particularly effective—should end.”

Instead, the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Education should focus efforts on vaccinating children and teachers, and narrowing the gap in learning caused by over a year of closed schools. 

Keeping schools open might be one of the upsides of the new post-pandemic normal. In fact, the road map authors insist that “the next normal” can be better than the pre-pandemic normal in many ways. Permanent mitigation systems could promote better work/life balance, faster development of vaccines and therapeutics, and more effective public health surveillance.

The authors note, “The next normal with COVID can be an improvement over life before the virus emerged.”