Much has gone wrong during the coronavirus pandemic as the virus tore through a polarized nation and public health leaders, policymakers and elected officials struggled to respond.
Chronic underinvestment in public health at the federal, state and local levels has only made matters worse. In total, more than 1.1 million people have died from Covid-19 in the United States, and more than 1,000 are still dying every week.
More than three years after the Trump administration declared the virus a public health emergency in January 2020, the government’s response to the pandemic is now entering a new phase. On Thursday, the Biden administration allow the emergency declaration to expireoffering a moment to take stock of how the nation has responded to the worst public health crisis in a century.
Here are some lessons from the country’s fight against the virus.
Get the right message.
Public health experts say that when managing an infectious disease outbreak, communication is not part of the response. He East the answer.
The coronavirus pandemic has shown that confusing messaging can worsen the spread of disease and erode trust in public health institutions. But messaging during a pandemic is tricky business. Science changes often, sometimes day by day, and guidance from public health officials — to mask or not to mask? — must also change, which can create confusion and a lack of trust.
The key, experts say, is for public health officials to bring their audience with them by explaining that the advice they give today may change tomorrow – and then acknowledging that what they said yesterday was possibly fake.
“When you’re in daily conversation with the public, you can explain those mistakes, what you learned from them,” said Dr. Richard E. Besser, former acting director of the Centers for Disease Control and Prevention during the the Obama administration. “You can own them.”
Facilitate data sharing.
The CDC has been crippled during the pandemic by outdated data systems and inconsistent data sharing between the federal government, the states and health care providers. And unlike Britain and Israel, which have national health systems, the United States has no mechanism for the free flow of data between public health agencies and private providers.
Responding to a rapidly changing virus that poses different risks to different populations requires better and faster data, experts said.
“We were in the awkward position of having to call the UK and Israel or South Africa to find out what was going on – how many people were infected with this new infection, what variant was it,” Dr Anthony said. S. Fauci. , who helped lead the response to the pandemic under the Trump and Biden administrations. “How many people were getting vaccinated and what was the effect of that data? We literally had to wait months instead of getting it in real time.
Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, cited school closings as an example where real-time data would have helped.
Some variants of coronavirus were more deadly for children than others, he said, adding that if officials had had access to timely data on the effects of the virus on children, they might have been able to adapt. school closures when students were most at risk.
“We need instant data to know what’s going on,” said Dr. Osterholm, who advised President Biden’s transition team. “And as conditions change, we have to change.”
Think carefully about school closures.
School closures have been a particularly controversial topic, but many experts now agree that some schools have been closed for too long and millions of children have been abruptly removed from American classrooms. had harmful effects on their emotional and intellectual health.
Dr. Fauci and Dr. Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania, said the pandemic has shown officials need to think carefully about school closures and limit them as much as possible. as possible. The two said better indoor air circulation could be a way to keep schools open safely.
“One of the things we’ve learned is that we’ve had schools closed for much longer than other countries, and we’ve had this terrible impact on educational attainment and we’ve seen the test results drop,” said Dr. Emanuel, who also advised Mr. Biden’s transition team.
Dr Fauci said that at the start of the pandemic, “at a time when hospitals were literally a day or two away from being overrun”, the closure of public places like restaurants, bars and schools was important for keep health systems functioning by slowing the spread of the virus.
“But once you put the brakes on the acceleration,” he said, “then you really have to look at how we keep kids in school safe.”
Stock up on vital supplies.
During the first months of the pandemic, frontline health workers had to deal with dramatic supply shortagesforcing them to reuse face masks, wear ill-fitting personal protective equipment or go without such equipment altogether.
Since then, the federal government has significantly expanded its stockpile of pandemic supplies, giving it a head start in responding to another devastating wave of coronavirus or another viral outbreak that would require similar resources.
Prior to the pandemic, government purchases for the National Strategic Stock were heavily skewed towards protect against bioterrorist agents like anthrax. In March 2020, the stock had 13 million N95 masks. At the start of this month, it had 352 million. During the same period, the number of ventilators has increased from 12,700 to around 150,000.
Invest in vaccines early.
As a model for responding to future pandemics, experts cite Operation Warp Speed, the Trump administration’s coronavirus vaccine development program. initiative brought effective vaccines to Americans in record time — in part, Dr. Fauci said, because the federal government had spent years investing in basic scientific research.
Federal Warp Speed program officials made huge bulk purchases of blueprints that were still in development. The federal government has funded or supported clinical trials conducted by Moderna and Pfizer, the makers of the two widely used coronavirus injections. And he has lent his expertise to companies with clinical trial specialists, epidemiologists and budget experts.
Set up large randomized trials quickly.
The first treatments for the virus such as hydroxychloroquine and convalescent plasma were authorized by the Food and Drug Administration without solid data from large randomized controlled trials – considered the gold standard of evidence used by regulators to authorize the medicines and vaccines.
Treatment trials stalled due to lack of funding or participants. Scientists, doctors and federal regulators relied on foreign data, such as a UK study of dexamethasonea steroid used to treat Covid-19.
“Britain has set up large randomized trials with very loose entry criteria, thousands of patients,” Dr Emanuel said. “Within 30 to 60 days, we learned that steroids actually saved people who were hospitalized or very sick.”
Dr. Walid F. Gellad, a drug safety expert at the University of Pittsburgh, pointed out an ongoing trial conducted by British researchers who he said would soon provide results on the effectiveness of Paxlovid, Pfizer’s antiviral drug for Covid-19 that is widely used in the United States.
“We didn’t have the infrastructure to collect the data we needed to make decisions,” he said of the US response to the pandemic.
But don’t rely solely on vaccines.
Vaccines have proven to be the most effective bulwark against hospitalizations and deaths from Covid-19. But the focus on vaccination has often overshadowed efforts to develop and deliver treatments, public health experts have said. Antibody drugs essential for immunocompromised Americans are no longer cleared for use by the FDA, and experts say more antiviral drugs are needed.
The Biden administration has focused heavily on rolling out recalls, which have had fewer and fewer takers since a first round was authorized in fall 2021. But other strategies intended to prevent the spread of the viruses, such as improving indoor air quality, have received relatively modest attention.
“The myopic focus on vaccines alone to the exclusion of other areas that are really low-hanging fruit for a far superior response – it’s like saying you’re going to build a house with a wall or no roof” , said Dr. Luciana. Borio, a former acting chief scientist at the FDA who advised Mr. Biden’s transition team.