Q&A: Chronicling the failures of the U.S. response to Covid

Excerpt – “Lessons From the Covid War: An Investigative Report,” which will be published Tuesday, was written by a consortium of scientific and public health experts, many intimately involved in the pandemic response. The group’s members originally came together to do the spade work for what they thought would be an eventual independent commission tasked with investigating the response to Covid. That inquiry, which they thought would mirror the well-regarded 9/11 Commission, never came into being. So the Covid Crisis Group, as they call themselves, have published their analysis of what went wrong and what needs to be done to fix it. [..]

The group’s members note, for instance, that in the first two years of the pandemic, U.S. excess mortality — deaths over and above what would normally be expected — was 40% higher than what European countries experienced. Spain, they wrote, performed 50% better than Florida in preventing premature deaths among its citizens.

[..] STAT spoke separately to two of the group’s members: Philip Zelikow, executive director of the 9/11 Commission, a history professor at the University of Virginia, and the person who “held the pen”; and Carter Mecher, a former senior medical adviser in the Department of Veterans Affairs who served as director of medical preparedness policy in the George W. Bush administration.

[STAT] I remember when I first read Albert Crosby’s book on the 1918 Spanish flu, “America’s Forgotten Pandemic.” It struck me as so inconceivable that people could have forgotten an event of that magnitude. But having come through Covid, and now watching how quickly people are trying to put it in the rearview mirror, maybe it’s easier to understand?

[Mercher] That’s one of the things that has surprised me through this pandemic, our reaction to mass death. I think back to the headline in the New York Times in late May of 2020, when we surpassed the threshold of 100,000 deaths in the United States, and the headline was “An Incalculable Loss.” Well, since May of 2020, we’ve had 10 more incalculable losses. I think it’s become almost numbing.

I think these large numbers, they lose all sense of meaning. And that’s been the most surprising thing to me is how we pretty much have gotten to a point where we just shrug our shoulders at these types of numbers.

[STAT] The report says that the members of your group are “angry” because Americans were let down. My overwhelming reaction to reading this report was a sense of … almost despair.

Some of the problems it identifies don’t seem like they can be fixed. The disconnect between chronically under-funded public health operations and private health care delivery. The country’s data collection quagmire. Do you see reason for hope that there’s a commitment to try to learn from the mistakes of the Covid response?

[Zelikow] It’s funny you have that reaction. I was talking with a member of our group last week and she said that she was re-reading the report, and she said she found that really encouraging and empowering. She said: “It’s impossible to read the report and not see all this stuff we could do.”

Let’s take the data problem, for instance. A lot of the data we need actually is already being collected. The private health care system actually has really first-class data systems that are proprietary data. And there are ways to anonymize it for privacy purposes. But it’s awkward for them to share their proprietary information with their competitors or with their regulators.

This is not a new problem for our government. It’s come up in a couple of places, like electric utilities and civil aviation, where airlines and aircraft companies want to share safety information or technical information, but they need a safe way to do that. So they create nonprofit intermediaries that do the data sharing.

So what we propose, for example, is you create an intermediary that then pools all this data and then in turn helps provide inputs for a network that we think probably the Centers for Disease Control and Prevention should run. [..]

[STAT] What were the worst mistakes the U.S. made?

[Mecher] I think one of the biggest mistakes early on was the time it took to recognize the threat that we faced, and the amount of time it took for us to get on a war footing. And so we spent January and February, when it was clear that this was moving pretty quickly, and this was a significant event, to really get on a war footing and to get moving.

I think what made things even worse was what happened with our testing. The problems with our testing just meant that during that period of time we really were flying blind.

[Zelikow] We were unprepared to do stuff. Everybody knows the story is the CDC botched the test. But even if the CDC test had been perfect, we still would have had the testing calamity. And even if we had had a lot of tests, we still would have screwed up because we had no idea what to do with them.

Should we use the test for biomedical surveillance? Should we use the tests to create 3,000 drive-thru testing centers? Should we use the test to set up point-of-care testing in nursing homes? Should we use them to help us reopen schools? And then how many tests do we need for each of these functions, deployed with what protocols? We didn’t do any of that.

Everybody has it in their heads that the CDC screwed up. But the deep problem is that we actually weren’t really ready to enact a testing program because we had no strategy for what to do even if we had the tests. [..]

[STAT] People seem to have cast this pandemic as the equivalent of a 100-year storm, which implies we have decades before we’re going to have to face another biological threat as serious as Covid. That’s a dangerous assumption.

I would think the best time to make progress towards being better prepared for the next time is while the event is fresh in people’s minds. Is your group worried this opportunity is being squandered?

[Mercher] The book refers to a cycle of panic and neglect. That we go through panic, and then we kind of blot it from our minds, and we move on. There’s always that risk.

[Zelikow] That’s why this report is in your hands. That fear. That’s why we produced it on such a crash basis. People said to us “Why, don’t you wait till this whole thing is over, and then do this in a laborious way, and this will come out in 2026 and it’ll be really thorough and careful?”

We’re in our window now, for just the reasons you articulated. And if we miss this window, shame on us.”

Full article, H Branswell, STAT News, 2023.4.24