Policy Lessons from Our Covid Experience

“As the country reopens, it’s important to assess how we can be better prepared to stave off such enormous economic losses during the next wave or the next epidemic. In my view, a few key policy changes will be critical.

First, expertise on pandemic-related policy and strategy should be located closer to the center of power. I believe that the type of pandemic-preparedness office (the Office of Pandemics and Emerging Threats) that now resides only in the Department of Health and Human Services (HHS) also needs to be reestablished as part of the National Security Council (NSC). [..]

Since the early 1990s, such an office has repeatedly been established after a national health scare β€” and then disbanded by the successor administration. The Biodefense and Health Security Office established during the Clinton administration was closed by President George W. Bush, reopened after the anthrax scare, closed by President Barack Obama, and then reopened after the Ebola and Zika scares, at which point the Directorate for Global Health Security and Biodefense was created.

[..] Second, in planning for unknown future epidemics, federal pandemic-preparedness officials must decide what constitutes a prudent level of supply stockpiling, with an understanding of the inevitable trade-offs between perceived readiness and the cost of equipment and supplies that we hope never to use. They should develop strategies for deploying supplies on an as-needed basis. And they should plan ways to provide surge capacity for beds, operating rooms, and trained personnel, which may involve calling on the National Guard, among other resources. Designation of particular people who will be accountable for these activities will be key to their success.

Third, when an outbreak occurs, determinations about policy and financial responses should be based on accurate epidemiologic knowledge. It is important to establish as quickly as possible who is most vulnerable to a new disease and to respond selectively, with targeted measures directed toward the most vulnerable populations. [..] We need to understand who is contracting the disease and experiencing serious consequences in order to craft an appropriate and differentiated response.

[..] Fourth, pandemic-control policies must have logically consistent components. The decision to shut down the U.S. borders to limit the entry of people carrying Covid-19, for example, required thousands of U.S. citizens to quickly reenter the United States, but no plans appeared to have been made for the safe reentry of large numbers of people through a limited number of entry ports. As a result, hundreds of people were crowded into inadequate spaces trying to get through customs and immigration. If any of them were carrying the virus, the crowding would have exacerbated the spread, with serious consequences for public health.

[..] Finally, beyond public policy, individual citizens clearly need to accept responsibility for acting in ways appropriate to fighting pandemics. [..] The refusal of some people to wear face coverings when indoors or to maintain reasonable social distances outdoors increases the burden on all of us. When a safe and effective vaccine becomes available, it will also be incumbent on all who are of an appropriate age and have no contraindications to get vaccinated.”

Full editorial, Wilensky GR. New England Journal of Medicine 2020.10.22