A Year Ago I Asked: How Bad Could Covid Get? Now We Know

“It was a catastrophic failure,” says Larry Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, a failure driven in large part by pandemic denial. “We should have jumped on it fast and hard and never let go, like so many other countries did successfully. But we refused to face the facts that were right in front of us. The reality was right there on television—what happened in Wuhan, and then this huge wave going across the ocean to Europe. We just didn’t pay attention.”

All the things Gostin says the US should have done a year ago—to massively ramp up testing capacity, hire scores of contact tracers, help people isolate themselves if they’d been exposed—are exactly what the Joe Biden–Kamala Harris administration proposed this week. The only thing that’s different is that now there are vaccines. “The rest of the playbook is the same,” says Gostin. “If we’d had that available even as early as March, we could have literally avoided hundreds of thousands of deaths.”

Anne Rimoin, a UCLA epidemiologist who studies emerging diseases in the Democratic Republic of Congo, has for years pushed for more investment in a global surveillance system to pick up pathogens with pandemic potential before they have the opportunity to spread globally. But, she says, finding the money and political will has been challenging. That kind of threat has felt too far removed, too hypothetical. “Hopefully, we understand at this point that it isn’t hypothetical how many lives are at stake,” says Rimoin. More Americans have died in this pandemic than during World War II. “It’s much more devastating than a war,” she says.

That’s why she’s encouraged to see that one of President Biden’s first executive orders was to rejoin the WHO, from which Trump began withdrawing the US in mid-2020. The health authority has taken some heat for being too deferential to China in the early days of the outbreak, especially as that government was censoring the flow of information out of Wuhan. But when the US’ most urgent health and security problems are truly world problems, which can’t be solved by sealing the borders and hoping for the best, it’s better to be a part of an organization with eyes and ears all around the globe.

“I think the lesson to be learned from all this is that an infection anywhere is an infection everywhere, especially if it’s a respiratory virus,” says Rimoin. It’s true, she acknowledges, that this respiratory virus, SARS-CoV-2, evolved an insidious new trick; it replicates so fast that people are most contagious days before they develop symptoms, if they develop symptoms at all. And it took scientists too long to notice that, and to update their priors on how coronaviruses operate.

But adding to that problem, she says, was that detailed epidemiological data was slow to arrive in those early days. Case numbers and death rates can help give an outbreak shape, but without information about where and how people got infected, it’s impossible to know how that shape will move and change. In the DRC, she’s accustomed to having imperfect data, to trying to assemble the puzzle of how a pathogen works with only a few pieces. But outside of sub-Saharan Africa, that’s not how scientists are used to doing things. And without good information, it’s easier to fall into that faulty “absence of evidence being evidence of absence” trap, and to mistakenly downplay the risks. “The only way to combat that is to have a real, substantive, and strong investment in viral surveillance and mechanisms to share that information, in the same way you would for any other issue of national or global security,” says Rimoin.

As part of the same executive order, Biden’s administration called for establishing an interagency National Center for Epidemic Forecasting and Outbreak Analytics, whose mission will be to modernize global early warning systems for emerging biological threats. That’s good, says Rimoin. But the trick will be keeping such systems running and well-funded even in biological peacetimes. That’s how to not miss the signal the next time. And with the way things are headed, says Rimoin, “it’s unlikely we’ll have to wait another 100 years for another devastating pandemic to come knocking on our door.”

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