Looking back at the U.S. response to the pandemic, many setbacks and mistakes are well-known. But a closer examination by a team of seasoned experts has brought to the surface a profoundly unsettling conclusion. The United States, once the paragon of can-do pragmatism, of successful moon shots and biomedical breakthroughs, fell down on the job in confronting the crisis. The pandemic, the experts say, revealed “a collective national incompetence in government.”
This warning comes through over and over again in “Lessons from the Covid War: An Investigative Report,” a book published Tuesday by a group of 34 specialists led by Philip Zelikow, the executive director of the 9/11 Commission and a history professor at the University of Virginia. Their verdict: “The leaders of the United States could not apply their country’s vast assets effectively enough in practice.”
Mr. Zelikow mobilized the experts to help get ready for a possible national commission on the pandemic. When Congress and the White House failed to launch a national inquiry, the experts wrote their own report. It is a compelling, disturbing account. They conclude the pandemic was not an inescapable tragedy. The United States could and should have done better.
The United States started out “with more capabilities than any other country in the world,” they note. But it ended up with 1 million dead. “The Covid war is a story of how our wondrous scientific knowledge has run far, far ahead of the organized human ability to apply that knowledge in practice.”
A year before the outbreak, in early 2019, the Department of Health and Human Services ran a set of four pandemic planning exercises, known as Crimson Contagion. The exercises assumed a new influenza virus was rising out of China, but did not spotlight the possibility of a virus spreading asymptomatically. They also assumed lockdowns and school closures would be short, failed to take into account the need to scale up testing, and assumed the government had enough medicine — 30 million doses — to treat the hypothetical flu. “In the Covid war,” the report recalls, “there were no such medicines at hand. The temporary lockdown and closures quickly and foreseeably spawned the question: If good medicines are not yet available, what should we do now?”
“The lockdowns could not be sustained,” the report says. “But leaders did not develop and communicate practical alternative strategies.”
Early on, the government went off the rails.
In February 2020, the focus was on containment, with measures such as the travel ban on China and repatriation of Americans, including those stranded on cruise ships. Emergency mobilization efforts “languished,” the report noted. There was “confusion and friction about who was in charge of what problems.” The government’s “crisis action plan” amounted to little more than jargon. “There was little in it about what people would actually do.”
On Feb. 24, 2020, President Donald Trump tweeted from India, “The Coronavirus is very much under control in the USA … Stock market starting to look very good to me!” But according to the report, that same day, the White House task force concluded “containment was failing.” It was time to shift to mitigation. The next day, a high-ranking Centers for Disease Control and Prevention official, Nancy Messonnier, announced that community spread in the United States was inevitable. The stock market dived.
“President Trump was furious,” the report recalls. He kept downplaying the danger. “It’s going to disappear,” he said on Feb. 27. “Everything is really under control,” he said Feb. 29.
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It was not. The authors of the report show, in detail, how federal crisis management “splintered by the third week of March.” HHS Secretary Alex Azar had placed the assistant secretary for preparedness and response, Robert Kadlec, in charge of the HHS effort — but at the same time, Vice President Mike Pence’s staff kicked him off the White House task force. The head of the Food and Drug Administration was not even on the task force for the first month. The CDC was “fractured into too many missions.” While some officials recognized the urgency of a crash program of testing and masks, “Kadlec had no money, no real emergency fund.”
“By late April, as a frightened and bewildered country became more and more confused about continuing business and school closures, and after some brow-raising comments at a White House briefing in which he discussed treating the virus with light, heat, or disinfectant, Trump essentially detached himself from his own government,” the report says. “He moved toward questioning and challenging what other government officials were doing.”
“The administration abdicated its wartime responsibility to lead,” they add. “It left the battlefield, and the war strategy” to the states and localities. By April, the White House chief of staff concluded the task force was “useless and broken.”
There were many other examples of dysfunction — confusion over face masks, shortages of personal protective equipment, conflict over reopening, mixed messages over boosters.
The aerosols mistake
The “most important and fundamental misjudgment” about the virus in the first months was about how it spread. Early on, the report says, both the U.S. government and World Health Organization “mistakenly assessed” that it was transmitted on surfaces or by large respiratory droplets. There were hints of aerosol transmission from the cruise ships, meatpacking plants and a stricken choir, but the initial conclusion that large respiratory droplets were the means of transmission lingered through 2020, leading to the six-foot social distancing recommendation.
The mistake centered on a calculation that was drawn from past tuberculosis research, and turned out to be misleading: an arbitrary and too-neat separation of droplets, with relatively large particles that fall to the ground, and aerosols, in which small ones hang in the air for a long period. In fact, both were present. But for many months, the misjudgment “slowed the use of one crucial tool — emphasizing the relative safety of outdoor activities and the role of air changes and ventilation.” And it fed uncertainty about the effectiveness of face masks.
The pandemic also found the United States navigating without critical information about the virus and how it was moving. “No federal agency, including the CDC, had designed or tried to build a rapid-action, interdisciplinary, systematic biomedical surveillance network,” the report says. “Such a network would show how many people were getting sick, reveal what kind of people were most vulnerable and the key risk factors, illustrate the usual course of the disease, and employ robust capabilities for genomic sequencing.” Other nations, including Britain, Israel and South Africa, used such networks.
U.S. policies were “being designed largely in the dark, reacting as people showed up in hospitals, sick and dying.” The U.S. government still had not created such a network when President Biden took office in 2021, the report says, although a pilot project was later launched at the CDC.
“Because authorities were flying blind about how the virus was spreading, many communities probably imposed social controls long before they needed to,” the report says. “Timing was hard when authorities could not track the virus spread.”
The experts call for building up “a worldwide set of early warning radars that can give enough notice of an emerging threat,” so the United States and other nations don’t have to rely on nations that “may be unwilling to sound an alarm,” as was the case with China, which covered up the spreading virus in the early weeks, allowing it to explode into a pandemic.
‘Let them down’
Even now, they note, “there is not yet any great push to fundamentally overhaul our public health or health care system.” Once again, the nation is repeating a familiar cycle of panic and neglect.
One of their major recommendations is to create a “national health security enterprise” that would better direct overall strategy from the federal level with a new undersecretary of HHS for health security. “The United States met the 21st century pandemic emergency with structures mainly built for 19th century problems,” they write. There is no U.S. national public health operational capability — practically all of it is in a patchwork quilt of states and localities, an anachronism from an earlier age. They also call for closing the “vast disconnect” between the fragmented chain of public health agencies, and the system that provides health care to people.
The United States did some things well, the experts conclude, such as the crash vaccine development and manufacturing effort, Operation Warp Speed, which was a bargain at $30 billion. But “one of the worst consequences” of the bungled response “was that Americans sensed their governance had let them down. It had let them down in performing the most fundamental task governments are expected to perform, to protect them in an emergency.”
This is a sobering, realistic assessment, one of the most important to come out of the pandemic. The nation should pay heed to it.
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