Here's a question for you:
- Knowing what we do now, what would the public health community do differently if a new pandemic broke out? (For purposes of this question, assume the new pandemic is basically identical to COVID-19.)
- How many lives would this save?
As you can probably guess, my answer is:
- Not much.
- Not many.
Go ahead, prove me wrong. I want to be proven wrong. I'll acknowledge up front that having a president not named Trump would help immensely, but that's not really a policy thing. I'm more interested in drilling down a little further. What would the CDC do differently? Would we speed up vaccine testing? Would we handle shortages better? Etc.
FWIW, I'm not asking for your personal hot buttons here. If you think we should vaccinate with half doses, that's fine, but the question is whether the CDC and FDA are likely to allow it based on our experience with COVID-19.
Knowing what we do now, what would the public health community do differently if a new pandemic broke out?
If they had free reign to impose best practices, or not? If it's the former, then you:
A) Stock up on massive quantities of PPG in advance, for just such an eventuality.
B) Prioritize getting the testing situation sorted out, with large quantities of test kits distributed early on.
C) Have a detailed, coherent borders policy in place, ready to implement. Notice I didn't write "close the borders." You don't actually have to completely close the border and prevent all international arrivals. You do have to restrict the number of flights, require everyone to submit negative test results before boarding, and require 14 day quarantines (which yes, means commandeering airport hotels by executive order and converting them to quarantine facilities).
D) Perfect and widely roll out contact tracing software early on. Ideally settle on a single app the entire country can use. No, even in optimal conditions, you're not going to be able to get every single resident of the country to use it. But you probably could require interstate businesses to require its use, and hopefully many state governments would get involved. If you've got to show your virus status to get into a Safeway or Walmart, even plenty of RedStaters will have to play ball. Widescale use of contract tracing apps would be a huge help.
E) Prepare in advance and roll out (nationally) a policy to quarantine those who test positive. That was never in the cards in the US, I think, but if you catch the next outbreak early, you're hopefully talking about very small numbers of infected persons, which would make it feasible.
F) If need be implement geographic isolation of hot spots. No, that doesn't mean tractor trailers carrying goods can't get through, but non-essential coming/going is temporarily halted.
G) Keep bending the curve until regular community spread isn't just low, but "zero." (as in the cases of New Zealand, China, etc).
That's what you do.
Since, given the current state of US politics and culture (everything is political; large percentages of Americans evince contempt for the public sector as a whole and consider every rule or mandate -- no matter how necessary or reasonable -- an egregious, Marxist assault on the constitution, etc) nothing like the above seems remotely possible, I'd say the best we can hope for is that next pandemic features a virus that, like SARS-CoV-2, doesn't kill a very high percentage of those infected. Because the United States very clearly has become the sick man of the developed world. I wish I were writing this in jest.
Forgot to mention masks and social distancing. These two issues seem to be relatively controversial, understandably so. Pretty clearly public messaging (and in the early days, scientific community understanding) has been muddled. I think it's clear that masks are helpful, but the inaccurate communication regarding their use turned them into it into political thing early on (maybe in America that was somewhat inevitable, but I do believe better messaging could have made this less so, and in fairness other countries haven't been immune to these controversies). Anyway, this public messaging should communicate that:
1) It's generally fine not to wear a mask outdoors or at home.
2) We mainly need them in crowded (primarily indoor) conditions.
3) The biggest benefit derived is a communal one (they're of limited efficacy for protecting the individual from virus-hazardous environments).
4) So, something along the lines of: "We all protect each other if we mask up indoors." Short and to the point. (No, I'm not very good at coming up with catchy slogans. People who know how to do this sort of thing would no doubt come up with something more compelling). Which would hopefully minimize the judgment some endured for going maskless outdoors. (I think it's fine to wear masks outdoors out of an abundance of caution if conditions are truly crowded, I should add).
5) Anyway, one other point I wanted to make is: mask wearing could likely have been sold as a policy to end lockdowns more quickly. IIRC here in China the actual countrywide lockdown was pretty brief, at least outside of Hubei. Only three weeks, I think. Society's goal shouldn't be to endure long, tedious lockdowns, but rather to avoid such a state of affairs, by nipping the outbreak in the bud fast enough so that any lockdown can be limited in duration.
The actual solution is simple!
Go HARD into a lockdown and require ALL people entering the country to have 2 weeks quarantine
That plus a decent tracking system could have saved the USA an absolute fortune and 500,000 deaths
That is what we did here (NZ) - and we have
A GREATER population density (most people live in cities)
MORE foreign travel (20 million people a year when our population is 5 million)
If you have a president who actually believe in addressing problems, intelligently and based on science, there is no end of difference. We didn't back when with the former guy who had his head up his fundament and contemptuously refused to take any responsibility or coherent action.
