Medical Health Cluster

30 abril, 2023

Experts trace flawed U.S. covid response and how to fix it

The director of the 9/11 Commission sought a congressional probe. Lawmakers never called, so he and a group of experts offered their own assessment.

Three years into the pandemic, America has reached — at best — an uneasy stalemate with covid: more than 1 million deaths, an exhausted health-care workforce, and a backlash that weakened public health officials’ power to fight the next outbreak.

And while most people have moved on, the virus remains on pace to be a top-10 cause of death again this year.

Breaking through this miasma comes “Lessons From the Covid War: An Investigative Report,” from 34 experts promising a “dispassionate guide” to the increasingly overheated arguments about the pandemic. The brisk analysis, published by Public Affairs on Tuesday, explores America’s myriad failures responding to the current outbreak and what it must do to prepare for the next one.

One quality that separates this book from dozens of other pandemic works is its unusual origin: Its authors first assembled two years ago, anticipating that Congress or the president would empower a 9/11-style commission to probe the virus response.

But the call never came, and the experts instead pivoted to this report, which offers lucid insights into how the United States relied on a creaky and fragmented public health infrastructure to combat the virus — limitations that transcended any single administration or agency. The book also synthesizes existing Trump-era memoirs and draws on the expertise of its co-authors, known as “the covid crisis group,” who include physicians, epidemiologists and former senior government officials. Philip Zelikow, former executive director of the 9/11 Commission, oversaw the effort.

The goal was “to provide a sketch of the overall crisis,” Zelikow, a University of Virginia history professor, said in a recent interview. Zelikow described how the book’s experts split into groups to tackle major issues, ranging from breakdowns in the domestic response, to the challenges with global vaccine distribution and rollout.

In its effort to be nonpartisan, the group often waves away the unique chaos and mistakes by President Donald Trump and his deputies that hamstrung the United States in the first year of the crisis. And with no subpoena power or congressional staff behind them, the book falls short of the authors’ ambitions.

“We cannot offer the kind of exhaustive investigative report that a Covid commission might have produced,” the authors acknowledge upfront.

What “Lessons From the Covid War” does do is trace the root causes of America’s pandemic dysfunction, such as how the rise of local health departments to fight cholera in the 1800s helped create a disorganized system that persists to this day — and is desperately in need of streamlining, strengthening and centralized leadership.

“The United States faced a twenty-first-century challenge with a system designed for nineteenth-century threats,” the authors conclude.

The book takes repeated aim at the Centers for Disease Control and Prevention for its academic culture, which the experts say contributed to the agency’s slow decisions on school reopening guidance and warnings about the virus’ spread.

“The CDC had some of the most technically gifted experts in the world. Yet the culture of the organization, emphasizing certainty before action, resulted in paralysis” on whether to warn about the spread of covid by aerosolized particles, the authors write, criticizing the agency’s too-late acknowledgment, for instance, that the virus could travel far longer distances than six feet.

The book also cuts through partisan grandstanding to offer some fresh perspectives. For instance, a March 2020 effort led by then-White House senior adviser Jared Kushner to secure emergency supplies — widely mocked in the media and by Democrats — “plainly offered some help,” the covid crisis group acknowledges, although with the caveat that Kushner’s involvement “added confusion” to the crowded and often chaotic government effort.

In seeking to rise above politics, however, the book goes too far to minimize Trump’s role — reducing him to a “comorbidity” in America’s pandemic response — despite acknowledging his own numerous mistakes, from constructing a team riven by internal feuds, to his repeated decisions to put politics ahead of public health.

For instance, Trump’s loud and visible resistance to masking sent a signal that politicized the issue of face coverings and hampered local responses. “In the face of public opposition from the leader of their own party, it was very difficult for state and local Republican officials to require masks,” the authors write about the breakdown of protective measures.

On another page, they describe the Trump administration’s failure to organize coronavirus testing in workplaces and schools, which fueled anxiety about reopenings and led to missed diagnoses and viral spread. “What was missing was a strong, clear, written articulation of a national strategy for how to use antigen or PCR tests for workplaces and schools … it should have been ready by the fall of 2020,” the authors write. “The Biden administration finally designed such a comprehensive program, which it deployed in the first months of 2022.”

