By Richard Skolnik
Los Alamos

A Day to Remember – with Sadness

The US hit a tragic milestone today – 300,000 deaths due to COVID-19. This is about 75 percent of the number of American military personnel killed in World War II. Yet, it did not have to be this way.

How did this happen in the US?

The Chinese did fail to transparently provide in a timely manner all of the information they had about an emerging infectious disease.

However, this cannot be an excuse for America’s failure to suppress the virus. A number of countries, such as Australia, New Zealand, S. Korea, Taiwan, Thailand, and Vietnam, for example, had the same information that we had at the exact same time. However, they still managed to mostly suppress the virus. 

I want to suggest below several of the most important reasons for why the virus has so badly defeated us to date.

Weak and slow response – The federal and many state governments ignored early information about the outbreak and were slow to respond to it. The federal administration was also very reluctant to use the Defense Production Act, even as there were major shortages of PPEs. In addition, the federal government basically left procurement of needed equipment and supplies to a free for all among the states. Moreover, the quality of the response to the virus varied dramatically across states.

Poor quality messaging, the politicization of the outbreak and the muzzling of science – The federal government’s messaging and that of many states, as well, was late, inconsistent, and often scientifically wrong. The federal government and many state governments put politics over science. The federal government took numerous steps to muzzle science, including having political actors vet CDC’s renowned Morbidity and Mortality Weekly Report.  

The decimation of CDC – The federal government sidelined CDC, which made made some early and some continuous mistakes of considerable importance. The CDC director showed a dramatic lack of scientific integrity and managerial competence.

Failure to focus on suppression of the virus – The federal government for months has basically put a large share of its eggs into the vaccine basket and largely ignored, mishandled, or spoken out against other aspects of a public health response to reducing transmission of the virus. The same can be said of many state governments.

 So, where is the virus going?

There is every indication that the number of infections and deaths will continue to increase in the coming months, fueled by fatigue, Thanksgiving, Christmas, and inappropriate policy choices at both the federal level and the level of some states. We will not be able to suppress the virus anytime soon. It will be many months and lots of good luck with complicated vaccine implementation before a large enough share of the US population is vaccinated that we can begin to return to a more “normal life”.

Did it have to be this way?

Some high-income countries do have higher rates of death from COVID-19 than we have. However, we have 3 times the rate of Canada, more than 45 times the rate of Japan, more than 80 times the rate in S. Korea, and more than 180 times the rate of New Zealand. In addition, large Asian countries like Vietnam and Thailand have had almost no deaths. No, it did not have to be this way. What happened is largely the result of failures of commitment, policies, and action.

So, what can we do now?

My guess is that President Trump will ignore the virus in the next month, that much of the Trump administration will focus on vaccines, but that CDC will begin to speak up as if it actually had a voice.

My guess is that we will make some progress on vaccines before inauguration, but not as much as the administration promised.

Rather, most of the work in addressing the outbreak will fall to the Biden administration, which I hope will focus on the following:

Messaging – They need to engage in consistent and clear messaging, based on science, which focuses on actions needed now. They also need to build trust in the vaccines that emerge.

Diagnostics, drugs, and vaccines – They need to strengthen the transparency of Operation Warp Speed and be sure that cost-effective vaccines that are easy to store and distribute will be produced and used. They also need to ensure that decisions on diagnostics, drugs, and vaccines are made solely on the basis of evidence that is transparently communicated to the public.

CDC – CDC needs to be resurrected. The new administration needs to replace the CDC Director with a well-regarded person of exceptional scientific integrity, as they have already announced they would do.  

Specific Measures to Fight COVID – Of course, the administration will also need to take a range of specific measures to address COVID, including: enacting a mask mandate for federal facilities, invoking the Defense Production Act to produce PPEs and tests, and entering into advance market commitments for items needed in the future. They also need to promote more selective lockdowns when needed by focusing on what the epidemiology says and on the need to keep schools open when that can be done safely. I also hope they will launch a universal test program, along the lines recommended by Professor Mina at Harvard. This would focus on repeated at-home testing with inexpensive tests that get mailed to everyone over and over again, until we have suppressed the virus. This would be coupled with financial incentives for isolation and quarantine and greatly enhanced backwards and forward contact tracing.

Global Cooperation – The US cannot be safe as long as the virus is circulating elsewhere. Thus, it will also be important for the US to join COVAX and do what it can to get vaccines distributed globally at affordable prices. We also need to rejoin the World Health Organization and help WHO get over its “sovereignty burden” and structural constraints on its budget.

Editor’s note: This column is based largely on comments Richard Skolnik made in an invited talk Dec. 7, 2020 to the Sarasota World Affairs Council.

Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.