Thursday, July 23, 2020

Ideas for a Coronavirus Commission Investigation

Environmental & Science Education
Edward Hessler

It was only on December 31, 2019, that Chinese authorities notified the World Health Organization of an outbreak of a "pneumonia of unknown causes" in the city of Wuhan, China. Oh, that it had been that simple. The disease COVID-19 caused by the virus SARS-CoV-2 is one that has resulted in many medical and scientific questions that must still be answered.

One of the questions is found in the borderland between science and public policy. It is about public health. How prepared was the United States--we claim to have the finest health care system in the world--to respond to COVID-19? Our leadership can be found in two numbers: confirmed cases and deaths.

This question is worthy of a bipartisan review commission.  Several writers for STAT have developed an outline starting with 10 issues such a commission should and would "undoubtedly investigate." I list them below, making a few comments but for more details see the original essay in which these are briefly expanded.

You may have other questions or differ with these but in the end, we must learn something from our response which we can use in looking ahead to the next viral outbreak as well as dealing with the current one in the future. It doesn't appear finished with us yet.

--The sidelining of the Center for Disease Control (CDC).  This includes the running of the response and also in communicating to the public. You will recall that the were not gramted clearance to hold press briefings.

--The politicization of evidence-based decision-making. We were told repeatedly that COVID-19 would "just go away."

--Airport screening and restrictions on foreign travel. The president has thrumped the drum that travel from China on January 31 and from Europe in March were decisive and quick. While they bought some time more than 40,000 entered the U. S. from China. The screening and follow-up of those who entered once in the U. S. was "inconsistent and spotty,"  relying on self-quarantine for 14 days.

--Guidance for Americans traveling overseas and boarding cruise ships.The alerts included caution, then reconsideration of travel plans, then do not travel but posting the highest level--avoidance--was delayed.

--The testing debacle. This is probably the most botched--prevalence of unreliable results, supply constraints, delays in test approvals, rationing, no contact tracing.

--The FDA’s decision to green-light an unproven drug.

--Oversight of the Strategic National Stockpile (SNS) and distribution of personal protective equipment (PPE). N95 respirators in the SNS were mostly expired and had not been replenished, including ventilators (fortunately this feared shortage did not become reality). There was an adminsitrative struggle for control of the ENS, eventually shifting from the CDC to an assistant health secretary where it functioned no better.

--The chaotic rollout of the first drug approved to treat COVID-19.

--The decision to reopen non-essential business.This occurred before there was a sign of the successful containment  of COVID-19.

--The reversal on guidance on whether to wear masks. "[The] decision-making process sowed distrust and confusion along the way, and questions remain about whether the turnabout happened as quickly as it should have."

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