Was Covid-19 A Failure Of Policy Or A Failure Of Information? – Forbes

Non-pharmaceutical interventions were critical to the control of Covid-19 prior to the development ... [+] of vaccines.

Reasonable people disagree, but my opinion is that the Covid-19 epidemic in the US, which has taken at least 592,000 and possibly as many as 900,000 American lives to date, was avoidable.

It is inevitable that new infectious diseases will emerge. What will be essential in the future is to prevent them from becoming as widespread in the population as Covid-19 has become.

I was asked earlier today if I think the failure to prevent the Covid-19 epidemic in the US was a failure of policy or a failure of information.

The answer is neitherand both. The question implies a binary answer, but we need to stop thinking of infectious disease intelligence and mitigation this way.

Yes, the Covid-19 epidemic in the US was partly a failure of policy. There was a tremendous lack of coordination both in the US and internationally that could have been prevented. There was a 69-page pandemic playbook developed in 2016 by the Presidents Council of Advisors on Science and Technology, but it wasnt used.

Perhaps part of the reason that our policy was ineffective was that we delayed taking action because we did not fully understand the virus we were up against. This could be viewed as a failure of information. Certainly, we did not have timely information during the early phases of transmission. But to say the fault lies here is mere finger-pointing. Complete information is never available during crises and if our society requires complete information to take action we will be routinely overwhelmed. The fog of war is just as real in epidemics as it is in wars against human adversaries.

What is needed is a paradigm for decision-making under uncertainty. Such frameworks are not unfamiliar. They already underlie national intelligence assessments and virtually all actuarial analysis. A plethora of conceptual frameworks exist for such decision making, including maximization of expected future value, robust optimization, info-gap decision theory, and adaptive management.

In addition to learning from Covid-19, we must learn from near misses as well. And there have been several.

In 2009, a new strain of influenza A originating in North America caused a worldwide pandemic. We were lucky that this particular strain wasnt nearly as lethal as some of the avian influenza viruses that are also considered to have pandemic potential.

In the introduction to an after action report titled 2009 H1N1 Influenza Improvement Plan, former United States Secretary of Health and Human Services Kathleen Sebelius

Kathleen Sebelius at the Aspen Institute on June 26, 2015

noted that preparedness is a process, not an end-state. The US experience with Covid-19 (and the experience of much of the rest of the world as well), seems to suggest that we have forgotten this fact.

The report goes on to say, euphemistically:

The real-world test of the 2009 H1N1 response provided valuable insight into the scope of previous planning and emphasized the need for continued planning and implementation efforts that focus on a broad range of scenarios, including differing severity levels.

Given the near complete failure to mitigate the 2009 flu pandemic, this statement translates we werent ready and wed better be much more prepared next time.

The 2009 experience is particularly pertinent because the transmission of influenza is very similar to that of SARS-CoV-2, the virus that causes Covid-19, and the playbook of interventions is virtually identical.

Not all pandemics are respiratory illnesses, and we should not let our imaginations fail us just because flu and Covid-19 have been our primary experiences. The US probably only avoided widespread transmission of Zika virus because the mosquito species that is most competent to transmit Zika, the yellow fever mosquito Aedes aegypti, is relatively rare in the continental US. Its only coincidence that its close relative, the much more common Asian tiger mosquito (Aedes albopictus), is relatively less effective at transmission.

An Asian tiger mosquito, Aedes albopictus. The species is capable of transmitting Zika virus, but is ... [+] not nearly as effective as its relative the yellow fever mosquito, Aedes aegypti.

Similarly, the introduction of Ebola into the US in 2014 showed that US hospitals werent prepared to widely implement the infection control procedures needed to combat an epidemic of that disease. If Ebola had been as transmissible and fast moving as Covid-19, those introductions would have been catastrophic.

Even though in a crisis decisions must be made under conditions of uncertainty, reducing that uncertainty is equally a critical task. This points to the value of information. Reducing uncertainty in a crisis requires real time data collection and real time research. Some critical questions that were still open early in the Covid-19 pandemic included

As we answered these questions we improved our ability to strategically intervene in the transmission process. But early lack of answers should not have delayed intervention as much as it did. In the future, answering questions like these quickly and unequivocally will be essential for rapid containment, but equally important will be the ability to act deliberately even when the intelligence is incomplete.

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Was Covid-19 A Failure Of Policy Or A Failure Of Information? - Forbes