If there's a fire, do you want a 5-year old or an intelligent adult doing the response? Things could be very different now.
The first thing we would do, I hope, is to try to contain the disease in China and not allow it to become a world-wide pandemic in the first place. Yes, that's a “having a President not named Trump” thing, but it's clearly a policy thing as well. You have people on the ground in China to give you a heads up without relying on the Chinese authorities (who may be reluctant to pass negative information up the chain). And you have the President call the Chinese Premiere and say in essence that, “We know you have a problem, and it's in our mutual interest to solve it.”
James Fallows’ June 2020 article The 3 Weeks That Changed Everything goes into more depth.
There are several things I agree with
I would point out that this was a NOVEL coronavirus. By the time we knew about it - it was already spreading - and with many people being asymptomatic they COULD have been carriers w/o anyone knowing it. With a long time between exposure to the virus and onset of symptoms (if you had ANY) we were behind the proverbial 8 ball. Here in NC we traced back an outbreak to, of all things a pharmaceutical conference in Boston that multiple people from NC attended.
By the time the Trump administrations incompetence became apparent it was already too late. We had Jared in charge of ventilators, several doctors involved in messaging and a failed real estate investor injecting his 2 cents worth at every opportunity- with the SOLE intent - of minimizing the damage done to his reputation - which only made things worse.........
"Novel's just another word for... intentional ChiCom bioterror lableak..."
-- Jon Stewart Liebowitz, channeling Janis Joplin
One of the things that we need to do in the future is keep an open mind
Too many people dismissed the aerosol component of COVID - and instead concentrated on the droplet sized particles. Whether that is wrong or right is immaterial - if SOME scientists hadn't played it down we may have had a better response at an earlier time.
PPE should be stock piled. I am quite pleased that I still see many wearing masks. I still wear one in stores. I have not had a cold nor the flu in over 2 years. I DID catch COVID and had a mild case.
As for testing and treatment? First, it needs to be free and available - and THAT needs to be pushed real hard. I fought for 6 months with a medical facility in my town over my testing costs. It should have been covered by Medicare. The Mrs test - done at the same time, in the same room, by the same physician was paid for with no problem. Because I have Tricare, and state government retiree health care in addition to medicate - my bill got lost in the cauldron of co-ordinated benefits. I FINALLY got someone to listen by saying "Look, I am not supposed to pay anything out of pocket for this. My wife and I had the same test, same day same Doc same room and Medicare paid hers in full but because I have 3 different insurances I have out of pocket expenses? Are you guys trying to shake me down"? The woman I spoke to said "Oh I see the problem your bill was coded differently than your wife's was. Medicare SHOULD have paid 100% so it should have been coded the same."
Finally - all stats regarding future pandemics - should be collected and published without regard to "politics". In other words - take it out of the control of the governors and let the chips fall where they may. Almost ALL the recent deaths are by people who did not get vaccinated for whatever reason. I don't want to force a vaccine on a person but at least tell us how many are sick, or dead.
We fell behind but made up ground quickly regarding development of the vaccines. I'm sure there's some streamlining that could have shortened the time frame some, but when you are injecting something into a body I would rather err on the side of safety than not
We can best prepare for a new epidemic by spending 100% of our time focusing on whether Sars-cov2 was a Chinese plot.
It is all about preparedness. The success of Asian countries--who were prepared after going through SARS--shows that pretty convincingly.
So:
- Maintain AT ALL TIMES a reserve of medical equipment (PPE, masks for the public, needles, syringes, ventilators (highly infectious diseases are most often respiratory), hospital beds, also of consumer items that become scarce in the situation (e.g. toilet paper).
- Keep a contract trace/test/isolate infrastructure alive. An app alone does not suffice. Ergo: Staff for the job must be trained and available for call up on short notice. Hotels must be evaluated as to potential as quarantine facilities (ventilation / AC) and commandeered if necessary (hotels suffer in pandemics; mandated quarantines would actually help the industry survive). Isolation for positive tests must be mandatory and enforced by the government. But isolated people must also be compensated for the sacrifice they make for the community (beyond free hotel stay, free meals and free medical attention). Obviously this requires legislation.
- Ensure that essential items are manufactured in sufficient quantity in the country. Not only does that help us; it helps the rest of the world if the US does not buy up any reserves available anywhere. The extra cost is a wise investment IMO.
Personally I would also wish for legislation that prevents profiteering from a pandemic--or from any other catastrophe. The bidding wars among states for ventilators and PPE should never happen again!
I agree with Kevin. There is no sign that even the competent administration we have right now (nobody knows for how long) does any work in any of these directions. Nobody would expect Congress to get active on this in the first place. So: Next time it will be just as bad as COVID. Or worse. COVID, bad as it is, is far from the worst possible virus.