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Despite partisan divides, pretty much everyone agrees that America’s leaders made mistakes during the pandemic.
Now, a group of more than 30 heavy-hitting experts from the worlds of policy, public health, science, biodefense and patient advocacy has written a book reviewing some of those errors and making suggestions for avoiding similar ones in the future.
The book “Lessons from the COVID War,” published Tuesday, is deliberate in its use of military metaphors. While COVID should have been attacked like a foreign invasion, too often, the nation’s leaders were absent from the battlefield, they argue.
Group members held “listening sessions” with nearly 300 people and in the absence of a federal commission on the topic, they felt a duty to speak out about what they found.
While data suggests the world remains extremely vulnerable to another pandemic, only 12% of Americans think their government is doing enough to prepare, according to a poll of 1,000 residents released earlier this month by YouGov, funded by the education charity Rhodes Trust.
To get a deeper sense of what they found and what they think needs to be done to prevent a repeat, USA TODAY spoke with two of the COVID Crisis Group members:
- the book’s primary author, Philip Zelikow, who also is the group’s director and former 9/11 Commission executive director
- Dr. Mark McClellan, who ran the Food and Drug Administration and then the Centers for Medicare and Medicaid Services during the George W. Bush Administration
Here’s what they said.
This interview has been edited and condensed. Find a full list of the crisis group members and their expertise at the end of this article.
What made you want to join this project and book-writing effort?
McClellan: “This process is so important right now. Taking a good, honest look with an eye toward the future. Not so much about complaining, but about what could have gone better and making sure it doesn’t happen again. I’m not sure we’ve learned those lessons yet.”
Are we any better positioned now than we were in January 2020 to fight another pandemic?
Zelikow: “Everybody got a sense of how well they thought institutions were performing in the crisis. Generally, everyone’s going to tell you: not good. Do you notice any really big things that have been done to fix the not good? No.
“Both of those fundamental perceptions are correct and our report details why.”
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Briefly, what’s the answer to why?
Zelikow: “We went into a 21st century pandemic with a 19th century system. We’ve come out of that pandemic essentially retaining the 19th century structure.”
What do you think were some of the biggest failures of the pandemic?
McClellan: “I think the big thing was not having systems in place, public health, health care, etc., that were well prepared for the kind of war we can fight now against new infections.
“The science available to address a new pathogen like COVID has changed enormously – the ability to develop tests and treatments and vaccines at a pace never before seen in the history of pandemics. We saw heroic activities by health care organizations (and) hospitals all across the country to try to respond to the threats of infection and serious illnesses. That was a remarkable achievement of American health care.
“What we were less good at was taking the steps in health care that could have prevented it. Health care and public health need to work together for an effective response in the 21st century.
“We’ve got effective treatments now for COVID. We shouldn’t still be seeing 250 deaths a day. We haven’t taken those extra steps to connect those amazing biomedical capabilities to getting it to the front lines.”
Zelikow: “The most palpable area was schools. There’s hardly an American family that doesn’t have an opinion on that. At its root, the (Centers for Disease Control and Prevention) was asked to make very practical judgements, including weighing costs and benefits about school closures, that it was utterly unsuited to make.
“Everyone wants schools to reopen. The issue is how to do it and what kinds of tradeoffs we would accept? If you don’t address those issues usefully, you have nothing to say. The result was paralysis.
“Why are closing our schools twice as much as (Europe and Israel)? They were practical and operationally-minded people who did the trade-offs, worked out toolkits and then implemented them. We did none of those things.”
Do you have a sense of why?
Zelikow: “We tried to answer the crisis with books and money. This person is having a heart attack in your front yard and you run to help. You don’t know what to do. Someone says ‘I have this book on emergency medicine.’ Someone else writes you a $10,000 check. We came to this crisis throwing people books and checks. The failure in the crisis that people sense is that the institutions were not fully operational and didn’t know what to do.
“The reason institutions were weak was because we hadn’t organized to do emergency operations. We didn’t have that kind of preparedness, but a number of other countries did and then therefore did way better than us in every respect, including retaining the confidence of the people.”
You mention America’s lack of data and data-sharing as one of the big problems. What do you mean by that?
McClellan: “Public health data systems are just out of date. There are over 300 local, territorial public health offices that don’t communicate well with CDC, let alone with health care responders. There are interoperable systems on the health care side, but we haven’t brought those to bear for working with public health and being systematic about being able to know when there are new cases being reported somewhere, rapidly connecting that to a local and federal response system with accurate data.
“Then you’ve got a much better ability to understand where federal resources need to go, how is the threat spreading, what seems to be working.
