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PUBLIC HEALTH

|November 20, 2020

The peak of America’s first wave of coronavirus—which at the time seemed like a mountain but now looks like a molehill—arrived on April 24, 2020. At that time, we had seen, in graphic detail, what the emerging pandemic could do to an unprepared nation. Stories from Italy spotlighted a blindsided population confronting 6,000 new cases per day. Hospitals ran out of empty beds and physicians were forced to choose who received care and who didn’t based on hunches about who was most likely to survive. Without any viable treatments, the chaotic situation came under some semblance of control only after strict lockdown measures took effect.

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life during pandemic

Based on how we have handled the current pandemic, it’s hard to make rosy predictions about how we’ll handle the next one.

Despite this advance knowledge, the United States balked, leaving decisions on whether to implement lockdowns to individual state governments. On March 26, we became the world leader in confirmed coronavirus cases. Just over 2 weeks later, the United States became the world leader in coronavirus deaths. We haven’t given up either position since.

Still, we’ve managed to uncover some silver linings amid this longstanding tragedy. We’re on the brink of several promising treatments. The pandemic has catalyzed new innovations in healthcare, tech, and business. And we’ve identified the many faults in our pandemic response.

But the rising cases and death counts make it clear: We haven’t yet fixed our pandemic response yet. Despite everything we’ve learned, this pandemic’s worst days might still be ahead of us. So how prepared are we to face them, and how has this pandemic prepared us for the next one, which is certain to come someday?

Leadership

As the US faces harrowing new highs this fall, it appears that lockdown measures will be enforced less strictly than they were in the spring. Though the new administration promises to enact the nation’s first official plan to curb the virus, members of President-elect Joe Biden’s COVID-19 Advisory Board are pushing back against the idea of a nationwide lockdown. Instead, they’re focusing on targeted measures like universal mask-wearing and local restrictions on socializing, which some governors have already put in place.

Regardless of who’s holding the political steering wheel in the future, it’s important that they defer to an independent, nonpartisan “Pandemic Review Commission”—one that will be responsible for delivering an objective, apolitical assessment of the strengths and weaknesses of our COVID-19 response, noted David Blumenthal and Elizabeth Fowler in Harvard Business Review.

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Cultural competence

Leadership can make a big difference, but precedence indicates that compliance with government directives will remain spotty no matter who’s in office. Any decisions made at the federal, state, or local level will likely be met with considerable population-level resistance, especially if they contradict each other, as they have in the past.

This is illustrated by the fact that, in the face of more than a quarter million deaths and 100,000 new cases every day, 25% of Americans continue to believe there is at least some truth to the conspiracy that COVID-19 was planned, nearly one-third believe the virus’s death toll is inflated, and roughly 30% say they sometimes, rarely, or never adhere to mask-wearing guidelines.

In order to prepare for the next pandemic, Americans need to know who they can trust for reliable information about preventing the spread of disease. That source of information must deliver a consistent, unifying, non-partisan message and be elevated consistently across influential platforms, from media outlets and scientists to local leaders.

Financial security

In the early months of the pandemic, many businesses ground to a halt. Unemployment rates soared to 14.7%, the worst since the Great Depression. The Trump administration responded by passing the CARES Act, a $2 trillion stimulus package that expanded unemployment benefits and issued $1,200 checks to those who qualified, plus extra for married couples and children. As infections began to fall, many governors eased lockdown restrictions, which allowed some people to get back to work.

The unemployment rate has since dropped to 6.9%, but many businesses remain shuttered and millions remain out of work. As a result, protests against lockdowns have occurred in nearly every state, which may play a part in exacerbating infections. It’s unclear when or if additional government financial support will arrive.

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Michael Osterholm, PhD, MPH,  an epidemiologist and a newly appointed coronavirus advisor to the Biden administration, has voiced his support for paying American workers to stay home for 4 to 6 weeks, a strategy used by Denmark. Before the next pandemic, a clear strategy for financial support should be put in place that disincentivizes behaviors that can spread disease.

Medicine and supplies

Months into the pandemic, problems with the US Strategic National Stockpile remain. Though PPE shortages have fallen from headlines, these critical supplies are still scarce.

To avoid such shortages, the FDA recently developed a list of 223 essential medicines and medical countermeasures to be stockpiled for future public health emergencies like the coronavirus pandemic. The list includes first-line antibiotics, antivirals, analgesics, steroids, sedatives, and many others. Ninety-six medical devices were also added to the list, including diagnostic kits, personal protective equipment (PPE), and ventilators.

The FDA’s list was developed in response to an executive order from the White House intended to protect the United States against “outbreaks of emerging infectious diseases and chemical, biological, radiological, and nuclear threats.” However, it’s not clear whether this measure will result in any action to improve our COVID-19 response.

What’s next?

Judging by our handling of the coronavirus pandemic, it would be naïve to make rosy predictions about how we might handle the next one. As we approach 1 year since the virus hit our shores, millions remain out of work, doctors are burning out in extreme numbers, cases have never been higher, and political division has made unification behind preventive measures seem impossible.

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But it’s not all doom and gloom. If 2020 has taught us anything, it’s that anything can happen. A new vaccine may be available within weeks. Roughly 75% of Americans support a mask mandate. A new federal plan may mobilize better resources. There’s plenty of hope for the future—especially if we unify to defeat the coronavirus pandemic in the present.

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