A Mild COVID Tale in 2 Parts: Part 2 - There was no blind side.
Part 2… (Part 1 is Here.)
Between March 25, 2014 and April 13, 2016, there were 28,616 cases of Ebola across Guinea, Liberia, and Sierra Leone. 11,310 died from it. (Read HERE.)
At the time, recognizing that without containment, it could become a global pandemic, the U.S. led the international response in West Africa. It was clumsy and rife with failures early on. At the end of it, Obama asked for a comprehensive report on what happened, where the weaknesses were, and how they could fix them to better prepare for next time. He asked for a “lessons learned” report. You can read the whole thing HERE:
This report said in very clear and certain language that they got “lucky” with the Ebola virus, and that all conditions were set for a full-blown pandemic with a zoonotic (virus that passes from animal to human), novel, and invisible respiratory virus. It was not an “if” it happens, it was a “when” it happens. It also said in very clear and certain language that current systems were inadequate to handle any part of it.
According to the author of the report (Christopher Kirchhoff), these are the conditions that made (and still make) a zoonotic pandemic inevitable:
1 - population growth;
2 - urbanization;
3 - deforestation;
4 - the expansion of agriculture;
5 - the bunching of species together in island ecosystems;
6 - global commerce flows; and
7 - unsurpassed levels of intercontinental air travel.
Other interesting notes from the report:
Kirchhoff found that resources were stretched way too thin in the Ebola crisis. They were stretched so thin that had any other like crisis sprung up, they would have had no one to deploy to help. He warned that a future pandemic, “especially those that are airborne and transmissible before symptoms appear, are plausibly far more dangerous than Ebola…” (4).
He wrote that “Merely maintaining the current scale of response activities as a standing capability is likely insufficient.” (5).
Many told Kirchhoff in interviews that the outbreak was so bad and had so many deaths largely because “we failed early” (9). Later, Kirchhoff wrote:
“The mathematics of Ebola had outrun the international response, with the epidemic at this point doubling in size every three weeks. The speed of the response now mattered tremendously, but the major organs of the U.S. government had essentially been caught flat-footed when the NSC Principals Committee began debating whether to recommend the deployment of military forces.” (18).
Note that Ebola doubled in size every three weeks. In the U.S., we are seeing COVID double in size by day. The report noted elsewhere that when handling an epidemic that spread so wantonly, speed was of the essence. Because speed was of the essence, the response teams could not afford to learn as they go or learn in the field. They had to have systems in place and be able to hit the Go button immediately. Again: This was written and published in July 2016.
Reading the report, I was struck by how the health of relationships and the consistency and clarity of communication helped or hindered efforts to contain the virus. Leaders had to integrate multiple organizations, departments, bureaus – some with a disaster-relief mission that was not health-focused, others with a disease-mitigation, health-focus. Conflicts between agencies (e.g., the World Health Organization – WHO – and everybody else) impeded progress. No one knew who was taking the lead or who should take the lead. Disaster response (e.g., after a tornado) is linear and follows a relatively standard protocol to assess and manage consequences of an event that happens once. Epidemics are not linear. “They grow, change shape and size, and can behave like a snowball rolling downhill.” (15).
Trust and relationships between countries and their leaders was integral. Guinea, Liberia, and Sierra Leone had to work effectively with each other and with helping countries. Once crisis hit, the U.S. asked France and Britain to help. They said, yes. France sent military and civilian responders to Guinea; the British to Sierra Leone. The U.S. covered the response in Liberia. I’m so glad Obama never called any of them “shithole countries”. How would that have impeded the process?
An interesting note: one barrier to recruiting medical help from around the world was the lack of assurance that health workers would be cared for. This made me think of nurses in NY hospitals wearing trash bags, because they do not have adequate medical supplies. Who is signing up for that?
But what does this have to do with Trump?
Recognizing the inadequacies of the response efforts, Obama formed the Global Health Security and Biodefense directorate to focus full-time on how to plan for, prevent, and respond to pandemics and biochemical warfare. As they had learned, a splintered effort across multiple departments was ineffective and caused confusion. They needed a unified hub that integrated disaster response and disease mitigation. This “lessons learned” report was published in 2016. The Obama administration was working on fixing our pandemic preparedness when Obama's final term ended.