“We were flying blind with all of that in the early months of COVID.”
Do you think people still care about COVID at this point?
McClellan: “People are understandably fatigued with COVID. Everyone’s ready to go on. There’s not really much bipartisan political interest in doing a deep dive. That’s going to make it hard implement, or take a fresh look at what kind of investments are needed to have health security in the country. Hopefully the book will help with that.
“We’re not that good at tracking or being accountable for public health threats in peace time, which makes it hard to gear up in war time.”
How concerned should people be that there might be another global pandemic in our lifestimes?
Zelikow: “Some academics have been doing work recently to try to estimate the probability of a COVID-like outbreak. They all think the odds are like 20-30-40% in the next 10 years. That’s a really substantial number.”
In some ways this is profoundly depressing. Is there any room for hope?
Zelikow: We hope “people will read the book in a way that’s reassuring, because you can really see human stuff that people can do to fix things. This is not some impossibly hard job.
“Prevention is hardest, but there are some fairly concrete things we can do that could make us much more prepared.
“The inability to see that and fatalism is what sets us up to be slaughtered the next time.”
Who is the COVID Crisis Group?
Here’s a look at members of the COVID Crisis Group and their affiliations:
- Danielle Allen, director of Edmond and Lily Safra Center for Ethics, Harvard University
- John Barry, historian and author of “The Great Influenza: The Story of the Deadliest Pandemic in History” (2004)
- John Bridgeland, co-founder and CEO of COVID Collaborative and former director of the White House Domestic Policy Council for President George W. Bush
- Dr. Michael Callahan, staff physician and director of clinical translation and mass casualty therapeutics at Massachusetts General Hospital
- Dr. Nicholas Christakis, author of “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live” (2020), and director of the Human Nature Lab at Yale University
- Doug Criscitello, former executive director of MIT Golub Center for Finance and Policy and former CFO of U.S. Department of Housing and Urban Development and the U.S. Small Business Administration
- Charity Dean, CEO and founder of The Public Health Company and former assistant director of California Department of Public Health
- Dr. Victor Dzau, president of the National Academy of Medicine
- Gary Edson, president of COVID Collaborative and former deputy national security advisor and deputy national economic advisor to President George W. Bush
- Dr. Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at University of Pennsylvania
- Ruth Faden, founder and professor at the Berman Institute of Bioethics at Johns Hopkins University
- Baruch Fischhoff, University Professor at the Institute for Politics and Strategy at Carnegie Mellon University
- Dr. Margaret “Peggy” Hamburg, former FDA commissioner
- Melissa Harvey, assistant vice president at HCA Healthcare
- Dr. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations
- Dr. David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine
- Kendall Hoyt, assistant professor at the Geisel School of Medicine, senior lecturer at the Thayer School of Engineering, and faculty director of the Pandemic Security Project at the Dickey Center, at Dartmouth College
- Andrew Kilianski, senior director at the International AIDS Vaccine Initiative
- Dr. James Lawler, professor of medicine at the University of Nebraska Medical Center
- Dr. Alexander Lazar, professor of Pathology & Genomic Medicine at The University of Texas MD Anderson Cancer Center
- James Le Duc, former director of Galveston National Laboratory and adjunct professor of microbiology and immunology at the University of Texas Medical Branch at Galveston
- Marc Lipsitch, director of the Center for Communicable Disease Dynamics at T.H. Chan School of Public Health, Harvard University
- Anup Malani, professor at the University of Chicago Law School and Pritzker School of Medicine, University of Chicago
- Monique Mansoura, executive director for Global Health Security and Biotechnology at The MITRE Corporation
- Dr. Mark McClellan, former FDA commissioner, former CMS administrator and director of the Duke-Margolis Center for Health Policy, Duke University
- Dr. Carter Mecher, medical advisor at The Public Health Company and former senior medical advisor at the Office of Public Health, U.S. Department of Veterans Affairs
- Michael Osterholm, director of the Center for Infectious Disease Research and Policy, University of Minnesota
- Dr. David Relman, professor and senior fellow at the Freeman Spogli Institute for International Studies at Stanford University
- Dr. Robert Rodriguez, professor of emergency medicine at the University of California, San Francisco School of Medicine
- Carl Schramm, university professor at Syracuse University
- Dr. Emily Silverman, assistant volunteer professor of medicine at UCSF School of Medicine and founder/host of The Nocturnists
- Kristin Urquiza, co-founder of Marked By COVID
- Dr. Rajeev Venkayya, CEO of Aerium Therapeutics and former special assistant to the president for biodefense
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