The book also excuses Trump officials’ decision to ignore a “pandemic playbook” left by the Obama administration — a decision guide that instructed officials to begin ordering personal protective equipment and making other preparations for an outbreak once certain conditions were met. While those conditions were triggered in January 2020, Trump’s government “did not start really trying to mobilize fully until about two months later, and even then in a haphazard way,” the authors write.

“Lessons from the Covid War” sidesteps some other issues. The book devotes just two pages to a section on “the rise of misinformation and disinformation,” which many experts tie to widespread loss of confidence in vaccines, treatments and protective measures. That fallout goes beyond the response just to covid: The Pan American Health Organization warned last week that the risk of preventable disease outbreaks in the Americas has reached a 30-year high because of lack of vaccine uptake, partly due to misinformation spread during the pandemic.

Among the book’s strengths are its expert contributors: Michael Callahan and James Lawler, infectious-disease physicians who deployed to the virus-stricken Diamond Princess cruise ship in the earliest days of the crisis; John Barry, who wrote the history of the 1918 flu outbreak that Trump officials nervously studied as covid cases began to soar; Charity Dean, the former California public health official who became a protagonist of another pandemic-era book, “The Premonition,” by Michael Lewis.

But a book billed as the most comprehensive look yet at the pandemic response feels, definitionally, like only a partial retelling of the fight against a virus that continues to kill hundreds of Americans daily. There’s no resolution on the origins of SARS-CoV-2. There’s no blockbuster exposé waiting in its narrative, in large part because it relies on others’ reporting and memoirs. Framed as a retelling of “the Covid War,” the book also makes scores of analogies between military conflicts and the medical response to the pandemic — comparisons that sometimes seem tortured, and that its authors acknowledge may not ring true to the “combatants” on the “covid frontline battlefields.”

And it inadvertently illustrates what might have been learned with the broad powers of a government-backed commission.

The 9/11 commission — focused on tracing the events that led to that tragic day — interviewed more than 1,200 people, including key officials like then-Secretary of State Colin Powell, Defense Secretary Donald H. Rumsfeld and CIA Director George Tenet, who sat for interviews under oath. There were a dozen public hearings. While those authors acknowledged the 9/11 commission faced setbacks and roadblocks, the report’s scope and scoops helped it have immediate and long-lasting impact.

The covid crisis group — trying to tackle the systemic breakdowns that pushed American casualties so high — held listening sessions with about 300 people. But numerous key officials across both the Trump and Biden administrations did not sit for interviews, including many who told The Washington Post they weren’t contacted. The notable omissions include former Trump Health and Human Services Secretary Alex Azar and Vice President Mike Pence, who took turns leading the White House coronavirus task force in 2020; Deborah Birx and Jeff Zients, who served as the nation’s first two covid coordinators; and more than a dozen other officials who helped set up key efforts, such as Trump’s Operation Warp Speed vaccine accelerator and Biden’s vaccine-focused response.

While that means the covid book lacks some sweep, it arrives as officials are being exhorted to patch the health system’s holes. The Government Accountability Office, a nonpartisan watchdog, reiterated on April 20 that the Health and Human Services department remains on its “high-risk” list for its potential to botch the next crisis. The agency “must improve its leadership and coordination of public health emergencies to save lives, mitigate severe economic impacts, and prepare the nation to respond,” GAO warned.

“Lessons From the Covid War” offers some advice on where those federal health leaders might focus. It suggests HHS install a new “undersecretary for health security” who would oversee CDC and other relevant offices, to “orchestrate real strategies to contain an outbreak and design, produce, distribute, and deploy the tool kits of countermeasures to help communities defend themselves.” It reiterates calls for better data systems, faster vaccine manufacturing and other investments that would speed future virus responses.

But amid the covid exhaustion of those health leaders, and of the public, it’s not clear whether the book’s calls will be heeded. Meanwhile, the story of this pandemic has still not been fully told — and with no signs of a government-sanctioned covid commission, it may never be.


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