Preparing for a Worse Pandemic

It looks like the Gulf Stream will eventually collapse, leading to a climate catastrophe, but maybe it will take centuries, not months, so let’s consider a different catastrophe instead. Eric Lander, the administration’s top science adviser, explains what we need to do to avoid a much worse pandemic:

Coronavirus vaccines can end the current pandemic if enough people choose to protect themselves and their loved ones by getting vaccinated. But . . .

New infectious diseases have been emerging at an accelerating pace, and they are spreading faster.

. . . That’s why President Biden has asked Congress to fund his plan to build on current scientific progress to keep new infectious-disease threats from turning into pandemics like covid-19.

. . . For the first time in our history, we have an opportunity not just to refill our stockpiles but also to transform our capabilities. However, if we don’t start preparing now for future pandemics, the window for action will close.

Covid-19 has been a catastrophe: The toll in the United States alone is more than 614,000 lives . . . A future pandemic could be even worse — unless we take steps now.

It’s important to remember that the virus behind covid-19 is far less deadly than the 1918 influenza. The virus also belongs to a well-understood family, coronaviruses. It was possible to design vaccines within days of knowing the virus’s genetic code because 20 years of basic scientific research had revealed which protein to target and how to stabilize it. And while the current virus spins off variants, its mutation rate is slower than that of most viruses.

Unfortunately, most of the 26 families of viruses that infect humans are less well understood or harder to control. We have a great deal of work still ahead.

The development of mRNA vaccine technology — thanks to more than a decade of foresighted basic research — was a game-changer. It shortened the time needed to design and test vaccines to less than a year — far faster than for any previous vaccine. And it’s been surprisingly effective against covid-19.

Still, there’s much more to do. We don’t yet know how mRNA vaccines will perform against other viruses down the road. And when the next pandemic breaks out, we’ll want to be able to respond even faster.

Fortunately, the scientific community has been developing a bold plan to keep future viruses from becoming pandemics.

Here are a few of the goals we should shoot for:

The capability to design, test and approve safe and effective vaccines within 100 days of detecting a pandemic threat (for covid-19, that would have meant May 2020); manufacture enough doses to supply the world within 200 days; and speed vaccination campaigns by replacing sterile injections with skin patches.

Diagnostics simple and cheap enough for daily home testing to limit spread and target medical care.

Early-warning systems to spot new biological threats anywhere in the world soon after they emerge and monitor them thereafter.

We desperately need to strengthen our public health system — from expanding the workforce to modernizing labs and data systems — including to ensure that vulnerable populations are protected.

And we need to coordinate actions with our international partners, because pandemics know no borders.

These goals are ambitious, but they’re feasible — provided the work is managed with the seriousness, focus and accountability of NASA’s Apollo Program, which sent humans to the moon.

Importantly, these capabilities won’t just prepare us for future pandemics; they’ll also improve public health and medical care for infectious diseases today.

Preparing for threats is a core national responsibility. . . . The White House will put forward a detailed plan this month to ensure that the United States can fully prepare before the next outbreak. It’s hard to imagine a higher economic or human return on national investment.

How It Beat Us

If you want a deep analysis of how this country screwed up its response to Covid-19 and what we need to do better next time, read this long article by Ed Yong for The Atlantic Monthly. It’s been recommended by intelligent people. I don’t intend to read the whole thing. The first 700 words were enough (by the way, Dr. Fauci says we need to get new cases down to 10,000 a day from the current 50 or 60 thousand or else the fall is going to be very bad):

America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.

In the first half of 2020, SARS CoV 2—the new coronavirus behind the disease COVID 19—infected 10 million people around the world and killed about half a million. But few countries have been as severely hit as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID 19 cases and deaths. These numbers are estimates. The actual toll, though undoubtedly higher, is unknown, because the richest country in the world still lacks sufficient testing to accurately count its sick citizens.

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me.

Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable.

A sluggish response by a government denuded of expertise allowed the coronavirus to gain a foothold. Chronic underfunding of public health neutered the nation’s ability to prevent the pathogen’s spread. A bloated, inefficient health-care system left hospitals ill-prepared for the ensuing wave of sickness. Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable to COVID 19. The decades-long process of shredding the nation’s social safety net forced millions of essential workers in low-paying jobs to risk their life for their livelihood. The same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories during the 2020 pandemic.

The U.S. has little excuse for its inattention. In recent decades, epidemics of SARS, MERS, Ebola, H1N1 flu, Zika, and monkeypox showed the havoc that new and reemergent pathogens could wreak. Health experts, business leaders, and even middle schoolers ran simulated exercises to game out the spread of new diseases. . . . [They showed that] the U.S. was not ready for a pandemic, [sounding] warnings about the fragility of the nation’s health-care system and the slow process of creating a vaccine. But the COVID 19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS CoV 2 is something of an anti-Goldilocks virus: just bad enough in every way. Its symptoms can be severe enough to kill millions but are often mild enough to allow infections to move undetected through a population. It spreads quickly enough to overload hospitals, but slowly enough that statistics don’t spike until too late. These traits made the virus harder to control, but they also softened the pandemic’s punch. SARS CoV 2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,” Zeynep Tufekci, a sociologist at the University of North Carolina . . . asked me.

