6 Lessons From Previous Pandemics

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Originally published on blog of Union of Concerned Scientists.
by , director, Center for Science & Democracy

Like many people, I have been reading a lot about the outbreak of COVID-19 around the world and doing my best to take precautions with the best information provided to me. And even more so since I and all my colleagues at UCS are working from home. After all, we follow the science. And the scientific evidence, clearly presented by the World Health Organization (WHO), is that this is a global pandemic. Not China, not Italy, global.

Map courtesy Johns Hopkins University & Medicine

But this isn’t the first public health emergency (or epidemic). It didn’t “blindside” us. Though, it is the first with the Trump administration running our federal government. Previous outbreaks of SARS, MERS, Ebola, and flu all taught us a lot about how to mitigate the damage if only we can heed the lessons. Here are six I have gleaned from my reading.

Science-led preparedness

As each epidemic has occurred, data have accumulated on not just what works to slow its course or reduce the death toll, but also how to prepare. And these data have resulted in a WHO comprehensive planning guide for COVID-19 that countries can use to be as ready as possible. Some of the steps are to ensure that technical resources can quickly be mobilized to address the outbreak and that a high-level task force is in place, led by experts.

Unfortunately, as has been widely reported, we actually had some of these mechanisms in place, but they were already dismantled by the Trump Administration. A lesson ignored.

Act quickly, following the science

A global pandemic is a clear case where a precautionary approach is needed. Most important is acting even if the information is uncertain, because the possible consequences of not acting are dire. Taiwan and Singapore acted very quickly and in a precautionary manner, rolling out a range of measures as early signs in China were evident.

President Trump has repeatedly boasted about his decision to “close the borders” as a step that can keep us safe. But the evidence that COVID-19 infections are now seen in every state — now with more than 4200 cases nationally and climbing — would indicate that that measure, taken on January 29, didn’t stop the spread of the virus. US citizens and residents returning home were not precluded from travel, of course, nor should they be. Perhaps more importantly, there was no real screening or testing of returning residents, as was conducted in Taiwan and Singapore, and no provision for quarantine even if symptoms were obvious. But that is exactly what a science-based precautionary approach calls for.

Test, test, test early and often

The problem of not quickly implementing a testing protocol has been very well documented. Other nations have testing procedures, and Americans rightly want to know why we are still only slowly rolling out our own. That’s partly because the WHO test was not adopted by the US. But it is also because the decisions about who should be tested were confusing and inconsistent.

Testing isn’t just to identify those who already have the virus, but also to understand its spread and transmission rates. This virus is highly contagious and the numbers of cases seems to be increasing exponentially. That matters in how we address the pandemic.

Availability of testing is further confounded by affordability. Like citizenship, the virus doesn’t care about your wallet. Anyone can be a carrier and prolong the infection, and there is no greater or lesser likelihood depending on income. Or whether you are citizen, resident or undocumented. None of that matters. Even though the virus is already here, and virtually everywhere, testing still needs to be provided equitably so that we aren’t flying blind. The administration has promised free testing. Let’s hope that comes true soon.

The president has touted a new proposal to set up drive-through testing (no mention about what happens if you don’t have a car or take the bus), but it isn’t in place yet and only pertains to those with symptoms. But what if you are a carrier, or in a household with others who are sick? We need wide-scale testing at all levels that occurs repeatedly and frequently. Much of that effort can be simply checking temperature. Everywhere, everyday. But the vice president’s task force hasn’t yet learned that lesson either.

Think globally, act locally

Health services are delivered locally, and most of the action will be at the town or neighborhood level. But localities can’t be left on their own to figure it out. Federal and state governments are deeply involved with expertise and resources that no locality can manage. And that all needs to be coordinated nationally, as well as internationally. WHO guidance and the experience of previous pandemics such as the swine flu make that clear. President Obama quickly declared a National Health Emergency when swine flu became a pandemic, but still a lot of people died. It would have clearly been far worse without international cooperation and national coordination.

President Trump on Friday declared a National Health Emergency. A bit late. And rather than build on the lessons from the swine flu experience, he chose to make it a political moment to criticize his predecessor. And, while President Obama worked closely with the WHO and other nations, President Trump seems to be driving us farther away from partners by implementing measures including travel bans without consultation with our closest allies.

For a global pandemic, we need a global response. Even if localities are given clearer guidance, and that has yet to happen, they can’t solve it — we as a nation can’t solve it alone.

Counter misinformation

There is a flood of information on COVID-19 just now. But misinformation is unfortunately a big part of the problem we face in confronting the pandemic. As WHO points out, clear authoritative technical information is needed that the general public can access, understand, believe, and rely on. Perhaps we have become inured to the President making things up and outright lying and pass it off as “just the way he is” and “he says what he thinks.” But in this emergency, that’s directly contrary to the lessons learned in previous epidemics, and it has already created confusion and differences regarding how seriously different populations are taking this pandemic.

Despite administration statements from the podium, there is no real evidence that this will disappear quickly. In fact, from other cases, the most likely scenario is a drop off, then a resurgence in the fall or winter. But even that isn’t sure.

And no, everyone who wants a test can’t get one. Neither is it the case that we have plenty of capacity to treat patients. Or that this is a “foreign” disease.

Part of the problem is that there are a lot of “official” statements made by those who don’t know what they are talking about. Other than Dr. Fauci, who has been straightforward and clear, few other people taking a microphone have any scientific training or expertise in infectious disease. Other health officials can’t release information without permission from the White House, and then stand by frustrated as misinformation spreads. And classifying information doesn’t help, it hurts.

What we really need are regular briefings directly from experts, free from politics, that tell people what they need to know. How fast is the contagion spreading? What should people do if there is an opportunity for testing? Who is your first point of contact if you feel ill? How can you ensure you are not shut out because of lack of insurance or money? How can you access resources if you need to stay home? How can you get help? These are not political questions, but they are part of maintaining a functioning society in a crisis.

Being inclusive is not just about fairness, it is life and death

Whatever measures we can take to slow the spread of the virus, stop its resurgence, treat the sick, and get our nation back on its feet must include everyone – young, old, rich, poor, employed, unemployed, hourly worker, CEO, white collar, blue collar, documented, undocumented. None of that matters to the virus and therefore to stopping it.

Health care access must be for everyone or testing will be incomplete, treatment will be insufficient, and the consequences will be worse.

Many workers should stay home if they are ill or have been exposed, their children are home, their elderly relatives need care, whatever. And they need to be paid so that they don’t HAVE to go to work. And those who must go to work, for example emergency responders and health care workers, must have support at home. If they do, we all benefit.

Interesting that of the CEOs who stood with the President on the stage on Friday to pledge their support, four of them (Walmart, Target, Walgreens, CVS) combined have 651,000 employees that are not eligible for paid sick leave. Rather than offering parking lot space for testing, they should support their workers and their families.

Stay strong

This is a scary and uncertain time. People will fall ill, the economy will slow, and our systems will hopefully not be strained beyond capacity. Or maybe the worst won’t happen, and we will come through faster and with less loss of life and livelihood than initially thought. If the latter, it will be because we have learned our lessons, and turned them to action. In our homes, communities and in the government.

And because we don’t turn against each other. Make no mistake, I am hoping as hard as I can that the Trump Administration will lead us through this crisis with minimum negative consequences. I will do whatever I can as an individual and as an employee of the Union of Concerned Scientists to mitigate the impacts of this pandemic. That means following the rules and guidance, helping my colleagues, neighbors, and family, and providing good information whenever we can. As well as calling out changes in course that are urgently needed. We all need to be informed and share accurate information when we can. Everyone, stay strong.

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