While change is a constant part of life; big changes often come about due to some extraordinary event – a natural disaster, a man-made disaster or something like a pandemic. Consider how life changed after 9/11. Organizations like the TSA didn’t even exist before that man-made disaster and air travel has never been the same since. Events like Hurricane Katrina forever changed the lives of people in the New Orleans area. The COVID-19 disaster is one such a big change and life will never quite be the same. A consist factor in all of these disasters was the lack of any planning on how to deal with them.
As the nation slowly finds a way to reopen, even in the face of a sure increase in the disease, we need to try to learn from the experience of having lived through this disaster, so far. Several things are fairly evident:
- Government at all levels was very unprepared for an event of this magnitude. A good deal of Monday morning quarterbacking will need to be done, once we have time to analyze and reflect on the data that has been collected. It was apparent as events unfolded that there was no plan for Federal and state cooperation in place for large-scale disasters like this.
- The American medical system was ill prepared to deal with such an emergency and reacted poorly in terms of decision making about what resources to commit to fight the disease and how to keep the rest of the system working while dealing with the crisis.
- The American public was initially cooperative out of fear and then began to suffer a split of opinions on the steps taken by governments to try to deal with the spread of the virus. The ugly head of selfishness prevailed for a significant portion of the population
- The economic impact of the preventative steps that were taken by state governments was hugely underestimated. The relative frailty of the economy was exposed. No state government was prepared for the impact of the loss of tax revenues.
What are some of the takeaways that should cause further change?
For one, there needs to be a strengthening of the CDC and it’s leadership role in dealing with pandemics like this, or a new agency created. Just as the Federal government created the TSA to deal with the terrorist threats to our society, a strengthened and more unified organization, led by the CDC, needs to be envisioned. This was not a situation where a thrown-together White House Task force had the authority or the resources needed to effect real change.
The role of government at the state and federal levels in stocking and dispensing emergency supplies, like PPE and ventilators will need to be revisited. The “strategic supply” on hand at the start of this disaster was totally inadequate and the dispersal of that stock was chaotic. The messaging at the federal level during the crisis was inconsistent and indicative of the lack of a plan. Clearly there was a huge federal role when this pandemic started crossing state lines and “leaving it up to the Governors of each state” was a ridiculous response.
There must be a way to continue to provide for other medical services while dealing with a future pandemic. The medical community needs to have a coordinated plan in place that will allow some hospitals to be quickly dedicated to the fight against a future pandemic, while others are allowed to continue to function in their normal roles. A plan like that will initially have to rely on an agreed upon triage process to identify and segregate the patients with the disease from those that are not impacted. As we learned in this crisis, the development of testing tools and procedures and a much quicker test results will be required. This may also require a provision for funding those hospitals that are designated to become treatment centers for a future pandemic, in order to off-set their financial loss from other services that they must suspend.
A detailed review and assessment of the treatment regiments that were implemented in hospitals also needs to be done. It was reported that up to 80% of patients who were put on respirators ended up dying. If that is the case, then that course of treatment, or some part of it,was probably not the best response. A critical look back at what was done and how that worked out should lead to different recommendations for treatments in future disasters.
There was a very large difference between the impact in urban areas and that in more rural or sparsely populated areas; however; most state government responses did not take that into consideration. The result was a quick rise in resentment and frustration on those less impacted areas to being subjected to the same restrictions or requirements as were applied to urban areas. This turned many who feared the economic impact of the forced shutdown more than the disease itself against their own governments. A much more localized and targeted response will be needed in the future.
There was also a noticeable difference in the impact of the pandemic on certain ethic or socio-economic groups within our society. That needs to be studied and understood, so that changes to the planned response are created for future pandemics. The population of the nation’s nursing homes was particularly hard hit and a review of policies, staffing and procedures for those homes needs to be done and changes implemented. The differences in impact on the black and Hispanic communities also needs to be studied, with causes and changes in mind.
There is always a completely different path that could have been followed. We need to look at the experience of Sweden and see how their decision not to enforce any shutdown worked out. The Swedish death toll pf 291 per million of population is higher than the U.S. toll of 219 per million and their economy has still taken a hit as a result of citizens taking their own precautions and staying at home. Doing nothing also proved costly in terms of lives lost in some starts in the U.S.
There will be no return to the old normal, just adjustments to the new normal that we must adopt to live with the virus. Watch what the politions say during the upcoming election campaigning and see if anything they say really makes sense. Did they learn from this crisis and what do they say that they will do better to get ready for the next one? And, there will be a next one.
There will be a huge amount of data available for analysis after this is over; let’s hope we used that data to learn something that will help make next time better.