Despite its epochal effects, COVID 19 is merely a harbinger of worse plagues to come. The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us. It needs a full accounting of every recent misstep and foundational sin, every unattended weakness and unheeded warning, every festering wound and reopened scar.

In Case You’re Wondering How Prepared We Are

So far, the number of confirmed coronavirus cases in the US is low. But there are now confirmed cases in at least 32 (now 35)(now almost 50) countries. The number of new cases outside China has doubled every 5.5 days since January. 

Today, an official of the Centers for Disease Control and Prevention (CDC) said:

Ultimately, we expect we will see community spread in the United States. It’s not a question of if this will happen but when this will happen and how many people in this country will have severe illnesses.

From journalist Judd Legum of Popular Information (a site worth visiting):

In 2018, the Trump administration ousted Rear Adm. Tim Ziemer, who served as the Senior Director of Global Health Security. Ziemer was a member of the National Security Council, where he was responsible for coordinating “responses to global health emergencies and potential pandemics.” Ziemer was lauded as “one of the most quietly effective leaders in public health.” His work on malaria during the Obama administration helped save 6 million lives.

“Admiral Ziemer’s departure is deeply alarming,” Congressman Ami Bera (D-CA) said in May 2018. “Expertise like his is critical in avoiding large outbreaks.” Beth Cameron, who served on the National Security Council in the Obama administration, said that Ziemer’s ouster was “a major loss for health security, biodefense, and pandemic preparedness” and noted that it “is unclear in his absence who at the White House would be in charge of a pandemic.”

John Bolton, who was serving as Trump’s National Security Adviser at the time, did not just remove Ziemer. He decided to eliminate the position, and “the NSC’s entire global health security unit.” Bolton also forced out Tom Bossert, a highly regarded expert who was Ziemer’s counterpart at the Department of Homeland Security. “Neither the NSC nor DHS epidemic teams have been replaced,” Foreign Policy reported in January.

Trump slashed funding for the CDC’s epidemic prevention activities, forcing the agency to end its work “in 39 out of 49 countries because money is running out” in 2018. The program, which started in 2014, was designed to “help countries prevent infectious-disease threats from becoming epidemics.” Among the countries no longer included: China.

Trump has also tried to decimate funding for the U.S. Public Health Service Commissioned Corps, which is tasked with fighting the spread of disease. Congress, however, has refused to comply. So the Trump administration has simply let the group slowly atrophy, failing to replace members who quit or retire….

Who is in charge of the United States’ response to the coronavirus? You might assume it is the CDC. You would be wrong.

There were several hundred Americans aboard a cruise ship, the Diamond Princess, that experienced an outbreak of COVID-19 near Japan. The Americans were evacuated and, before they were flown home, 14 tested positive for the coronavirus. The CDC advised that these infected passengers should not be flown home with the rest of the group, arguing that they could infect the others.

The CDC, however, was overruled by the “State Department and a top Trump administration health official.” The decision was made even though to government “had already told passengers they would not be evacuated with anyone who was infected or who showed symptoms.” CDC officials were so distraught that they “demanded to be left out of the news release that explained that infected people were being flown back to the United States.”

At the moment, there is no “clear chain of command for pandemic response.”

… There are also serious problems with the system set up to identify new outbreaks.

The test developed by the CDC to detect the coronavirus has not been able to be verified as accurate by most labs. As a result, just “three of the more than 100 public health labs across the country have verified the CDC test for use.” This has “hampered CDC’s plan to screen samples collected by its national flu-surveillance network for the coronavirus.” These issues “could impede the U.S. government’s ability to detect scattered cases before they snowball into larger outbreaks”….

Inside the White House, the concern has been around how the coronavirus could impact T—-‘s reelection. Senior officials fear “a sustained outbreak could slow global markets and upend a strong U.S. economy that has been central to [his] political pitch.”

T—- has been eager to downplay the threat of the coronavirus in public, recently expressing confidence that the virus would dissipate in a few weeks when the weather gets warmer….

There is no scientific basis for [this] claim, which is based on the assumption that the coronavirus will follow the same pattern as the seasonal flu. Columbia University epidemiologist Stephen Morse called T—-‘s comments “wishful thinking” and warned against being “lulled by hopeful, but quite possibly wrong analogies.”

Unquote.

From Senator Richard Blumenthal of Connecticut:

This morning’s classified coronavirus briefing should have been made fully open to the American people—they would be as appalled & astonished as I am by the inadequacy of preparedness & prevention.

We have a president whose main concern at the moment isn’t keeping people healthy. It’s how the spread of the disease will affect him. He’s also a pathological liar who doesn’t believe in science. Maybe this won’t be so bad, but that’s how prepared we are.