We must act before ‘more damaging’ pandemic
COVID-19 has lessons we can learn even now
COVID-19 exploited America’s weaknesses at a terrible cost: more than 330,000 deaths so far; more than 20 million workers collecting unemployment; the permanent loss of 100,000 businesses and the temporary loss of another 65,000.
And the pandemic is far from finished.
Already, though, health care experts are stressing the urgent need to improve plans now before the world faces the next serious outbreak.
“We have already learned many crucial lessons that demand immediate action if we are to say with any confidence ‘never again,’” declares the second report by the Global Preparedness Monitoring Board, an independent accountability body focused on health crises.
The group’s first report, released in September 2019, three months before the discovery of COVID-19, warned the world: “For too long, we have allowed a
cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides.”
The 2020 report cautions: “Failure to learn the lessons of COVID-19 or to act on them with the necessary resources and commitment, will mean that the next pandemic, which is sure to come, will be even more damaging.”
Although COVID-19 caused devastation around the world, the U.S. has paid heavily for its mistrust in science and willingness to politicize health care.
America’s response to the pandemic was crippled by its longtime failure to address racial and social inequities in health care, and by its inability to mount a uniform, federal response across all 50 states.
Lies and misinformation emanated from the highest levels of government, and reverberated across social media. Fundamental safety measures were mocked and ignored by many.
Even the data released on the pandemic lacked consistency, with some states choosing not to report hospitalizations.
“To be honest, I think it was a surprise to a lot of people that there would be that many challenges and that much confusion in the (U.S.) response,” said Jessica A. Bell, a senior program officer at the nonpartisan, not-for-profit Nuclear Threat Initiative.
The group, founded in 2001 by former U.S. Sen. Sam Nunn of Georgia and entrepreneur and philanthropist Ted Turner, focuses on reducing both nuclear and biological threats.
Bell and others believe that U.S. leaders in health and government will overhaul the nation’s pandemic plans, if they are not already doing so.
“You would probably want to call them living documents because we’re still learning from COVID,” Bell said.
Indeed, a stark reminder came with the recent discovery in England of a new variant of the virus that appears more contagious than others.
“They’re not going to be going back to the drawing board,” Bell said, “but I think they will be going back to these planning documents to reflect on the lessons learned.”
Restoring faith in science and government won’t be easy
Until COVID-19 deaths drop dramatically, the nation’s focus will be on the essentials needed to confront the current pandemic: vaccinations, hospital space, medical staff and equipment.
The development of the vaccines represents one of the few bright spots in the response to COVID-19. Scientists and drugmakers cooperated as never before, and regulators paved the way for the fastest vaccines in history.
At its best, the global scientific community showcased a collective resolve, leaving behind other projects to research the inner workings of the new coronavirus, and to develop vaccines and potential treatments.
“People dropped everything to work on this,” said Pedro Beltrao, leader of a research group at the European Bioinformatics Institute in Cambridge, England.
Before joining the global investigation of COVID-19, Beltrao’s lab had been examining a series of on-off switches for different cellular activities. He shelved that work “when things in Italy were really getting rough and you could see that this was something that would snowball across the world.”
“This has no parallel,” he said of the pandemic’s scale, “and the reaction has no parallel either . ... I often joke that this is science at science fiction speed.”
In the U.S., though, researchers and health leaders confronted the pandemic at a time when many Americans displayed open mistrust of government and science.
Trust in both began declining long before COVID-19. Political polarization has shrouded the public response to almost every action taken by government. As for science, just as millions of Americans deny the evidence behind climate change, many are wary of vaccines. Health leaders have cautioned that the COVID-19 vaccine will only be as effective as the number of people choosing to receive it.
Restoring faith in government and science won’t be easy.
“Like the trust you have in a family member or a friend, it takes a while to build that back once it has been broken,” Bell said.
“A lot goes into rebuilding faith in institutions,” agreed Noor Shakfeh, a research assistant at the Center for Global Development in Washington, D.C., who has specialized in pandemic preparedness.
Rebuilding trust, experts said, will mean ensuring that both the White House and the Centers for Disease Control and Prevention send consistent messages supported by clear, scientific evidence. Trust also will require the separation of science from politics.
