Five lessons COVID-19 has taught us for the next pandemic

One year later, scientists say we can learn from our mistakes

The pandemic that launched the nation’s first and most ambitious experiment to slow the spread of COVID-19 — stay-home orders for 7.6 million Bay Area residents — is easing.

It’s left behind shattered lives, economic upset and widened racial inequities, but also valuable lessons which could strengthen our future response to outbreaks of deadly contagion.

“Despite these enormous hardships, we have so many reasons for hope and a better future now,” said Dr. Dan Lowenstein, executive vice chancellor and provost of UC San Francisco.

A year ago, Bay Area health officials did the unthinkable: They pushed us into isolation, ordering that people leave their homes only to “obtain or perform vital services.”

With merely five deaths and about 245 confirmed infections in the region, it seemed a heavy-handed step that upended our lives.

But their instincts proved prescient. In a matter of weeks, the Bay Area was swept by its most dire public health crisis in a century. In the year since, the pandemic has claimed more than 5,780 lives here, with more than 426,000 confirmed infections.

“Every single bed was filled…It was horrendous,” recalled Dr. Paul Silka, medical director of emergency medicine at Regional Medical Center in the heart of East San Jose, which was so overwhelmed with COVID-19 patients last spring that a refrigerated truck was parked outside ready to serve as a makeshift morgue.

Now, Bay Area deaths have fallen from a peak in late January of 75 deaths in a day over a seven-day period to 18 at the start of this week.

“The chaos has gone away,” said Silka. “But no one can ever take away the experience from those who went through it.”

As we emerge from the nightmare, those fighting on biomedicine’s battlefield offered a list of lessons learned, many of them surprising and specific. For instance, we need a more diverse supply chain for things like gloves, gowns and masks, said Dr. Joshua Adler, vice dean for clinical affairs at UC San Francisco. The broader lesson is that it is now time to prepare for the next pandemic.

The man vs. microbe war is far from over, experts warn. But if we adapt, we will be defined not by the virus, but our response.

Lesson: Time is of the essence.

The race to create a vaccine has been stunning. But many lives were also saved by California’s early and aggressive stay-home measures.

Our statewide order came four days ahead of New York’s, and followed several days of increasing restrictions. During that time, New York’s COVID-19 cases multiplied to 15,168 — 10 times the 1,536 cases in California at the time.

Even within California, a few days made a big difference in slowing the exponential spread of infection. The Bay Area’s stayhome order took effect on a Tuesday; Southern California’s took effect on a Friday, along with the rest of the state, but was largely ignored in the southland until Monday, according to UCSF infectious disease expert Dr. George Rutherford.

“That one-week difference was was huge,” he said. “It basically meant Southern California had many more chains of transmission to deal with. In general, they’ve never recovered from it.”

Lesson: We need direction from the top.

“When there’s no leadership at the federal level, the responsibility is pushed out to the state. And then at the state, it becomes quite political and it’s pushed down to the county level,” said Dr. Sara Cody, Santa Clara County Health Officer.

“So you get like this extraordinary patchwork,” she said. “A ‘county, by county, by county, by county’ approach — all across the country — is not the most successful way to fight a pandemic.”

In hospitals, as case counts climbed, doctors were on their own to strategize the best approach to care, recalled Dr. Peter Chin-Hong, a professor of medicine and infectious disease specialist at UCSF.