Dear Aventine Readers, 

It’s been five years since the world was subsumed by Covid-19. Since then, the acute catastrophe of the pandemic has morphed into evolving versions of what we’ve come to refer to as the new normal. And though much of the world functions very much like it did before Covid, it is also unalterably changed. To mark this moment, we spoke with five experts in pandemic-related fields to talk about what we learned from Covid and what needs to work better next time. 

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Thanks for reading,

Danielle Mattoon
Executive Director, Aventine

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It started five years ago.

The first case of Covid-19 in the United States was reported on January 20, 2020. Soon after, on January 31, then-Health and Human Services Secretary Alex Azar declared a public health emergency. By that point, the World Health Organization had reported almost 10,000 cases of the disease globally and more than 200 deaths in China. The details of what happened over the subsequent months differed in some respects from country to country, but around the world most citizens, wherever they lived, shared some aspects of the following: economic upheaval and uncertainty, social distancing, self-isolation, shortages of household supplies, working from home, remote schooling, masks, vaccinations and — most indelibly — the illness itself and the loss of friends and family. 

Simultaneously, the world witnessed the most effective global coordination of scientific expertise in decades, as doctors, scientists and private industry collaborated to develop tests, treatments and ultimately a vaccine for Covid. The speed with which novel vaccines were developed, tested and deployed was a testament to how quickly and effectively researchers and corporations can swing into action when required. 

So where are we now? Covid’s designation as a public health emergency was finally lifted in the U.S. in May 2023, and though people continue to become ill and die from the virus, it is now less threatening to the population at large. Between mid-October 2024 and mid-January 2025, between 8,000 and 9,000 people died of Covid; about the same number as those who died from the flu in the same period. Globally, deaths due to Covid fell to about 1,000 in the first week of 2025, compared to 4,300 in the same period of 2024, 32,400 in 2023, 45,600 in 2022 and 86,300 in 2021. Long Covid, meanwhile, continues to be a scourge, affecting about 7 percent of U.S. adults, according to the CDC, with roughly 17 million people reporting they had it in March 2024. Worldwide, a study published in 2024 showed that 400 million people had been affected by long Covid, with an estimated economic cost of about $1 trillion worldwide per year — or about 1 percent of the global economy. As the acute emergency of Covid has faded, possible new threats lie on the horizon. The H5N1 bird flu, which is decimating poultry farms and has caused one human death, does not currently pose a great threat to people, though mutations of the virus could change that. 

For the five-year anniversary of the Covid pandemic, we reached out to experts in infectious disease, epidemiology and public health to get a sense of what we’ve learned and what we should do better or differently next time. Even as the hunt for a smoking gun that could definitively determine the origins of the virus — animal-to-human transmission or lab leak — continues, if there is one thing health researchers can agree on about a future pandemic, it is that the next one is a matter of when, not if. “I'd say virtually all of us in public health and infectious diseases would say there will be another pandemic,” said William Schaffner, professor of preventive medicine at the Vanderbilt University School of Medicine. The continuing expansion of human settlements into areas with populations of wild animals, our changing climate and frequent travel are all considered drivers of an increasing frequency of epidemics — and therefore by extension, drivers of a future pandemic. “Where it will come from, when it will arise and which particular virus will be the cause of this pandemic [though], we clearly don't know,” added Schaffner.

The plan for dealing with these future pandemics, at least among the G7 nations, has been developed by the International Pandemic Preparedness Secretariat, a global entity supported by the U.K.’s Wellcome Trust and the Bill and Melinda Gates Foundation. Its so-called “100 Days Mission” has a strong focus on science and technology, with the goal of developing tests, treatments and vaccines within, yes, the first 100 days of a pandemic. Experts who spoke with Aventine agreed that these goals are important. But they also considered the scientific response on those fronts during the Covid-19 pandemic to have been a bright spot in the global action taken against the virus. “I think the scientific community and the clinical community have the wherewithal [and] the dedication to do this again, just as they do every day,” said Schaffner. “You can rely on them to do that again.”

Instead, the experts who spoke with Aventine were concerned about how to improve the human elements of pandemic response through better communication, coordinated social interventions and more forward-thinking vaccine distribution, among other things. What follows are excerpts from interviews with five health experts who have studied Covid-19, public health or infectious diseases closely, in which they explained their views on how we should think about a future pandemic.

Floating solar panels in a water reservoir in Rayong, Thailand Jackyenjoy/Getty Images

Floating solar cells could help power millions of U.S homes. There’s no rule that says solar panels have to be mounted on rooftops or in fields, and a new study published in the journal Solar Energy, by researchers at the U.S. Department of Energy’s National Renewable Energy Laboratory, suggests that floating photovoltaics on water could help dramatically increase solar’s deployment in this country. So-called ​“floatovoltaics,” which are being deployed in large-scale projects across Asia, are composed of solar panels attached to rafts that float on the surface of bodies of water. According to the study, deploying this technology on federally owned or managed reservoirs that are suitable for such projects could theoretically add as much as 1,476 terawatt-hours of clean electricity generation to the U.S. grid, or enough to power about 100 million homes per year, according to Canary Media. The possible sites are scattered across the U.S., though Texas, California and Oklahoma have the highest potential generating capacity. There are also possible side benefits to these sorts of installations, Canary Media reports: The water beneath the panels helps keep them cool, increasing their efficiency, and the panels themselves reduce evaporation from reservoirs, helping preserve water. There’s little chance that the U.S. will build out the full 1,042 gigawatts of potential floatovoltaics; at the moment there are no floating solar installations in the country greater than 10 megawatts. But there is precedence of scale in other parts of the world: Notably, China has one installation located on a fish farm in the Zhejiang province that covers about 1.9 square miles and provides 550 megawatts of power, about half the generation capacity of a typical nuclear power plant. 

