Dear Editor,
On 5 May 2023, the World Health Organization (WHO) announced that the coronavirus
disease 2019 (COVID-19) epidemic would no longer be listed as a public health emergency
of international concern (PHEIC), 3 years after the first PHEIC alert on 30 January
2020
1
. The WHO committee highlighted the reduction in death rates and hospitalizations,
along with the increased levels of population immunity against severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2), as reasons for ending the PHEIC status. To some
extent, this could be regarded as a symbol of the end of the global COVID-19 pandemic
and we are witnessing a turning point of the most severe emergent infectious disease
pandemic in the 21st century
2
.
Moreover, as we know that artificial intelligence (AI) technology includes machine
learning, deep learning, data analysis, and data mining, is an important scientific
approach to studying the spread routes, spread processes, and epidemic laws of infectious
diseases and has played a critical role in effective prevention, control, and elimination
of the global COVID-19 pandemic. Based on the lessons learned from the COVID-19 pandemic,
some scholars believe that AI-enabled clinical trials might be a faster way to conduct
rapid clinical trials and counter future pandemics
3
. In addition, when referring to AI, an exponentially growing AI application called
ChatGPT, a general large language model (LLM) developed by OpenAI company, has attracted
substantial interest from researchers. GPT refers to Generative Pre-training Transformer
and GPT-4 is the latest version of OpenAI’s LLM system
4
. Recently, numerous studies have explored the potential of ChatGPT/GPT-4 in the biomedical
field, including medical imaging, virtual assistant, clinical decision-making support,
health management, precision medicine, and so on. As for the field of infectious diseases,
our research group has analyzed the most concerned questions about the use of ChatGPT
in the infectious disease domain
5,6
. Additionally, several scholars also acquired answers and recommendations from ChatGPT
on the frequently asked questions about COVID-19, such as spread, symptoms, diagnosis,
treatment, vaccines, and pandemic management
7
. At the time point of WHO announced the end of COVID-19 PHEIC, we conducted an online
survey using GPT-4 (https://chat.openai.com/chat).
Continued vigilance is needed
PHEIC represents the highest level of alert issued by WHO under the International
Health Regulations (IHR). It refers to an unusual event that poses a public health
risk to other countries through the international spread of disease, warranting a
coordinated international response. Since 2009, the WHO has declared seven international
public health emergencies, including the H1N1 influenza pandemic, polio outbreak,
Ebola outbreak in West Africa, Zika epidemic, Ebola outbreak in Congo, COVID-19, and
Mpox (monkeypox), with the first being the H1N1 pandemic in Mexico and the United
States. On 30 January 2020, in response to the escalating global threat, the WHO declared
the COVID-19 pandemic as a PHEIC. As of now, the cumulative number of confirmed COVID-19
cases worldwide has reached 760 million, with 6.92 million cumulative deaths. Approximately
5 billion people have received at least one dose of vaccine. Of note, COVID-19 is
no longer deemed a PHEIC does not imply the virus or disease has vanished, but rather
that we have the ability to effectively control the epidemic. With this downgrade,
countries/regions are no longer required to implement mandatory public health measures
and control strategies. This shift is expected to stimulate new developments across
the global and national medical care, transportation, trade, and other sectors
1,2
. Nevertheless, many experts maintain that we are only at the beginning of the journey
toward long-term COVID-19 management. As illustrated in Supplementary Figure 1 (Supplemental
Digital Content 1, http://links.lww.com/JS9/A636), GPT-4 also believe that the WHO’s
decision to no longer classify COVID-19 as a PHEIC does not necessarily mean that
the disease is no longer a health threat. Continuous research indicates that COVID-19
continues to mutate, and sporadic outbreaks persist worldwide, suggesting the disease
still poses a risk. For instance, one study from China CDC Weekly showed that SARS-CoV-2
reinfections were monitored in Guangdong Province between December 2022 and January
2023
8
. According to their estimates, the reinfection incidence was 50.0% for the original
strain primary infections, 35.2% for the Alpha or Delta variants, and 18.4% for the
Omicron variant. Up to now, the Chinese government continues to manage COVID-19 using
measures applicable to Class B infectious diseases. Therefore, in alignment with GPT-4,
we believe that ongoing vigilance, surveillance, testing, and localized responses
to potential outbreaks remain necessary. Furthermore, the established prevention and
monitoring mechanisms for COVID-19, including surveillance, contact tracing, and testing,
may still be required in the future.
