As the coronavirus pandemic rages on, it is important to not only deal with the present reality but also to think ahead. And on the latter score it is instructive to read the words of Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota:
What should the industrialized world be doing to prepare for the next pandemic? The simple answer: far more. … (W)hat is needed is a detailed operational blueprint for how to get a population through one to three years of a pandemic. Such a plan must involve all the key components of society.
He wrote that in 2005, two years after the SARS outbreak, four years before H1N1, seven years before MERS and, of course, 15 years before COVID-19. Yet his critique applies as much today as it did then. There needs to be greater preparation for these crises. It needs to not only be on all levels of government (and on the part of all nations), but as Osterholm wrote, among those in healthcare and law enforcement, those in the food and medical-supply industries and those in the emergency-management sector.
That his assessment applies as much now as it did in 2005 is obviously reason for alarm, especially considering experts are certain that another pandemic will strike at some point in the not-too-distant future. Particularly concerning is the prospect of “the Big One” — i.e., a pandemic comparable to that of the 1918 Spanish Flu outbreak, which is estimated to have infected between 20% and 40% of the world’s population and killed over 50 million people.
Harvard epidemiologist Marc Lipsitch told USA Today in April that he believes the COVID-19 outbreak has in fact been the Big One, calling it “the worst thing we’ve had from a public health standpoint in terms of an acute infection since 1918” and citing social disruption that is “unparalleled” since that pandemic just over a century ago.
“I hope never to see bigger,” Lipsitch said.
The grim numbers seem to support his contention. Through June 10, the World Health Organization reported that there were over 7 million confirmed cases worldwide, with over 400,000 deaths as a result of the virus. Over 1.9 million of those cases, and over 110,000 of those deaths, had occurred in the U.S.
Whatever this pandemic might be considered — we are far from discerning its full scope — the point remains that preparedness was lacking. That is the key takeaway, the lesson that needs to be applied in advance of the next pandemic.
Osterholm and Mark Olshaker wrote as much in a recent piece for Foreign Affairs magazine. So too did Mikkel Vestergaard Frandsen — a man who has done yeoman’s work in all but stopping the spread of malaria and Guinea worm in Africa — in a piece for the World Economic Forum. David Blumenthal and Elizabeth J. Fowler opined similarly in the Harvard Business Review.
Specifically, the writers of all three pieces believe there is a need in the U.S. for a single independent, nonpartisan organization capable of rapidly responding to a new outbreak. Frandsen writes that ideally it would be the healthcare equivalent of the Federal Reserve, in that it would feature the best minds in the field and operate autonomously. Such a body would, for example, be able to implement widespread testing without having to cut through miles of red tape.
From a global standpoint, the World Health Organization can continue to serve as the eyes and ears of all nations, in the estimation of Blumenthal and Fowler. They add that cooperation could be better, and greater funding is certainly necessary. But on the face of it, the WHO is capable of serving as a much-needed early warning system.
Then it becomes a matter of execution, if and when a threat arises. And on that score, Frandsen writes, the U.S. and Europe have been far too passive in dealing with the current crisis. He suggests that when the next pandemic comes, several measures could and should be explored. One is central isolation, which was used in China after COVID-19 first broke out there. It involved gathering those diagnosed with the virus at a dedicated medical facility.
Frandsen also writes of the possibility of herd immunity — where certain vulnerable age groups are protected and those who develop the necessary antibodies can continue to go about their everyday lives — but admits that this is not an option with every disease.
And finally, he mentions the test-isolate-trace approach, which was used to stop the spread of Ebola in Nigeria in 2014. According to Frandsen, that nation’s Polio Operations Center identified “patient zero,” quarantined him and those with whom he had contact and eradicated the disease within Nigeria’s borders within three months.
No matter the approach, it is important to be forward-thinking, to get out in front of any threat that emerges. Osterholm and Olshaker suggest that military-style planning is best, where forces from various sectors (i.e., public health, communications, manufacturing, transportation) are gathered, the necessary resources (notably personal protective equipment, or PPE) are stockpiled and disaster drills are carried out.
All of this makes a world of sense, but there is also the danger of human need running headlong into human nature. Osterholm and Olshaker referred in their piece to something behavioral scientists call “hyperbolic discounting,” where leaders make decisions based on what is easy and will provide immediate dividends, as opposed to doing something difficult, where the payoff is far in the distance.
Will our memories of the current pandemic be too short? Will we be too complacent about future threats? Those are pertinent questions, and the past would suggest some very troubling answers. But at a time like this, when people are still suffering and dying, it is best to remember an old adage: Those who don’t learn from history are doomed to repeat it.
Joel Landau is the founder and chairman of The Allure Group, a rapidly expanding provider of skilled nursing and rehabilitation services throughout the New York downstate area.