I will consult my crystal ball and discuss some things that will become entirely apparent by the end of 2021 when the #COVID19 will either be entirely crashed or on its way to be crashed.
1) As a field, we have been too reluctant to follow up & eliminate acute infectious dz 1/

that kill. I opened up my old microbiology textbooks (pre SARS) and the CoVs were not even considered seriously because of their association with upper respiratory disease. This despite their isolation in the context of lower respiratory dz & groundbreaking epi & virology 2/

work in the 1960s and 1970s. The discovery of 229E CoV is itself an amazing journey and one could interpret various studies from the 60s & 70s as indicative of an outbreak of pneumonias by this virus that interpolated just prior to the 1968 flu epidemic https://twitter.com/ChristosArgyrop/status/1233496452023902208?s=20 3/

What is equally disheartening is the failure to follow up with vaccines against the SARS virus (which hit us in 2003). The work died in the early 2010s when these vaccines demonstrated toxicity in animal models. Coupled with the disappearance of the virus, these results 4/

condemned further development in the area. However ACE2 (the receptor of #SARSCOV1 , #SARSCOV2 and NL63 CoVs) appears to be a major vulnerability of human biology: it is expressed in the lung (so at some point one virus will emerge that will cross the species barrier) and 5/

also on the blood vessels and kidney, leading to a disease with systemic manifestations that will be extremely hard to deal with. It happened with SARS (as anyone who remembers the Toronto autopsy series knows https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2009.02153.x) and it became a hot point with #COVID19 6/

We thus really need to be concerned with things that are highly expressed in the lung and other organs: the lung will open the door to a virus that can cause multisystemic disease. So the systematic characterization of these potential viral receptors & development of drugs 7/

that modulate the expression of these systems, will be critical to having a portfolio of molecular bullets that either stop the virus from spreading or shutting down its systemic manifestations. Since it is not my field, I have no COI in saying: spend $$$ on ACE2 research now 8/

and create tools that may help when the 4th virus targeting ACE2 emerges.
2) the other thing that will become obvious is the importance of NGS in investigating infectious diseases of unclear aetiology. We should no longer accept ppl dying from undiagnosed infectious dz in 9/

our ICUs. The next #COVID may emerge anywhere, so sequencing (and sharing) the potential sequences will allow us to see dz to which we are now oblivious so that we not caught with our pants down. To see why this is critical consider the path to the RNA vaccines in testing 10/

Once you have a sequence and the basic research that identifies the viral receptor, one can literally have a vaccine candidate within 4-8 weeks (indeed follow @KizzyPhD ,if you are not following already, for the story behind the NIAID vaccine !) that you can test in trials 11/

I bet that at least one (and possibly more) RNA vaccines against #COVID19 will gain regulatory approval 12 months from patient zero. This is very fast a development, but we should not stop there. Could we have done any better? 12/

I think the answer will be a resounding yes, but ONLY if we speed up the ridiculously convoluted and complicated clinical trial environment. Bureaucracy does indeed kill and hopefully our clinical trial system will critically cut the fat out of the current inefficient process 13/

There are additional observations that we can and should make about the utterly uncoordinated, ineffectual and ideologically blinded response to the spread of the virus, and I hope to come up with a few bullet points later in the week. In the meantime, stay safe & wear a mask!