Preparing for future pandemics: Learning from Covid-19

Taking stock of what went wrong in the US response to the Covid-19 pandemic can help the nation better prepare for the next global health emergency. With the official “emergency” over, Knowable Magazine looked back at the many lessons we heard from experts from throughout the pandemic — many of which still haven’t been acted upon. From the need for a more robust disease surveillance system to moving away from the idea that nations are isolated from health threats that arise on other continents, scientists discuss a number of shifts that must happen if the nation is to be ready for another massive outbreak of an emerging infectious disease.

Key takeaways from the interviews include:

• We need to expect the emergence of new diseases that jump to humans from animals. People play a role through climate change, habitat destruction and closer interactions with wildlife.
• Public health emergencies need to be viewed as potentially destructive as natural disasters such as wildfire, hurricanes and floods. And the response needs to be as swift.
• No one should underestimate a new emerging disease. Officials need to be frank about its potential threat and open about what’s still unknown.
• The US can and should learn from other countries, many of which have more experience identifying and controlling emerging infectious diseases through strong surveillance and testing regimes.
• Public health measures are not focused on an individual, they are meant to prevent illness and reduce spread of disease within a community. It’s not just about one person but many.
• Pandemic responses must be balanced with respect for individual liberty in a democracy, which can make it harder to control the spread of infection. Communities need to work together to figure out the right balance.
• Establishing and maintaining trust with the public is a key part of any disease response. Misinformation and disinformation about the pandemic have serious repercussions on the population’s health and need to be addressed.
• Education is a key part of preparing for a pandemic and more could be done in schools to introduce students to the science of how diseases emerge and spread.
• Individuals have a lot of power to help curb disease outbreaks.

This video is part of  Reset: The Science of Crisis & Recovery, a series exploring how the world is navigating the coronavirus pandemic, its consequences and the way forward. Reset is supported by a grant from the Alfred P. Sloan Foundation. Watch more videos from Knowable Magazine.

Transcript

Apoorva Mandavilli (science and health reporter, the New York Times): I think this pandemic and the climate change that we’re seeing right now should really serve as a wake-up call to all of us that this world has changed.

WHO official: The magnitude of this [monkeypox] outbreak poses a real risk.

Apoorva Mandavilli: We are going to see more zoonotic viruses, because people live in such close proximity to animals now, and there’s so many more opportunities for viruses to jump back and forth between humans and animals. And throw into that, this mix of climate change, warming climates everywhere. Infectious diseases are going to be a bigger problem, right along with all the environmental problems we’re going to see. So we really need to prepare and plan for a future that includes a lot of other bad surprises like this one.

Jonna Mazet (epidemiologist and disease ecologist, University of California, Davis): I think that if everyone had jumped in really early and vigilantly — like we do for wildfires and other kinds of disasters — we would’ve gotten it under control and wouldn’t still be sitting in these circumstances that we’re in now.

President Donald Trump: I mean, view this the same as the flu. I really think, Doctor, you want to treat this like you treat the flu, right? And it’s going to be fine.

William Hanage (epidemiologist, Harvard T.H. Chan School of Public Health): Unfortunately, there was a real tendency to compare this with flu, which has had a number of damaging effects. For a start, the most recent flu pandemic was H1N1, which was a pandemic, killed lots and lots of people, but was nowhere near this scale. So people understand it in the wrong way then. It is not the flu, and yet for reasons that I do not understand, there have been some throughout the pandemic who have been working really, really hard to minimize it, to pretend that it isn’t as bad as it is. There was also a tendency, even among some infectious disease professionals, to say that this would fade away, it would be like SARS. And the public health consequences of that have been what you’ve seen. They have been dreadful. And they’re still going on even as we’re talking now.

Anthony Fauci: I hope we are still learning a very important lesson from Covid, is that you never ever underestimate an emerging infection in which you don’t know where it’s going.

Global responses: Lessons to learn

Andrew Lo (economist and professor of finance, MIT Sloan School of Management): The United States is at the top of the list in the number of Covid-related deaths, but we’re certainly not the most populous country on the planet. We spend more money per capita on health care than virtually any other country in the world. So we’re going to have to answer a lot of very difficult questions about what we did right and what we did wrong.

Newscaster: The Democratic Republic of Congo announced that it was facing an outbreak of Ebola.

