Guest Column | March 19, 2020

When Leaders Fumble, Responsible Public Prepares To Ward Off A Pandemic

By Suresh Kumar

Suresh Kumar_Sanofi

Editor’s Note: In this fast-changing and fluid environment of media coverage regarding COVID-19, we will continue to update this column as the situation evolves. For an ongoing update of the total cases and deaths by country, check this chart.

Author’s addendum: Affluent Naples, FL with a population of 21,300 and median age of 65.6 years boasts a median annual income of $90,500 and a median property value of $853,000. Access to specialist medical practitioners remains constrained (see January 2019 column), and its two hospital systems combined have 918 beds — likely inadequate to support patient needs. Naples was in the eye of the storm of Irma. It now prays that COVID-19 spares its demographically vulnerable population and does not break an already strained infrastructure.

Global public health is U.S. health. That is the profound, unstated meaning of a pandemic which this column predicted COVID-19 would become, weeks before the WHO’s declaration. A pandemic is a new disease for which people do not have immunity, which spreads across the world beyond expectations. Prevailing over such disease requires disciplined containment, rapid and inventive interventions, and learning from experiences elsewhere. It also involves nimbly adapting and scaling —in real time — the tests for the virus while collaborating to quickly establish and share diagnostic and treatment protocols. Public health safety is in our hands. It is in the robustness of our institutions. It is in the scientists, clinicians, and overall healthcare infrastructure we have spawned. And, it is in the programs in which we invest. Our safety is in the hands of all others we share in this world. Eventually, the greatest risks to our well-being are the weakest links in today’s local public health infrastructure — and the ability of our political leaders to act responsibly and assertively in the public interest.

The COVID-19 pandemic is revealing. It has affected more affluent countries than poor ones, and it has impacted urban more than rural areas. It has spread through travel and social contact and affected the rich and more mobile more so than the less wealthy. Mercifully it has challenged better-resourced public health systems and infrastructure, and yet it found us wanting. COVID-19 is not egalitarian. It has picked on the elderly, the frail, and those with co-morbidities and pre-existing conditions. It has affected high-density dwellings and largely spared the young.

The Good, The Bad & The Ugly

It all started in December in Wuhan. Predictably, China wasn’t immediately forthcoming in its reporting. In the face of growing public ire, China took draconian steps toward locking down Hubei province and enforcing travel and social distancing initiatives nationwide. It likely contained a calamitous spread. Nevertheless, by yesterday March 17, 3,226 of the almost 81,000 people infected had died. Countries with geographic and cultural proximity took the cue: Taiwan and Singapore established stringent screening and travel controls. Their leaders clearly articulated policy and enforced containment initiatives. While the situation remains fluid and epidemiologists warily look for signs of resurgence until yesterday no one has succumbed to the disease in Singapore and Taiwan. South Korea’s rapid roll out of diagnostic interventions helped to establish a ground zero and they could test, identify, and isolate the infected. These interventions are examples of real-time learning and action that likely saved lives.

The 100 days since the Wuhan outbreak would have been a call to action for productive U.S. White House administrations. Regulatory pathways would have been streamlined; the private sector would have been enrolled and engaged; and incentives would have been in place to rapidly develop diagnostic kits, vaccines, and therapies while also mobilizing the manufacturing necessary for stockpiling necessary supplies from masks to respirators to ventilators. War-game-like planning to address and supplement critical infrastructure shortages would have been standard operating procedures. Not in this administration, though. Its disdain for institutions and due process, proclivity to cut investments to secure the nation’s future, penchant for trashing health insurance, and track record to protect fewer people and provide lesser healthcare coverage are well chronicled. The administration did what it does best — belittled experts, blamed everyone else, and provided disinformation to diminish the threat. President, Secretary and the front line, all hide behind contradictory claims and outright falsehoods from “There is no testing kit shortage, nor has there ever been,” to “Anybody that wants a test can get a test,” to "The system is not really geared to what we need right now... let's admit it." Ad hoc actions and tweets cannot surrogate policy prescriptions. Daily media briefings are like reality shows with officials pandering to kiss the Presidential ring rather than provide information to keep people keep safe. Decisions by committees and groups can build collaboration, but authentic communications from a credible leader are necessary to build public trust. The world’s richest and most endowed nation did little to inspire today (March 17, 2020) — tragically, it announced its 100th death from COVID-19. This has not been America’s finest hour.

Much can and needs to be done to pre-empt an Italy-like 8 percent fatality — 2,158 of Italy’s 27,980 infected have succumbed, two thirds in the Lombardy region alone. Why? We know that COVID-19 has disproportionately impacted high-density urban dwellings, U.S. casualties have been concentrated amongst seniors in assisted living and nursing home facilities, and infection has been limited to few nexuses. All these factors could yet change in the face of imminent shortages of medical equipment and workers.

Reactively, we have done some things well. The COVID-19 response team acknowledged Australian Dr. Craig Dalton’s succinct prescription for social distancing and containment as best practice, an encouraging openness. Broadly communicating and enforcing it will be even more impactful. Foresight, planning, and rapid mobilization have not been our forte, and yet this is exactly what is needed now. Where are the Wall Street trading-like circuit breakers for public health interventions? What is being done to prepare nationally, and even more importantly in vulnerable locations, to neutralize or mitigate a crisis at least partially created by inept stewardship?

Yesterday, Today, And Tomorrow

We cannot change what has happened, but we can learn from it and ensure it never happens again. What worked in some countries, and why do others struggle to cope? What does plan for the worst and hope for the best look like? Square up with America and mobilize resources now.

Can the President or someone more trustworthy he designates (one person, not a pandering committee) commit to stand in front of a banner factually updated with the daily number of cumulative U.S. infections and deaths and just inform the public what the administration has done to keep Americans safe? No spin, just facts stated on TV, social media, and a government website.

  • How many test kits are available? Where are they?
  • What is the current testing and treatment protocol?
  • What is the earliest date by which the nation can expect a new vaccine or drug to be commercially available?

Can the administration post on its website community-level details by zip code and numbers of:

  • people over 60 years
  • available doctors and nurses
  • hospital beds
  • ventilators

Also, can the administration post plans for additional infrastructure to tackle an outbreak (e.g., other nations have commissioned pre-fab facilities within weeks) and provide information on school closures, business hours for grocery stores and restaurants, and social distancing protocols?

The public needs and deserves the facts. Can the administration quit grandstanding and its name-calling of global, state, and local leaders? Take responsibility! Public health interventions are planned globally and nationally but delivered locally. Federal governments, the WHO, CDC, etc. must remain scientific-standards-setting and resource-mobilization institutions that assist the doing organizationsstate and local health systems. In doing so, they help to deliver necessary services to patients where they reside. That is how we will ride out the current crisis.

This is not a time for politics and debating or debasing the merits of Medicare for All. Remaining safe is on top of everyone’s mind. Putting America first and keeping Americans safe requires planning for emergencies during good times and investing in our institutions and programs. Uber partisanship and perverted one-upmanship must never bring us to a health emergency abyss. “Make America Great Again” is more than a bumper sticker or blurb on a hat: It is always about keeping citizens safe, essential supplies within reach, and leading the world with all our resources, infrastructure, institutions, and talent. The world and its people are interconnected, mobile, and mostly responsible. Public health is an integral part of national security, and COVID-19 has taught us that urban planning and global mobility are fundamental elements of public health policy. Throughout this current crisis, the public everywhere has been the hero — they have voluntarily exercised abundant caution, and when necessary, even self-imposed sequestration. They have behaved admirably, even inspirationally. It is time for our leaders and politicians to learn and follow.