Seven days before Trump took over, the Obama administration warned the Trump administration of the impending threat and ran them through a "tabletop" simulation of a pandemic. Read HERE.
These 2017 briefing exercises were part of legally required transition exercises between the outgoing and incoming administrations. You can read through a powerpoint from that exercise HERE: Note the repeated bullet points describing shortages of medical and non-medical countermeasures (e.g., vaccines and Personal Protective Equipment-PPE).
After all of that... In May 2018, the Trump administration disbanded the Global Health Security and Biodefense directorate. While there was still a pandemic response planning function to what remained, the number of staff was halved and those who remained were absorbed into other offices with other duties – directly in opposition to the findings and recommendations from the Ebola outbreak report (that part of the failures in the early Ebola response was that efforts were spread too thin across too many different bureaus and departments. And that even just maintaining the current capabilities was inadequate. We needed MORE focus and MORE unified efforts.).
From January-August, 2019, the Trump Administration ran their own simulation of a global pandemic, Crimson Contagion. The scenario included a novel influenza virus originating in China. The report (a draft, dated October 2019) from that simulation can be read HERE.
The findings were much the same as what had been described in the Obama administration report back in 2016. I’ll quote a few for you here:
“The current medical countermeasure supply chain and production capacity cannot meet the demands imposed by nations during a global influenza pandemic.
Exercise participants were not clear on the applicability or use of Title I, Defense Priorities and Allocations Authority, of the Defense Production Act to mitigate medical countermeasure and ancillary supply shortages during an influenza pandemic response.
Application of resource scarcity mitigation measures were not clearly communicated.
States experienced multiple challenges requesting resources from the federal government due to a lack of standardized, well-understood, and properly executed resource request processes.
Some states were not clear on pre-pandemic vaccine or the Strategic National Stockpile asset distribution in response to an influenza pandemic.
States questioned federal resource allocation decisions in response to an influenza pandemic.” (5).
One interesting note. As I read about the Crimson Contagion simulation exercise, the study culminated in a 4-day event in Chicago from August 13-18, 2019. These four days of exercises included:
- 19 federal departments and agencies,
- 12 states
- 15 tribal nations and pueblos
- 74 local health departments and coalition regions
- 87 hospitals
- 100+ healthcare & public health private sector partners
They focused on:
- whole-of-community response & workforce viability,
- critical infrastructure protection,
- economic impact,
- social distancing,
- scarce resource allocation,
- prioritization of vaccines and other countermeasures,
- available (or potentially available) funding streams or mechanisms to fund the response,
- medical surge operations. (14).
It looks like it was pretty comprehensive and covered basically everything that has now emerged as critically inadequate. So... why has Trump seemed so clueless about everything -- talking about no big deals and no serious threats and 5 people and 15 people and magical disappearances?
I got curious about what Trump was doing during the simulation. Did he participate? Was he involved? The answer is no. Trump played golf every single day at his club in Bedminster, NJ from August 10 – 18, 2019. You can read about it (as well as all of his other golfing trips and how much that has cost American taxpayers) at TrumpGolf Count.
In a press briefing on March 9, 2020, Pence repeated what we’d been hearing over and over: that the risk for this becoming serious in the United States is low, that tests are available by the millions in all states, and that a pharmaceutical treatment is coming.
In the same briefing, Trump, talking about working on payroll tax cuts, said, “And we have a great economy, we have a very strong economy, but this came -- this blindsided the world. And I think we've handled it very, very well." You can read the transcript at Factbase.
And it has NOT been handled well. In fact, just as the author of the 2016 Ebola report said that the deaths and out of control spread of Ebola were due to early failures, the Trump administration also failed early. Those early failings (dismissing loud and explicit warnings and factual and scientific studies) contributed in a very big way to the fact that we now are leading the world in the number of coronavirus cases. And HE HAD WARNING! He had information. The path had been partially paved for him. He only had to continue the work.
It’s nice that he now wants to buy everyone’s 2020 Presidential vote with a stimulus check, but it seems pretty clear that if he had heeded any of the warnings from 2016, 2017, or his own administration’s simulation in 2019, the situation probably wouldn’t be quite so dire right now.
Anyway, allow me to leave you with this: Yesterday, the number of deaths in the U.S. due to coronavirus hit 2,000 -- doubling in just 2 days. In light of this news, Trump tweeted this:
Good job, Fella. Way to keep focus on the important stuff.