“Wearing a mask wasn’t a political issue in Canada, it was a scientific issue,” said Ali H. Mokdad, chief strategy officer for population health at the University of Washington in Seattle.
Mokdad said one factor crucial to swaying the public response to COVID-19 is the prompt and consistent release of state data on the pandemic. This means providing test results and a daily census from hospitals, explaining how many COVID-19 patients have been admitted, how many discharged and how many have died.
“You cannot fix what you cannot measure,” Mokdad explained. “Better data leads to better health decisions.”
Mokdad said U.S. health data in general is often out of date and severely restricted because of concerns over patient privacy.
“We need to address the health issues of today,” he said, “not the health issues of two years ago.”
Mokdad said that scientists must do a better job of preventing their disagreements from boiling over into broad conflicts that only confuse the public.
Entrenched racism led to disproportionate effect of virus and must be addressed
Part of that picture reflects America’s entrenched struggle with racism.
In November, a paper in the Journal of Racial and Ethnic Health Disparities noted: “Black Americans are disproportionately affected by poverty, a fallible public school system, unsafe neighborhoods, food deserts, mass incarceration, police brutality, maternal and infant mortality, obesity and chronic health conditions, to name a few. These issues have compounded synergistically in what some refer to as the COVID-19 ‘syndemic,’ but they are not new.”
The COVID-19 death rate for Black Americans was more than twice that of white Americans as of Aug. 18, according to the authors, who included doctors from Creighton University, New York-Presbyterian Hospital and the University of Arizona College of Medicine. COVID-19 hospitalization rates were more than four times higher for Latinos than for whites.
Recent outbreaks have shown similar disparities. In the 1989-91 measles epidemic, minority children experienced infection rates that were “four to seven-fold higher” than those of white children. In the last 10 flu epidemics, Black Americans were hospitalized at a rate almost twice that of white Americans,
according to the paper.
To combat these entrenched problems, the authors recommended antiracism and implicit bias training, recruitment and hiring of more diverse health care workers, and increased monitoring and accountability at health care and public health institutions.
An opportunity to prepare, improve response to next pandemic
Although fixing the flaws exposed by COVID-19 appear to be long-range projects, it is unclear how long Americans will have to make significant progress before they must face the next pandemic.
“I want to say, ‘We don’t have any time’ because it is such an urgent need,” said Bell, at the Nuclear Threat Initiative. “Right now we are at our weakest. If there were another pathogen that jumped from animals to humans, even if it had half the virulence, we would be in a tough spot.”
Bell stressed the importance of leadership and trust in that leadership, a point echoed by the Global Preparedness Monitoring Board in its report. The board stressed the need for leadership that takes decisive action with health as its top priority.
“Emergency response,” said the board’s report, “is not a choice between protecting people and protecting the economy; public health action is the quickest way to end the threat and return to productivity and security.”
The board said preparedness is not simply what governments do to protect their people, but also “what people do to protect each other.”
In the U.S., the concept of collective sacrifice through mask-wearing and social distancing has been a friction point throughout the pandemic.
Even with a vaccination campaign underway, health leaders have said Americans must continue to wear masks, keep at least 6 feet apart and avoid large gatherings.
In 2020, however, millions of Americans fought the calls for collective sacrifice to protect one another. Instead, cheered on by President Donald Trump, crowds protested mask mandates and state lockdowns. Thousands attended the president’s campaign events. Tens of thousands of college students packed Florida beaches during spring break; and in August, 365,000 motorcyclists rallied in Sturgis, South Dakota.
In addition to selling many Americans on collective sacrifice, leaders will need to boost funding for emergency preparedness programs, according to the Global Preparedness Monitoring Board.
“Expenditures for prevention and preparedness are measured in billions of dollars, the cost of a pandemic in trillions,” the board wrote.
Despite its somber message, the board’s report looked to the future with a modicum of hope.
“COVID-19 has the ability to leave a fractured, broken world in its wake,” the authors wrote.
‘It also creates an opportunity to recognize the vulnerabilities implicit in our interconnected, crowded, environmentally stressed planet, and allows us to embrace our common humanity in formulating solutions.”