Tiny lab-grown organs could accelerate new treatments. When it comes to testing possible new drug therapies, the rule of thumb tends to be: the rarer a disease, the more difficult the testing. That’s a significant barrier for a promising school of drugs called antisense oligonucleotides (ASOs) that use customized strands of RNA to fix genetic mutations that stop a person’s body from producing important proteins. (The best known disease that mutations like these cause is probably Duchenne Muscular Dystrophy, a genetic disease occurring primarily in boys that affects about 6 in 100,000 people and causes progressive muscle weakness.) Currently, this sort of drug must go through time-consuming and expensive animal toxicology studies before it can be used in humans, Science reports. Now, researchers at Children's Mercy Research Institute in Kansas City, Missouri, have published work in the journal Nature that describes a new way to test customized drugs like these. The approach, which takes a few weeks, takes a patient’s blood cells into a lab, turns them into so-called induced pluripotent stem cells (the cells in our body that can grow into any type of tissue), and then coaxes them to grow into small clumps of muscle, heart or brain tissue. These mini-organs, or organoids, can then be used — safely outside the patient’s body — to test whether ASOs will work on an individual’s condition. In one early success, an ASO drug successfully re-enabled the function of heart muscle in an organoid with a genetic mutation that causes Duchenne Muscular Dystrophy. While the research is really just beginning, the hope is that these kinds of organoids could remove some of the red tape around testing customized medicine that can hold back the rollout of therapies like ASOs.

AI has almost entirely solved translation — if you have the right data. The Babel fish in The Hitchhiker’s Guide to the Galaxy offers a glimpse at a tantalizing future: one in which instantaneous translation from one spoken language to another is always possible. Meta’s latest AI translation model doesn’t quite offer that but it’s not far off, and it doesn’t require putting a fish in your ear. It can perform real-time speech-to-speech translation from 101 languages into 36 target languages. It can also perform variations of text-to-text, text-to-speech and speech-to-text translations, with the number of supported languages in each case varying slightly depending on the quality of the available datasets. The results were published in the journal Nature in January. The system, called SeamlessM4T, was trained on four million hours of multilingual speech and tens of billions of sentences, as well as 443,000 hours of audio with matching text — such as video with subtitles. The software is up to 23 percent more accurate then previous speech-to-speech systems and performs better in situations with background noise. What’s pretty obvious at this stage is that the act of translating from one language to another, however you wish it to be done, is possible with AI — if, and this is a big if, you have the requisite data. While 101 languages may account for many of the words spoken on the planet, there are thought to be as many as 7,000 languages spoken in total. Extending the technology to encompass them all will require sourcing appropriate data on which to train models, and potentially designing AI that can make far more efficient use of that data.

A Start-Up Claimed Its Device Could Cure Cancer. Then Patients Began Dying, from The New York Times
6,000 words, or about 24 minutes

John Carreyrou, whose reporting for The Wall Street Journal helped expose massive fraud at the blood-testing company Theranos, and who wrote a best-selling book, John Carreyrou, whose reporting for Bad Blood ,about the scandal, reports here about another startup, ExThera Medical, that has perhaps been testing ethical boundaries. Now writing for The New York Times, he reports that the company, working with the private equity firm Quadrant Management, last year began charging $45,000 for rounds of a blood filtration treatment that, its leaders claimed, could treat late-stage cancers by removing tumor cells that circulate in patients’ blood. But while the filtering had been shown to effectively capture viruses and bacteria — working particularly well in patients with extreme cases of Covid-19 — the Times reports that there was little or no evidence to support the claims about cancer made by both ExThera and Quadrant. According to Carreyrou’s reporting, the companies convinced at least 20 cancer sufferers to pay to receive one or more treatments on the Caribbean island of Antigua. At least six of those 20 patients have since died. 

AI hallucinations can’t be stopped — but these techniques can limit their damage, from Nature
2,700 words, or about 11 minutes

Long-time readers of this newsletter might remember that the first-ever edition, back in June 2023, grappled with how we should think about and tackle one of the scourges of modern AI: the hallucinations created by large language models, or LLMs. More than a year and a half later, they’re still a problem because, just as we reported back in 2023, hallucinations are an inevitable byproduct of LLMs as they are currently built. This story from Nature describes approaches being developed by both researchers and companies to mitigate the mistakes generated by LLMs, or at least to provide users with a sense of how much confidence should be placed in a model’s output. One method being tested: Ask a model a question several times, and if the answers are all pretty consistent, it’s likely that the responses are correct. Another: Determine which parts of the underlying neural network are activated when a question is asked, and ignore answers that come from regions known to be associated with mistruths. Implicit in these and the other possible solutions described in the story is the acknowledgment that, at least for the foreseeable future, hallucinations aren’t going anywhere, so the best course of action is to try to work around them.

Mysterious Blobs Found inside Cells Are Rewriting the Story of How Life Works, from Scientific American
3,200 words, or about 13 minutes

The cell biology you learned in high school needs an important update, and it has to do with … blobs. Over the last decade, biologists have slowly come to understand that microscopic blobs — or biomolecular condensates, to give them their official name — made from proteins and RNA help with almost all kinds of cellular functions. They repair DNA. They regulate the production of proteins.They protect cells. And they behave in weird ways compared to other parts of cells, forming spontaneously from collections of molecules and changing phase from liquid to jelly, all the while floating around within parts of the cell. As the story explains, we still don’t fully understand these blobs, but we are starting to learn that they may also play a role in diseases such as Alzheimer's and cancer. Understanding how they work, and how to control them, could help us develop entirely new medical treatments.