Jonna Mazet: In the US and other really highly developed countries, we have a convenient arrogance. We see these tragic diseases happening elsewhere and we think, “Oh, well, that’s because they don’t have a good public health system” or “They don’t have the health insurance and doctors that I have.” I don’t think that’s true, actually, and this one proves it.

They may have the perfect storm for more spillover events in those other places, and so they see more disease on a regular basis, more mystery disease, more fevers of unknown origin, so they’re more likely to jump in and investigate than we are here.

Pardis Sabeti (computational geneticist, Harvard University): A lot of us knew that the US wasn’t prepared for anything like this. Our public health systems were just not up to the challenge, and I’d seen that during the Ebola outbreak. Our response to the Ebola outbreak nationally was not great. We didn’t have diagnostics in most states. The first cases were misdiagnosed. We bumbled a lot. We haven’t locked in and said, “Oh, this is actually our problem. It’s something we need to solve.”

Apoorva Mandavilli: One very big lesson from this pandemic is that we don’t really have good systems in place to know when there’s a new pathogen that’s circulating, and to be able to alert people.

Jonna Mazet: Our system is very good for known diseases. It has almost no resilience for emerging diseases. When you go to the doctor with a fever, do they investigate that fever? Or do they say, “It’s not the usual suspects, go home and rest. Get plenty of fluids. You should be better. If not, come back and see me.” So that’s our attitude here, because we feel like we’ve controlled so many of the diseases, and we feel like the world is separated into places that are really developed and places that don’t have the infrastructure to take care of their people. And I’m here to tell you, we are one global community. And if we don’t learn from this tragedy that we are connected to every other person in the world — I can get to any other person in the world in 48 hours. So if that’s the case, then we are one community. And we need to care about what’s going on in DRC, in China, if we’re going to protect ourselves.

Apoorva Mandavilli: One thing this has told us is that the world is so interconnected that we can’t just take care of surveillance in our own country and forget about everywhere else. If there is something that is brewing somewhere else, it is going to come here. So the world needs to come together to figure out how to alert each other to an emerging pathogen. Can’t just be left up to the World Health Organization, which these days is underfunded and really quite beholden to the US and China. We need so much more surveillance on an international scale.

Pardis Sabeti: Some of the places that have had the greatest, best response are places in Africa and Asia. They don’t have the kind of hubris that we do in the United States to feel as if we are impervious to this kind of thing. They understand the threat of infectious diseases. They’re much more trained. They’re much more thoughtful to this. They were poised and more ready for a response. Where in the US, this is really the first thing we’ve experienced in most of our lifetimes like this. It just showed. It showed.

William Hanage: So the United States is suffering this massive death toll despite the fact it spends a huge amount of money on health care. The thing is that public health is somewhat different from the sort of individual health. It’s not an individualistic thing at all. What we [public health workers] do is we think about prevention. We try to think of ways in which we are able to avoid people getting sick in the first place. We try and think of ways in which we can avoid transmission. That’s what this game is about. And the inability to think about that in those terms has been really difficult, has been really problematic for the US. There are other countries which have had pretty bad responses, but the capita mortality is still nowhere near what it is in some states of the US. So that is the thing which is truly remarkable. It is that inaction which is so difficult to comprehend.

Pardis Sabeti: Viruses expose and exploit the cracks in our society, and so whatever the problems were before, they’re just going to be heightened. And so we had racial injustice — it’s going to, you’re going to double down during an outbreak. We had sort of issues with trust in our leadership — you’re just going to double down. And we had perverse capitalism, capitalistic incentives — they got outrageous. This is everything that is wrong in your society is just going to be through a magnifying glass in this kind of a circumstance. An outbreak is a crucible where you have all of these different forces collectively coming together to create sort of a very toxic culture that we call outbreak culture.

And in order to overcome it, you have to first recognize that that’s the case. It’s something that will happen and it’s OK to get crazy during an outbreak, but then to commit to altruism and commit to cooperation and to bring your best self to every interaction, because you realize that the virus thrives with this misbehavior.

The more we fight amongst ourselves, the easier it is for the virus to get out. One way or another. Maybe at first you stop [it], but then at some point these breakdowns happen, and we’ve seen it again and again. Every time we see a breakdown in our society, the virus thrives.

