It's hard to imagine a time when we were scared about another contagious disease, but in 2003, many of us working in hospital preparedness were incredibly worried about SARS. Although the number of cases was initially low, some estimates show that 10 percent of infected patients died. When my colleagues and I at the Johns Hopkins Center for Health Security mapped out what widespread transmission of a SARS-like virus could look like in the US, it was terrifying.
Thankfully, we came to learn that SARS was really contagious only when patients were very sick, not when they were asymptomatic or had mild illness. The epidemic was brought under control in about six months, with only 8,098 cases worldwide; the US had only eight patients and zero deaths. As an internist and emergency physician who focuses on preparing for pandemics, I knew that we had dodged a bullet.
I also knew we might not be so lucky in the future. So in the intervening 17 years, my colleagues and I studied the course of SARS and a later disease called MERS with an even higher fatality rate (both caused by novel coronaviruses), as well as other scary novel viruses such as Nipah, Ebola and a series of avian influenzas, to anticipate what we might encounter next.
And yet, here we are.
By the end of October, Covid-19 had infected more than 8 million people and killed more than 220,000 in the US alone — and we may still be less than halfway through the pandemic. The University of Washington's Institute for Health Metrics and Evaluation (IHME) has predicted another nearly 180,000 US deaths from October to February if current trends continue. The United States has 4 percent of the world's population but about 20 percent of the Covid-19 infections and deaths.
The country must face all the mistakes it made with Covid-19 to mitigate the effects of the next pandemic. And there will be a next one: Climate change, population growth and poor environmental policies around the world have created an age of epidemics. When I think of all the steps we should have taken, and how many deaths could have been avoided, my head spins. But some lessons are crystal-clear.
Putting Pandemic Lessons Into Practice
1) First and foremost, Americans need to embrace the fact that public health interventions such as social distancing, wearing masks and avoiding crowded indoor areas really work. The challenge, now, is to understand the relative value of each of the interventions and find ways of minimizing their disruptions to the economy and society. For instance, correctly wearing a good-quality mask can enable many activities to resume more safely and save lives — more than 60,000 between now and February, according to the IHME.
2) Infectious disease experts must also get a better understanding of the asymptomatic spread of SARS-CoV-2. If half of people can spread the virus before they show any symptoms, it becomes much more difficult to contain. We researchers have to reconsider our assumptions about asymptomatic transmission of other respiratory viruses — the adage of "stay home when you're sick" may no longer be a sufficient mitigation tactic.
3) The US government needs greater control over the medical-supply chain. We should never again have to ask providers to treat patients without proper protection. To avoid a repeat failure, let's stockpile more personal protective equipment (PPE) and rely less on just-in-time international supply chains. To make that happen, we must better monitor the national supply chain so that the government knows if there is an impending shortage and what can be done to fix it. There must be some degree of federal leverage if there are shortages, so the government can incentivize or compel businesses to increase production.
4) The US must create a high-level, permanent federal office with the authority, political power and budget to prepare for and immediately respond to catastrophic health emergencies, including pandemics. This office should be in the National Security Council, with direct access to the President, and be supported by a corresponding office in the Department of Health and Human Services. These offices would focus exclusively on preparing for and responding to disasters that are beyond the norm — those that have the potential to inflict catastrophic damage to people's health and the economy.
5) American hospitals need much more surge capacity. During the early days of the pandemic, hospitals largely made space for patients by cancelling other services, such as surgeries. This is not sustainable in the long term. Hospitals must develop strategies to add additional space, staff and supplies to truly expand their capacities, rather than just displacing other services.
6) To mitigate the effect of any infectious disease, rapid testing that provides results in hours (or even minutes), not days, would make all the difference. If such testing were widespread, the world would look very different right now: People could go to work and school, and maybe even visit relatives in nursing homes. Technology now enables new tests to be created very quickly (in days or weeks), but we need to overcome archaic and glacial bureaucratic obstacles, and we must plan for testing on a much larger scale.
7) Finally, the US suffers immensely without consistent leadership and communications. Irregular messages have led to much confusion and undermined the public's trust in health authorities and the government, just when it's most needed.
We spent nearly two decades preparing for a major pandemic, but when it came, as we knew it would, we still fumbled — and at times dropped — the ball. Let's start putting what we've learned into practice now, in time to blunt the impact of this pandemic, and before the next one hits.
Eric Toner , an internist and emergency physician, is a senior scholar with the Johns Hopkins Center for Health Security and a senior scientist in the Johns Hopkins Bloomberg School of Public Health.
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