Missed opportunity to suppress the transmission of COVID-19 and save lives

“I have no desire to suffer twice, in reality, and then in retrospect.”  – Sophocles, Oedipus Rex

 After initial stumbles, the response to the COVID-19 crisis seemed straight forward. We needed to “flatten the curve,” push the virus reproduction rate (Rt) below 1.0, apply therapeutic lessons learned during late March and early April, maintain discipline as we reopened the economy, and stamp out hotspots through effective testing and contact tracing. To support the fight, we borrowed $2.2 trillion to provide a financial bridge through the end of July to offset the impact of the economy’s lockdown. We expected to reach a manageable level of risk by early August and be mostly virus-free by the fall. It would be safe for children to return to school and parents to work. In broad terms, this was the plan.

 

How did we do? In short, we squandered our initial success to “flatten the curve” and are no better off today than early April. We’re worse off! The reproduction rate (Rt) indicates that COVID-19 is a growing versus declining threat. We blew it!

 

Before the coronavirus’s resurgence, there were calls for a bi-partisan 9/11-type commission to examine what worked, what didn’t work, what we need to do better in the future, and who is accountable to make the necessary improvements. While the emergency phase will continue for the foreseeable future, the following chart provides a glimpse into the United States’ management of the crisis. In late July, new daily cases per million in the U.S. stood at 217.67, while Italy had bottomed out at 2.12, and daily deaths were 22 times the rate in Italy.

Some may argue this is not an appropriate comparison. Still, evidence of the coronavirus appeared in both countries at roughly the same time. They were largely impacted by the strain that passed through Milan. The initial response was lackluster and the early stage “spread” statistics were very similar. The trend lines mirrored each other for several weeks during March and April and then diverged. Italy “bent the curve,” while the U.S. plateaued and headed in the wrong direction in mid-June.

 

If we broaden the per capita comparison, the United States’ performance trails other developed countries. On a global basis, the U.S is ranked 10th highest in positive cases, 10th in deaths, and 20th in testing. As the rate of new cases is outstripping the rest of the world, the U.S. standing will only worsen. It is unclear how and when we’ll turn the corner.

 

When the current public health crisis ebbs, we need to examine our response to the COVID-19 pandemic and focus on preparedness for unlikely-but-dangerous future events. While there are various frameworks to guide our evaluation, the Kill Chain process provides a useful methodology to assess missed opportunities, determine corrective actions, measure progress, and ensure readiness. It brings into sharp focus the importance of threat hunting, early warning systems, zero-day efforts, hotspot identification, triage, and mitigation. The goal should be to pandemic-proof the planet by building the capability to ferret out and crush zoonotic outbreaks before they leave further economic and social devastation. We need to be ready for the “cytokine storm” that would be unleashed by the ”Big One.”

 

Eventually, a commission will be established, but the final 9/11 report’s timing suggests that a COVID-19 inquiry may not be completed until 2023. In the meantime, we wonder:

 

  • Why did the S. do so poorly in the management of this public health emergency, especially in light of its wealth and abundance of medical talent? Supposedly, we had a game plan on the shelf. Instead, we are on track to have the least successful response in the developed world. COVID-19 won. Perhaps, we ignored the Henny Pennies until it is too late. More likely, it’s the result of conflicting messages, a climate of “gotcha” politics and scapegoating in which individuals refuse to work with those across the aisle. Instead of solving problems, we jump on any sign of weakness at the expense of serving the common good.

 

  • How did a facial mask become a source of division instead of a symbol of national resolve? For some, the objection to federal mandates dates back to the founding of the U.S., with Jeffersonians arguing for limited interference from a central government. Americans don’t like being told what to do. For others, it may be the result of misinformation, coronavirus fatigue, influenza fatalism or merely a selfish disregard for their fellow citizens.