Long-term response plan
While recognizing the ongoing uncertainties posed by the potential evolution of SARS-CoV-2,
experts from IHR emergency committee suggest that it is time to transition toward
the long-term management of the COVID-19 pandemic. To address this challenge, the
WHO released a strategic plan on 3 May 2023, outlining the transition from emergency
status to long-term disease management of COVID-19 for the period of 2023–2025. The
plan presents 10 essential recommendations organized into 5 primary areas: emergency
coordination, collaborative surveillance, community protection, safe and scalable
care, and access to countermeasures (Fig. 1A). These guidelines will assist countries
in their crucial roles within the long-term management of COVID-19 while safeguarding
public health and safety. In addition, as shown in Figure 1B and Supplementary Figure
2 (Supplemental Digital Content 2, http://links.lww.com/JS9/A637), GPT-4 also gives
nine recommendations for COVID-19 long-term management. These recommendations concern
continued surveillance and monitoring, vaccination efforts, healthcare capacity and
infrastructure, public health measures, research and development, education and communication,
global cooperation, mental health and socioeconomic support, as well as pandemic preparedness.
It is not difficult to see that GPT-4 seems to give a more comprehensive recommendation
checklist. Combining the suggestions from WHO and GPT-4, long-term COVID-19 surveillance
and vaccine development are still the top priorities. Take vaccination as an example;
under the circumstances that current vaccines and antiviral drugs are not capable
of completely ending the COVID-19 epidemic, the future market still needs an ideal
COVID-19 vaccine that is broad-spectrum efficient and could induce long-term immune
protection. And if new strains of the COVID-19 virus emerge that demonstrate resistance
to current vaccines, it may be necessary to develop and distribute updated vaccines.
Additionally, the COVID-19 vaccine also has a high possibility of becoming part of
routine healthcare, similar to the annual flu shot.
Figure 1
Long-term response plan from WHO (A) and GPT-4 (B).
Lessons for surgeons
The unprecedented scale and reach of the COVID-19 pandemic have compelled healthcare
systems, already under significant strain, to undergo adaptive changes and evolution.
As a result, there has been a considerable shift in practices, altering the roles
and expectations of many physicians. In the domain of surgery, the pandemic has induced
a paradigm shift, leading to an ongoing evolution of clinical guidelines. Surgeons
have found themselves reassessing nearly every facet of their daily clinical practices.
This reevaluation has included the deferral of non-emergent surgical procedures. Elective
surgeries have been canceled, and the provision of clinic services has been curtailed.
Therefore, at this historical turning point, it is of great importance to collate
the experiences and lessons learned by surgeons during the COVID-19 pandemic. Such
a compilation will aid surgeons in accumulating knowledge and will better equip them
to tackle potential future outbreaks of infectious diseases. As shown in Supplementary
Figure 3 (Supplemental Digital Content 3, http://links.lww.com/JS9/A638) GPT-4 has
briefly summarized seven key points for surgeons, including elective surgery and prioritization,
telemedicine, personal protective equipment (PPE) and infection control, preoperative
testing and patient management, well-being and mental health, collaboration and flexibility,
and research and innovation. Take well-being and mental health as examples; in fact,
the change from the COVID-19 pandemic and work overload has generated significant
stress and strain on healthcare professionals and surgeons. It is reported that the
mental health of healthcare professionals has worsened since the pandemic’s second
year
9
. Numerous previous studies also have found that 50% of all surgeons experienced at
least one COVID-19-related burnout
10
. Moreover, with the start of a long-term response plan, the global fight against
the COVID-19 virus appears to be a long battle. Although COVID-19 global health emergency
was finally declared over, the psychological impact on clinicians may linger long.
It is clear, therefore, that larger studies are needed to gain a more comprehensive
understanding of the needs of surgeons in the current situation. Several studies have
noticed this phenomenon and called for strategies to address pandemic-related burnout.
Conclusion
All in all, the WHO announced that the COVID-19 epidemic was no longer listed as a
global public health emergency, which showed that we have made important progress
in controlling this epidemic. However, the end of PHEIC does not mean COVID-19 is
no longer a health threat. In the future, it may co-exist with humans for a long time,
and there is a need for constant vigilance. Meanwhile, it is time to transition toward
the long-term management of the COVID-19 pandemic. Continuous surveillance and vaccine
development are still the top priorities. In addition, although the war against the
epidemic has not been declared a final victory, at this historic moment, we should
express gratitude for the efforts made by people all around the world. Let us all
work together to continue to fight COVID-19.
Ethical approval
This study does not include any individual-level data and thus does not require any
ethical approval.
Sources of funding
This study is supported by China Postdoctoral Science Foundation (2022M720385) and
Beijing JST Research Funding (YGQ-202313).
Author contribution
K.C.: conceptualization, methodology, data curation, formal analysis, investigation,
and writing – original draft; C.W.: conceptualization, methodology, data curation,
and formal analysis; S.G.: data curation, formal analysis, resources, and investigation;
Y.L.: data curation, formal analysis, resources, and investigation; H.W. conceptualization,
methodology, data curation, formal analysis, resources, and investigation; C.L.: conceptualization,
methodology, data curation, and formal analysis.
Conflicts of interest disclosure
The authors declare no conflicts of interest.
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Guarantor
Haiyang Wu and Cheng Li.
Data availability statement
The data underlying this article will be shared by the corresponding author upon reasonable
request.
Supplementary Material
SUPPLEMENTARY MATERIAL