Exposing gaps in our health care system

People all over the world are getting an education in exponential growth. On Thursday, the World Health Organization said it took more than three months to notch the world’s first 100,000 confirmed cases of COVID-19. The next 100,000 took just 12 days.

Here in Ohio, we may delay that moment of exponential acceleration, thanks to the state’s aggressive moves to keep us apart and slow the spread of the disease. But that moment likely is coming -frightening, given that we’re already seeing signs of strain and overload in our public health system.

COVID-19 is also teaching a different lesson, about something most of us take for granted but that’s showing weaknesses: our public health system and its preparedness for a pandemic crisis.

The United States is home to the world’s pre-eminent experts in both public health preparedness and pandemic response. Yet, as a country, we just haven’t invested adequately in those systems. Nor have we safeguarded the pipeline for supplies that front-line medical and safety workers desperately need in a health crisis.

That’s why, in Ohio and nationally, we’re not just struggling to find enough ventilators to rescue COVID-19 patients in extremis. Shockingly, we’re also trying to locate adequate face masks and other personal protective equipment that our overtasked medical workers need to keep from falling ill themselves.

Nor have we been able to ramp up testing to the level needed, exposing fundamental weaknesses in how the Centers for Disease Control and Prevention, long the gold standard for disease identification and control, approached this challenge.

Partly, this traced to a still-inadequately-explained flaw or flaws in the original test the CDC distributed, a flaw that took awhile to identify and that seriously delayed distribution of replacement tests. But it also appears to involve possible systemic flaws in how we approach a pandemic like this one, that spreads insidiously but aggressively and with delayed onset of symptoms, making containment challenging, possibly impossible.

It turns out that fighting pandemics launched by new viruses shares at least one attribute with actual wartime combat -- the temptation, often fatefully wrong, to fight the last war instead of the current one. And with each pandemic, with each war, even as the tools advance, so do the challenges.

How we fought SARS, how we fought H1N1 (also called the swine flu although that proved a misnomer), what we now understand about the virulence of the 1918 pandemic flu -- these are only part of the tool chest we now need to fight COVID-19.

The good news is that this nation is capable of rapid mobilization of resources. And they are being mobilized.

The good news is that if we follow the state’s directives and self-isolate, we will keep the pressure-cooker lid from blowing off our already overstressed health care system, and we will give our valiant front-line medical workers the window they need to get equipped properly, to get some sleep, and to save those who fall most violently ill from this novel coronavirus.

The good news is that exponential pandemic curves always hit a peak, and then go down.

And the good news, looking forward, is that what we’re learning now in the midst of this crisis will make us far better prepared for the next one.

Dr. Amy Acton, the noted public health expert who leads the Ohio Department of Health, told our editorial board in a March 3 meeting -about a week before Ohio saw its first confirmed COVID-19 case -- that each health crisis, each pandemic, builds on the one before, teaching new lessons that make our public health response ever more sophisticated and comprehensive. That process accelerated after 9/11 when there was federal support for disaster preparedness at the local level.

At the same time, Acton noted, pandemics also teach that, “They’re predictably unpredictable.” Predictably unpredictable. That is what COVID-19 has turned out to be.

But, similar to SARS, similar to H1N1, long after we conquer COVID-19, we’ll be studying it. We’ll study where our public health response fell short. We’ll delve into why the first CDC test failed. We’ll learn the true hidden “demographics” of this disease that can now only be inferred -who it strikes most harshly, what attributes accelerate or intensify its lethality, how to break its lethal progression into the lungs.

These are the gold standards of public health, and we will deploy those tools, and make ourselves stronger for the next time.

Read the edirorial from the Plain Dealer at bit. ly/2UzKNrG