History will reflect on the 2020 pandemic and offer opinions because that’s just what it does, but more important, we must learn lessons from our experience to improve our response to the next one. There is little question that the US management of the pandemic is/was abominable. The US has about 5% of the world’s population but has 25% of the infections, yet we pay 18% of GDP on healthcare and have/had the world’s foremost public health organization. In the US, everything about the pandemic is surrounded by confusion rising to a national stage – some argue it is a hoax in the face of a terrifying death toll; some argue (and even fight) for no masks, while research argues that masks will save lives; the danger of the virus on surfaces remains a mystery; social distancing, an obviously good idea, uses arbitrary metrics (who says 6 ft is correct?); testing wallows in chaos; states open schools without mandating masks and offering less stringent, still arbitrary distancing metrics; some states open everything while others move back to lockdowns; and the president shrugs, saying “it is what it is” and “it will go away.”
No matter what is said publicly, there are countries managing the pandemic much better than the US. For example, Japan has an infection rate of 0.04% of the population, while the US’ is near 2%. South Korea has a death rate of 0.5 deaths per 100,000 population, while the US’ is 52. Taiwan, a country of 24 million people, has had only 480 cases, 10,000 times less than the US despite a population difference of only 10. Even Caribbean and Third World countries are doing better; for example, Cuba’s infection rate is 0.036 and the Congo’s is 0.2 (10 times less than the US). So how can a country that spends 18% of GDP on healthcare and had a CDC pandemic response plan in the can perform 10 times worse than a Third World country?
One answer, and thus a lesson to be learned, is the lack of a strong national response. The reason for that is not just a weak, incompetent, and irresponsible president, but it also lies with the nature of US public health. Public health in the US is managed at the state and local level, thus offering 50 different ways to handle a pandemic. Integrate these variations into one country and you get the pandemic chaos seen in the US. There is a solution for next time, however, but it may take national legislation and definitely needs strong leadership. The US already has a history of declaring national emergencies to override local discretion in times of dire need. Pandemics are times of dire need. There should be the ability to allow federal management of pandemics when an emergency is declared that covers equipment supply, testing/tracing, and behavior management (e.g., quarantines, masks, shutdowns, etc.).
We should examine if there already are sufficient laws and practices and whether we simply squandered them. After all, the CDC did have a pandemic response plan, but the president sidelined the CDC. The US did have a stockpile of protective equipment, but the president did not replenish it. Reliable testing was available at the onset of the pandemic, but the president insisted on developing our own test, wasting precious time. Scientific experts were voicing alarms early on, but the president downplayed the threat, beating an “America is great” drum. The Defense Production Act exists to ensure supplies needed in an emergency can be there, but the president used it too little and too late. A pandemic, defined as a worldwide condition, requires worldwide coordination, but the president instead isolated the US from the rest of the world. Scientific experts advise to control the pandemic first and then the economy will follow, but the president insists on doing it backwards. The one impressive thing we are doing is fast-tracking vaccine development. It is ironic that a president who doesn’t believe in science is relying on science to save the day. Even the president’s support of vaccine development has been argued to be insufficient, however. Better worldwide coordination (it’s currently run like a competition) and much more money/effort (adding $100 billion more to the effort pales to the $7 trillion so far juiced into the limping world economy). The shameful thing we are doing is buying up the world’s stock of Remdesivir because our president cares about nothing but “America first” (and himself).
Perhaps from the above, one might suspect that the problem has been our president. Although strong, selfless leadership is always needed in a crisis, the lessons we must learn on top of this for the next pandemic (or for this one if it lingers) are:
- The ability for an emergency override to impose national public health actions (state and local public health authorities should be ready to implement, not independently design) with appropriate enforcement.
- A fully replenished stockpile of equipment and supplies with a US (internal) capability for further replenishment during times of use.
- A national testing plan, including test development and implementation with sufficient contact tracing.
- Quarantine rules and enforcement.
- Clear criteria for public, business, and school operation/shutdown.
- A short-term financial plan to help those affected, optimized for its impact on the long-term economy, including national debt considerations.
There may be other things we can do by studying what worked and what didn’t the world over, but this may be the best we can do. It still doesn’t guarantee our long-term survival.