Grading the U.S. response to the pandemic

How should we grade our collective response to the covid pandemic?  What lessons should we draw for the future? 

I believe that our response was poor.  To see why, just imagine where we would be today if effective vaccines had not been developed.  Our current strategy of moderate social distancing, intermittent partial lockdowns, and economic assistance for businesses and the unemployed would not have been sustainable for another 1 or 2 years as the covid virus slowly burned its way through an unvaccinated population.  We would inevitably have shifted to a different approach – very likely a de facto “herd immunity” strategy that lets the virus rip. Perhaps we would have offered some additional protections to the most vulnerable, but I doubt it.

An alternative strategy of mass testing, contact tracing, careful and humane isolation of infected people, widespread availability of high-quality masks, and improved treatments would have been far preferable, but we did not do the necessary preparation to implement it, even though quick development of an effective vaccine was considered unlikely by many experts, and the value of increasing testing capacity and mask production was understood by many academics, policymakers, and practitioners.

The value of an aggressive, multi-pronged approach to virus suppression and treatment would have been even higher if covid had been more transmissible or had a higher infection fatality rate. 

Below is a partial list of policy failures related to covid, with just a bit of commentary.  These are failures that come easily to mind.  No doubt others could be added to the list, and it is certainly possible that some are not really failures.

• Initial failure to stockpile masks, ventilators, etc.
• The original testing failures at FDA and CDC. 
• Failure to use advance market commitments – financial incentives – to get companies to invest in plant and equipment needed to produce large quantities of high quality personal protective equipment.
• Inadequate use of advance market commitments to get companies to invest in vaccine development and testing and to invest in vaccine manufacturing capacity before clinical trials were completed (Warp Speed was much too small).
• Failures at the Emergent BioSolutions plant in Baltimore (I suspect there was a major oversight/management/contracting failure here).
• Failure to speed vaccine approvals.  (Yes, hesitancy is a potential issue, but we need to figure out how to overcome this, not slavishly follow procedures developed for non-pandemic situations.)
• Failure to aggressively and systematically vet existing drugs for efficacy against covid.
• Failure to ramp up population surveillance and testing for variants to adequate levels.
• Health communication failures, including failure to communicate uncertainty, failure to speak honestly about the magnitude and source of risks (i.e., aerosol versus droplet transmission; indoor versus outdoor transmission; importance of handwashing), unwillingness to ask people to take precautions for the sake of others, excessive gloom about re-opening, etc.
• Failure to change policy choices and messaging that turned out to be inappropriate as information about transmission improved (closing of parks, outdoor masking, too much handwashing, not enough ventilation).
• Logistical failures in the vaccine roll out, and perhaps prioritization failures.
• Failure to make a concerted effort to get isolated/disadvantaged groups vaccinated.
• Failure to economize on use of scarce vaccines, failure to switch to a policy of first doses first, fractional doses, and prioritizing people who have not had covid.  This probably cost tens of thousands of lives.
• Failure to protect the vulnerable – in crowded homes, in nursing homes, in factories, in stores, and in workplaces and prisons.  We didn’t require employers to take steps to keep workers safe.  Why doesn’t every worker in every factory have access to an N95 mask?  Why didn’t we use empty hotel rooms to allow sick people to isolate from their families? 
• Failure to invest in vaccines for low- and middle-income countries. 
• Failure to facilitate international cooperation on many aspects of pandemic response (I think).

The economic policy response to the pandemic was a mixed bag.  It had some strong points, notably the UI piece, which avoided untold disruption and suffering.  But aid to business was quite wasteful.  Many checks were sent to organizations that were not in danger of closing and to businesses that could not be saved.  Too little thought was given to creative alternatives for helping small businesses, such as changes to bankruptcy rules.  If a Democrat had been President and Republicans had control of one house of Congress, it is doubtful that much in the way of economic assistance would have been forthcoming.

No government is going to respond perfectly to a pandemic.  New ideas about what we should be doing take time to gain a foothold.  Persuasion does not happen overnight.  Deciding what to do in the early phases of a pandemic, when the fog of war is thick is especially challenging.  When it comes to operational tasks, governments learn by doing – by making mistakes – just like other organizations.    Even taking this account, our failures were numerous.  With a more dangerous virus, or without the rapid development of a vaccine, the cost of our failures would have been much, much higher.  Let us hope we can learn and do better next time.