Anthony Fauci: Go to Rand Paul website and you see “Fire Dr. Fauci” with a little box that says, “Contribute here.” So the only thing you…

Senator Rand Paul: You have politically attacked your colleagues…

Pardis Sabeti: These are not uniquely American problems, but you do realize it’s worse here. I mean, we’ve done really poorly. We have a lot of bureaucracy. We have a lot of self-focused kind of behaviors, and so you put those all together and I think we are the least well-positioned in that regard.

Andrew Lo: One issue that I think we do have to acknowledge is the fact that our form of government may actually contribute to these kinds of issues. So that’s a question that we’re going to have to answer. I don’t have the answer. It’s not even just an economic question. It’s a moral, ethical, cultural, political set of questions that we have to deal with, about how in the situation of a pandemic, we as a country can come together to impose rules and regulations to minimize the number of deaths, while at the same time respecting everybody’s liberty.

Establishing trust: Media and science

Jonna Mazet: If you have the community with you and willing to mask and vaccinate and all of those things, you can have much better outcomes than many places where there was no pre-communication, no pre-planning, no pre-establishment of trust.

William Hanage: It’s kind of Pandemic 101, that you maintain confidence from the public, and trust in the information that they’re getting, and you have to earn that trust. It’s not something which you can take for granted. Now, what actually happened in the United States and other places — but the United States, in particular — is that that information became suddenly political. Whether or not you thought the virus was a problem became a badge of identity rather than a matter of scientific fact. And the people who have been trying to supply that information, they ended up being subjects of misinformation, basically — and misinformation which is still going on. I think that the social media companies, the Facebooks and the Twitters of the world, they bear a strong degree of responsibility for that kind of thing. And, as I keep saying, it’s not over yet.

Jonna Mazet: We need the whole world to come together and recognize that there are big unknowns that are existential threats to us, and we cause them, and we have the power to fix them, but only if we actually acknowledge them and work on them.

Pardis Sabeti: The interesting thing about an infectious disease is unlike any other existential threat to humanity, every single person matters. And because one person can launch a pandemic, one person can stop it. And so there was an opportunity to go out to the people and say, “You matter. Let’s get you prepared. OK, every single person, let’s go. OK? This is how diagnostic works. This is how contact tracing works.”

When are we ever going to get kids to understand genomics or diagnostics? This should have been… If I was the secretary of education, I would’ve said, “You know what? We’re scrapping all lesson plans this year. Lesson Plan 101 is figure out everything we can about an outbreak. Kids, let’s do this.” Group project, right? Because you have to know history. You have to know public health. You have to know mathematics, epidemiology, clinical medicine. We could have taught them a range of skills that would’ve prepared them, and we would’ve had them participate with us to identify cases to support each other.

And you also have to teach sociology and care and mental health, like every single thing we would’ve done. If it was my opportunity to make that, is to just make that the challenge and make it be a group collective project. And ultimately when the stakes are high and when it’s personal, it’s where all the brain cells turn on. And to me, it was just a real waste that we didn’t engage students around the country. And we didn’t do this thing where we say, “Let’s figure out how to do this and how to create circles of protection, how to protect Grandma and your community and your church.” I mean, that was sort of for me the opportunity that was lost.

Jonna Mazet: I worry that we keep thinking about the next surge and then the next influenza, and we should, but we can’t sit on our laurels while we do that and not think about disease X — the next one. We have five of these a year happening and they just don’t get out of control. If we don’t get ready for the next one to be way worse, more deadly, and more transmissible, if we let ourselves not be ready for that, the consequences will be much, much more severe even than this.

If we do nothing and just say, “Wow, that was terrible.” Human nature again — our enemy here. “I don’t want to think about that anymore. That was terrible. I just need a break. I need to get on with our lives.” And we’re seeing that even in our public health agencies and government counterparts. “Let’s just get back to business then, then we’ll think about that later.” We’re just sitting ducks for the next one.

William Hanage: When you consider that the evolution of the virus is going to be happening all the time, I think it’s easy to see that we’re not out of the woods yet and we’re not going to be out of the woods for quite some time. Exactly how long? That’s up to us on how we handle the virus.

Jonna Mazet: The biggest obstacle to keeping us safe is our own desire to put this in the rear-view mirror. Human behavior and the way that we have evolved our systems is what’s in the way, and it’s no small task to break down those silos and to find all the virus, but it absolutely can be done. And we are the people — I mean, all of us watching this are the people — who can make that happen, because we say we care and we want to be protected.