 

  • What role should the traditional and social media have played to instill a national sense of purpose to “bend the curve?” Their talent lies in organizing and managing coordinated and persistent public relations campaigns. Instead, cable commentators participate in daily broadcast versions of Calcio Fiorentino, with armchair spectators cheering for their favorite team, whether the Blues, Greens, Reds, or Whites. A lot of hot air and “told you so’s,” but a little tangible contribution towards solving the problem.

 

  • Why have businesses been more effective on a national level to cuase individuals to adhere to requirements to slow the spread? On July 15, the National Retail Federation, a top lobbying group for the retail industry, called on all retailers to create mask requirements for customers. Scientific evidence is mounting that masks matter. In the absence of political leadership, we rely on corporate America, which has a vast reach. For example,150 million individuals visit Walmart each week. As the pandemic has intensified, business in America has transformed. In a recent Axios / Harris poll, consumers overwhelmingly approve of corporate leadership in solving social and societal issues. CEOs are taking the place of our elected leaders.

 

  • Have American cultural traits of personal independence and desire for privacy hindered our response to the crisis? While we value rugged individualism, rights are not absolute. Instead, they operate on a sliding scale, with the rights of whole trumping the individual during a crisis or national need. The Supreme Court has explained that unilateral actions can be taken to promote public health and safet The next fight will center on universal vaccination. We need to invest more in civic education and supporting the elements of good citizenship.

 

Many other concerns, including leadership at the national, state, and local levels, are being adjudicated in the court of public opinion. On November 3, we’ll have the opportunity to provide our input. For now, “it’s déjà vu all over again.”

 

As we enter the redux phase to defeat the “invisible enemy”, we need to get it right. The cost is too high. In addition to the loss of life, economic turmoil, political disruption and social unrest, the impact on our youth could last a lifetime. The cost of missing school, primally in-person instruction, will affect the long-term economic well-being and mental health of our children, and the U.S. as a whole. Some models suggest that today’s crisis will have a negative impact 40 years hence. Assuming we return to normal in-person instruction by January 2021, learning loss since the beginning of the crisis could be 7 – 12 months, with the most significant impact on children who don’t have access to high-quality remote learning or a conducive learning environment. Perhaps, our school reopening plans should consider the requirement for students to repeat their grade to offset the effect of the “COVID slide.” Failure to address the learning loss will widen the academic achievement gap, deepen the economic divide in our society, and continue to fray social cohesion.

 

Each time we embark on a national priority, we turn to investors to finance our effort, with taxpayers footing the bill over time. In addition to the $2.2 trillion we borrowed earlier this year, we plan to spend another $1.1 to $3.5 trillion. The level of this investment depends on the outcome of the negotiation between the White House and Congress. The current impasse needs to be resolved before the August recess! Today, the U.S. is the largest debtor nation in the world. We need to borrow and spend wisely. What happens when investors stop funding our escapades?

 

Over the foreseeable future, we’ll continue to rely on non-pharmaceutical interventions to create safe pathways to return to school and work. It will be a period of continued learning and adaptation as we tackle issues related to this public health crisis, household fiscal stress, the dying of American businesses, and staggering state and local budget shortfalls. We’ll be threading a needle between the nation’s economic and public health. For some, maybe many, it is a time of dread as we wonder what looms around the corner. Realistically, we may need to endure another 18-months of uncertainty as we develop, license, manufacture, and distribute a vaccine. Hopefully, we can finally declare victory before the 2nd anniversary of the coronavirus outbreak in Wuhan.

 

Joe Smialowski

August 1, 2020

Follow at Twitter @joe_smialowski

Missed opportunity to suppress the transmission of COVID-19 and save lives

One thought on “Missed opportunity to suppress the transmission of COVID-19 and save lives

  • August 2, 2020 at 11:16 am
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    Excellent analysis! I hope we can marshal the will to put this behind us soon. While a vaccination could bail us out it may not be here for several years according to some epidemiologists. I also agree that we need to develop a very good strategic plan to deal with the economic consequences.

    Reply

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