A year into the COVID-19 pandemic in early 2021, a group calling itself the Covid Crisis Group gathered to lay groundwork for what its 34 members anticipated would eventually be a commission tasked with studying the nation’s response, along the lines of the 9/11 Commission.
One of the group’s members, Philip Zelikow, a history professor at the University of Virginia, served as executive director of the 9/11 panel. The Covid Crisis Group gathered data, organized working groups on different topics and interviewed nearly 300 people.
But the call for a national COVID-19 inquiry didn’t come. So the group decided to share what it learned about what went right, what went wrong and how to fix it before the next pandemic. Their book, “Lessons from the Covid War: An Investigative Report,” was published last week.
Among the authors was Dr. James Lawler, associate director of the University of Nebraska Medical Center’s Global Center for Health Security. Also on the panel was Melissa Harvey, who was involved with regional disaster response work at UNMC for a time and now works in emergency operations at HCA Healthcare.
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The group pointed out a number of successes, from the Operation Warp Speed initiative that put millions of shots in arms in record time to local initiatives such as successful vaccination efforts by some Native American tribes. The authors lauded the heroism of health care and public health workers.
But they also called out failures, including pandemic response systems unsuited to the current day and a sluggish initial response. In spite of spending trillions of dollars, the United States’ excess mortality rate, or deaths above what usually would be expected, was about 40% higher than that among Europeans during 2020 and 2021.
Lawler said Zelikow, the book’s lead author, summed up the situation well in an opinion piece he wrote in Time: “The COVID war shows how our wondrous scientific knowledge has run far, far ahead of the organized human ability to apply that knowledge in practice. If we want to avoid a repetition of the catastrophe of 2020-22, we cannot ignore that the COVID war revealed a collective national incompetence in governance.”
Lawler, who was part of a working group that looked at state, local and community responses, said that while the report wasn’t a complete examination of the response, “it was enough to give important insight into what happened and where we really need to refocus efforts.”
In a Q&A, he addressed some of the points in the book:
Q. What were the big takeaways you saw from this effort?
A. An overarching theme is that in many ways, we’ve lost the ability to do the things that are required to solve problems. A lot of that is at the government level, certainly federal and maybe state and local as well. This is the country that created and executed the Marshall Plan to save Europe after World War II and put men on the moon. In the pandemic, we couldn’t do those types of things. We couldn’t take strategy and create common understanding and direction and execute against common goals as a nation. America was always the one country that could tackle these huge issues and solve these big problems. And we may be losing that, and we need to focus on how we get that back.
There are 10 lessons that Philip (Zelikow) talked about in the book. Communications is one them. One of the more prominent themes we need to take away from examining the pandemic is our inability to counteract disinformation, literally and intentionally false information and narratives that really warped people’s understanding of what’s fact and what’s not, what really happened and what does the scientific data tell us.
And thirdly, a theme for me, is our health care system is still not well-situated to respond to these large-scale emergencies. It was fraying and somewhat threatened even before the pandemic, and now it’s unraveling.
Q. What are the symptoms of that?
A. We have a workforce that’s in crisis. We’ve lost a tremendous number of folks who’ve exited the workforce because the stress of working in health care … and the pandemic has accelerated what was already happening. We have lots of hospitals and health systems that are fiscally on the brink of insolvency. People think health care is making all this money, and certainly there are some folks within the overarching health care system, like insurers, that seem to be doing just fine. But actual hospitals, especially hospitals that are serving rural and underserved communities, are really in jeopardy.
We among peer countries have some of the worst health indicators of any similar wealthy industrialized economies. We’re among the bottom of our peers, in terms of health indicators for population health. Our life expectancy has declined for the first time in many, many decades. And that’s really inexcusable for a country with the wealth of the U.S.
Q. Were there any good things that came out of it, such as Operation Warp Speed and getting vaccines done that fast?
A. That was an amazing achievement. That’s one thing as a government and a country we were able to do well, to rally biopharma to make these amazing vaccines.
We had a little less than 5 billion doses of (all kinds of) vaccine given worldwide in 2019. In the first year of the pandemic, from late 2020 to late 2021, the world produced 11 billion doses of vaccine. That’s an incredible achievement, to bring novel vaccines to market, and then ramp up production and then produce 11 billion doses within the first year. And vaccines that are among the safest and most effective that anybody’s ever made.
We nailed it. The problem is we can’t get anybody to take them. At least 90% of Americans had at least one dose. That’s a great achievement. But almost nobody is up-to-date on vaccines, and that’s what we know you need to do to protect the community and protect the population.
Q. What were the biggest mistakes the U.S. made?
A. First of all, I think, initially it was our slowness in response and our inability to make decisions quickly.
And we continue to make these same mistakes. We’ve turned off a number of systems we had to understand COVID-19 activity in our community, so we’ve blindfolded ourselves again.
Another important mistake to point out is that everybody tends to look at faults and problems in pandemic response through the lens of politics and blame the other political side.
Politics exacerbated some of the fundamental problems, but they didn’t create most of them. We would have had a bad response almost no matter who was in the White House, because fundamentally a lot of these systems we rely on just don’t work. We need to think about how we reinvent that.
Q. The book mentions that responses happen county by county. How do you get around that?
A. What we can do is have local systems that work well together, share information and coordinate responses. It’s crazy that in 2023, we don’t have integrated data systems that can look at health data across geographic regions to understand what’s going on in real time with population health. That’s not just for disasters, it’s everyday medicine.
It’s not a good thing when you go to the hospital for a problem and the doctors there can’t see what happened at other hospitals or other doctors’ offices, because the electronic medical records don’t talk to each other.
We wouldn’t tolerate it in any other industry, if airlines had their own radar and aircraft identification systems and didn’t talk to each other and planes were crashing into each other.
Q. Do you think this is the last word on the pandemic response?
A. We need to do a lot more in terms of understanding specifically what happened. I think more importantly, figuring out how to make sure it never happens again. This is a starting point.
It’s really important that people recognize it didn’t have to be this way, and we can make sure that the next time it isn’t. We really could have done a lot better, and we should have done a lot better, and we need to do better next time.
Editor’s note: Questions and answers were edited for length and grammar.