I’ve been engaged with the issue of pandemic preparation for over 10 years. Former Sen. Bob Graham, D-Fla., and I headed up a nonprofit, early in the last decade, which sponsored a stem-to-stern study of how well America’s public health infrastructure would respond to a pandemic. We found a number of areas where the national chain or resilience was lacking. I was concerned that COVID-19 might be the perfect storm that the public health establishment has been fearing.
The disease is certainly a handful. It has caused and will cause tragic deaths, economic damage, and social disruption and uncertainty that always attend a serious pandemic. Its R –∅ rate (the rate at which the virus spreads) seems to be high, close to seasonal flu.
But I’m getting more optimistic about the actual public health impact of the virus because its virulence appears to be much lower than the 3.4 percent mortality rate claimed by the World Health Organization. The New York Times spoke with “a number of experts in epidemiology, and they all agreed that 1 percent was probably more realistic.”
We have reasonably good information, at least outside of China, for the numerator – the number of deaths – but poor data about the denominator – the number of people who have the disease. I think people are walking around with the disease unaware that they have it or without reporting that they have it because its effects on them have been minor.
If that’s true, it means that the impact of COVID-19 is closer to a normal flu than I had originally feared. President Trump was roundly criticized in many quarters for saying something to that effect, but he may well have been right.
The Trump administration has, on the whole, responded vigorously and effectively to the disease. The president shut down flights from China in late January, which probably did not prevent the disease from taking hold in the United States, but it did slow its progress. This gave public health officials vital time for the necessary preparations: putting together the right team to manage the response, establishing communication protocols within the public health apparatus, preparing information for the public, identifying the key items to stockpile and the most promising medical countermeasures to pursue, and beginning the process of securing a vaccine and therapeutics.
Putting the vice president in overall charge of pandemic preparation was the correct decision. Bob Graham and I proposed the same thing to the Obama administration 12 years ago.
Trump’s style of leadership is on balance a plus in this kind of a crisis. He is neither afraid to make decisions nor overly concerned about being criticized for the decisions he makes That is vital. I have participated in tabletop exercises involving pandemic response; indecision is both seductive and dangerous, as Japan and South Korea are finding out.
At the same time, the president needs to be patient with his own team. He has the right people in the right places. They are all working 24/7 under difficult circumstances, and it’s not like there is a huge pool of people who can replace them if they leave. This is one time where Trump needs to lead with positive rather than negative reinforcement.
There have been snafus but that was to be expected. Response to a pandemic is a lot like a military campaign; the fog of war surrounds everything, even good plans have to be adjusted, decisions are made on the fly, and some of them go wrong.
In the next few weeks, we’re likely to see a spike in the number of reported cases as the testing regimen broadens and we discover the extent to which the disease has spread.
The federal government should continue its focus on increasing the availability of necessary equipment (like respirators) and facilitating communication among health authorities and to the public. Every effort should be made to develop countermeasures as quickly as possible; even if they are not available in time to make a difference in this pandemic, we will need them, or better capability to produce others, for the next one.
Day-to-day responsibility will increasingly shift to state and local public health authorities who have to decide what restrictive measures are appropriate. The key will be to stay ahead of the virus where possible, protect the high-risk demographics, increase surge capability in hospitals and continue to be responsive to constituents who want to make sensible decisions with the best information available.
The economy will take a hit, if for no other reason than that travel and tourism account for about 8 percent of GDP. There may be spot shortages of certain items. I’m concerned about the supply of drugs since China produces so much of the world’s pharmaceuticals. But Beijing has every incentive to restart its economy and all the powers of an authoritarian society in getting its people back to work.
The stock market is overreacting, but there is a good chance that the fundamentals of the economy will recover quickly as the disease moves through its various stages and businesses adjust their operations and supply chains. In fact, if I had more skill and more money, I’d be looking for sound companies whose value has been artificially suppressed by the fear that always accompanies the early stages of a pandemic.
I’m sure the professional traders are alive to those possibilities. Few things are so bad that no one profits from them.
Looked at most broadly, what’s happening is that a new risk factor has entered our lives. In such situations, the first tendency is to ignore the new danger; then, as its presence is forced upon us, to ping pong in the opposite direction and flail around attempting to eliminate the risk. Finally, as we adjust to the new normal, we tend to make better decisions until the danger passes.
Most of us are past the first stage already, and we should try to shorten the second stage as much as possible. The best way to do that is to think of this as an unexpectedly bad flu season with no effective vaccine available. To be sure, the risk is higher than the flu for certain demographics, and that will certainly affect our decisions, but the difference is more in degree than in kind.
In sum, a lot of people are going to become infected. We may never know how many. The vast majority will experience symptoms consistent with a regular case of the cold or flu. As a practical matter, most of those will care for themselves, or be cared for, at home. The Centers for Disease Control and Prevention has good recommendations about home health care on its website.
Yes, government at every level should have prepared better for this emergency. Some of us have been saying that for a long time. But there is a lot to be thankful for. The disease could be much worse than it is, and America has an advanced public health infrastructure with a long tradition of dedication and mutual support that is ramping up as quickly as it can. Many of us will escape the virus entirely; most of those who don’t will experience manageable sickness; and for the small minority that has more severe cases – chiefly the elderly, especially if they have serious medical conditions – there is a lot more help available than most people in most places at most times have ever had.
We should, as the British say, keep calm and carry on.