While on a tour of the Centers for Disease Control and Prevention (CDC) last week, a reporter asked President Donald Trump why the White House shuttered its office of pandemic preparedness in 2018. Trump responded, “I just think this is something … that you can never really think is going to happen.” He was referring to the ongoing global spread of the new coronavirus.
In contrast, Anthony Fauci, the longtime director of the federal National Institute of Allergy and Infectious Diseases, told Congress this week that, “It would be nice if the office were still there,” and that COVID-19, the disease caused by the new strain of coronavirus, is an estimated “10 times more lethal than the seasonal flu.”
Leaving aside that the previous existence of that preparedness office shows that some in government had indeed thought a pandemic could happen, the coronavirus outbreak makes it clear that the government needs to communicate clearly, operate transparently, and have the necessary resources and well-developed plans in place.
Without these elements and a sense of urgency from the White House, the government cannot respond early and effectively to contain outbreaks, or slow their spread to prevent a pandemic from overwhelming our healthcare system. While the Trump administration took actions to curtail travel from China—where COVID-19 first appeared—in early February, the nature of global disease outbreaks is that there are rarely silver bullets, and efforts may need to be sustained and evolve over time to deal with the shifting threat.
While projections vary, many estimates of the impacts of coronavirus show it could massively tax our healthcare system and lead to hundreds of thousands of deaths, especially if measures are not taken to slow the spread of the disease. One measure is to increase social distancing—where people avoid congregating in groups where the virus could spread to many people more quickly—which many state and local governments, and private sector organizations, are beginning to do by encouraging or requiring employees to telework.
What’s happening today is not unprecedented. In 2011, the Government Accountability Office (GAO), an arm of Congress, issued a report on the lessons from the 2009 H1N1 flu, which “was the first human pandemic in over four decades.” Some estimated 89 million Americans were infected by H1N1.
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One lesson learned was that consistent and accurate federal communication is important to avoid confusion. During the early days of the H1N1 outbreak, the Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS) at times provided conflicting messages. According to the report, “at one point DHS officials were telling states that confirmation of H1N1 influenza cases needed to be completed by a laboratory, which was the initial CDC guidance, while HHS officials were telling states they could confirm H1N1 cases by laboratories or an analysis of symptoms that the patient was experiencing.”
Conflicting messages also make it harder for the public to know how serious the risks are and what to do.
Trump has been a source of inaccurate and misleading messages on the coronavirus, often at odds with government experts.
Trump said last week, “Anybody that wants a test can get a test. That’s what the bottom line is.”
But that was not and is still not true. As Senator James Lankford (R-OK) told a reporter this week, “That is not accurate right now.” Production of coronavirus tests and their distribution lags far behind the need and demand for testing. Testing is needed to determine where the infections are so that those who are infected can be treated and isolated until they can no longer transmit the disease.
In an address to the nation on Wednesday night, Trump said treatments will be available “in record time” and “will significantly reduce the impact and reach of the virus.” But earlier that day, in congressional testimony, Fauci said of an antiviral treatment being developed, “we don’t know if it works. I don’t want to promise anything.”
Trump made additional confusing and outright incorrect statements during his address Wednesday. White House officials and others have scrambled to clarify his remarks, including regarding the scope of the European travel ban. Trump also said insurance copayments for coronavirus treatment will be waived, which is not true—only copayments for testing will be waived, as a spokesperson for a health insurance industry association told Politico, and the White House subsequently confirmed. This kind of basic information shouldn’t need to be rectified by journalists talking to private sector experts.
Along with accurate, consistent, and clear messaging—which Vice President Mike Pence is officially in charge of coordinating—transparency is important. Unnecessary secrecy can engender mistrust with the public and it can inhibit experts from responding to threats. That’s why it’s so concerning to see news reports that “the White House has ordered federal health officials to treat top-level coronavirus meetings as classified,” that some confirmed infections are not being disclosed, and that a whistleblower had to file an official complaint about the lack of training and protective gear for federal health employees.
Another lesson is that relationships matter. And, most important, they can and should be developed long before a pandemic hits, partially through exercises that test the ability of federal, state, and local governments, as well as the private sector, to work together. “HHS officials said that federal coordination during the H1N1 pandemic was much easier because of these formal networks and informal relationships built during pandemic planning activities and exercises,” according to the GAO report from 2011. Homeland Security officials also said, according to the report, that “exercises offer the best opportunity—short of actual emergencies—to determine if plans are understood and work.”
These working relationships are important because plans often have to be altered to adapt to new information and developments, as assumptions based on past experiences don’t always hold. For example, whereas the H1N1 flu did not affect older Americans as severely as the young, medical experts are seeing the opposite with the coronavirus. So making flexible plans that account for a wide array of contingencies and having people who can work together quickly and make good judgment calls is key because they’re the ones who’ll have to alter plans.
People don’t get expert training and experience, or form the right working relationships, overnight. But Trump has defended budget cuts to government health agencies, saying, “I don't like having thousands of people around when you don’t need them.” He said, “when we need them, we can get them back very quickly.” That’s not how government works—at any level—and in an emergency, you need to have trained people ready to deploy with the resources they need. While it can make sense to add additional staff when an exceptional crisis demands it, even with emergency hiring authority, it still takes time. The time to hire firefighters isn’t when a fire breaks out, it’s well before. The same goes for pandemic preparedness.
Eventually, a vaccine will likely be developed, though it may be after the worst of the pandemic has passed. The Project On Government Oversight (POGO) wrote in 2008 and 2009 that the federal government needs to be transparent about its procurement of vaccines, including its plans and contracts with vaccine manufacturers and the quantities and timetable for production and distribution. As the Government Accountability Office pointed out in 2011, “The credibility of all levels of government was diminished when the amount of vaccine available to the public in October 2009 did not meet expectations set by federal officials.”
The current crisis has some unique aspects, but, again, it is not unanticipated—though preparation has been wanting. Last fall, Johns Hopkins University’s Center for Health Security issued a report on “Preparedness for a High-Impact Respiratory Pathogen Pandemic.” The report states that “preparedness for a high-impact respiratory pathogen pandemic has received little specific focus” in previous reviews on infectious disease preparation. Aside from planning for pandemic flu, “there have been few (if any) high-level reviews or recommendations focusing on the possibility of other high-impact respiratory pathogens with pandemic potential,” the report states. “While there is overlap between the systems and capabilities required to respond to any disease outbreak”—such as those mentioned here—“a high-impact respiratory pathogen poses serious additional challenges that deserve special consideration,” the report says.
In the last two decades, there have been epidemics caused by outbreaks of other strains of coronavirus: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The Johns Hopkins report lists the coronavirus group as one of a handful “most likely to be a source of pandemic-initiating pathogens.”
Although Congress has shut down public access to the U.S. Capitol for the rest of the month after a staffer for Senator Maria Cantwell (D-WA) tested positive for coronavirus, legislative oversight has an important role to play. Congress should hold hearings, virtually if necessary, on the effectiveness of the continuing response, and on short- and long-term planning. Bringing in experts from institutions such as the Johns Hopkins Center for Health Security to testify is an obvious step.
The oversight so far, such as the House Oversight and Reform Committee hearing featuring Fauci, has publicly generated credible information on the disease and what can be done to save lives and minimize the impacts of the virus. More broadly, the White House and top officials should permit health and infectious disease experts to respond to inquiries from public officials, press, and medical professionals seeking information. This is not the time for political filters or spin, but for facts.
Misinformation can spread faster than the virus, and it can inhibit the response and lead to more problems. During a pandemic, trustworthy information is a key part of the cure.