The U.S. Must Learn the Lessons of Its COVID-19 Response Failures
The United States’ response to the Covid-19 pandemic has been an epic failure. The data could not be more clear. The U.S. has suffered the most Covid-19 deaths and disease than any other nation [1]. Despite free and immense vaccine availability, by December 2021, America has nearly 50% of the world’s active Covid-19 infections [1]. Sadly, Covid-19 mortality is higher than all combat deaths in every American war [2].
Astonishingly, these outcomes occurred despite the U.S. being a global leader in life sciences, medical research, and spending the most per person on healthcare [3,4,5]. Moreover, the United States has the prestigious Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and many of the world’s highest-ranked medical schools and hospitals [6,7,8,9].
America’s lack of success appears to be a combination of political pressure, blunders, lack of preparation, and governors blocking public health initiatives [10,11,12,13]. Conspicuously egregious were the White House Task Force physicians in the Trump Administration, along with the CDC’s and FDA’s leadership. These medical advisors provided rosy predictions at the beginning of the pandemic but little guidance when it could have made a difference [14,15].
During the pandemic’s initial weeks, former Labradoodle Breeder Brian Henderson led the White House Coronavirus Task Force’s response [16]. On January 21, 2020, Dr. Anthony Fauci, Task Force member and Director of the National Institute of Allergy and Infectious Diseases, asserted that coronavirus is not a major threat to the people of the United States [17]. One week later, Dr. Nancy Messonier, the CDC’s Director of Immunizations and Respiratory Diseases, contradicted Fauci, warning that coronavirus could lead to “disruption of everyday life” and parents should ask about school closure plans [18]. Messonier stated that communities should begin “social distancing” [19]. Dr. Fauci took an opposing view, asserting that social distancing was unnecessary at the time [20]. Messonier was soon silenced, while Fauci became a regular guest on TV and later the feature of a documentary [21,22].
In February 2020, President Trump declared that Covid would miraculously disappear and no longer be a problem by April [23]. Similarly, Task Force physicians offered comforting yet unsubstantiated statements to the public. These included, the infection is low risk; asymptomatic infections won’t drive transmissions; flu is a bigger risk, and the U.S. has one of the lowest Covid mortality rates [24,25]. Then in April 2020, Dr. Fauci predicted, “the final death toll may be 60,000,” taking summer vacations during 2020 “may be in the cards,” and schools likely would reopen in fall 2020 [26,27,28]. Unfortunately, all statements and predictions were incorrect.
Furthermore, CDC Director Redfield falsely argued that the White House and other federal agencies were not involved in reducing Covid protections for workers [29]. However, recent evidence shows the Trump Administration interfered by not only changing those protections, but former political appointee Paul Alexander told the CDC to cease publication of truthful scientific evidence [30,31]. Later, Dr. Scott Atlas, an academic radiologist without infectious disease expertise and summer-appointed Task Force member, made disease-spreading changes to the CDC’s coronavirus testing recommendations [31]. This alteration stated that Americans exposed to coronavirus did not require testing. Since asymptomatic carriers can spread Covid-19, this recommendation could balloon disease transmission.
By mid-March 2020, President Trump began touting hydroxychloroquine as a coronavirus treatment “game-changer” [32]. A few days later, U.S. Surgeon General Jerome Adams supported Trump’s claim, stating he too would recommend hydroxychloroquine use if a family member were hospitalized with Covid-19 [33]. Then, despite no clinical trials, the FDA authorized both hydroxychloroquine and chloroquine for emergency Covid use at the end of March [34]. At the time of these statements and actions, Dr. Rick Bright, director of the United States’ Biomedical Advanced Research and Development Authority, was removed from his job after declaring his opposition to hydroxychloroquine use for Covid infections [35]. Two months after Bright’s removal, the FDA withdrew authorization of chloroquine and hydroxychloroquine, determining the drugs were unlikely to be effective treatments [36].
President Trump’s numerous misrepresentations were unwittingly endorsed by White House Coronavirus coordinator Dr. Debra Birx [37]. She argued that President Trump was attentive to the scientific literature and data, reassuring the public that his ability to integrate data “has really been a benefit” [38]. Soon after, Birx’s assertions were contradicted by a Cornell University study findings that between January 1 and May 26, 2020, President Trump was the world’s most significant driver of Covid misinformation [39]. Not until late 2021 did Dr. Birx admit that the former President ignored pandemic advice that would have saved tens of thousands of American lives [40].
Because another worldwide pandemic will undoubtedly occur, the United States needs to determine why we failed, how to prepare for future contagions, strategies that will restore trust in U.S. scientific institutions, and ways to keep politics out of science [41].
Many questions require answering. Some are itemized below.
In 2019, the U.S. practiced a mock pandemic originating in China entitled “Crimson Contagion” [42]. Following this, the U.S. Department of Health and Human Services report enumerated needs months before the first American Covid-19 patient; more ICU beds, ventilators, personal protective equipment, and better national coordination [43]. Why were these warnings ignored?
Based on the data from China, pandemic hygiene measures should have occurred within a few weeks after the United States’ initial Covid infection [14,44]. This would have required a coordinated mitigation effort to reduce disease spread [45]. Unfortunately, the federal government was slow to act and did not synchronize its response among states. While many other countries immediately tested and isolated infected citizens using the German-made World Health Association (WHO)-recommended coronavirus test, the CDC shunned this technology [46,47]. Instead, they developed a flawed test but released it anyway [48]. At the same time, the FDA prohibited private labs from using their own assays [49]. The testing error and FDA’s inaction resulted in rapid disease spread [50]. Why wasn’t the WHO or private lab tests used until the CDC had an alternative?
Notably, soon after Covid-19 infections occurred in their country, other nations began using facemasks to blunt the virus’ respiratory transmission [51]. As early as February 7, 2020, the U.S. knew how the virus was transmitted when President Trump admitted to Bob Woodward that Covid was airborne and he was downplaying the virus’ risk [52,53]. Despite this, the CDC, Surgeon General, and Dr. Fauci told Americans not to wear facemasks three weeks after Trump’s admission [54,55,56]. Although Fauci later admitted he wanted to preserve facemasks for medical workers, why didn’t he or other officials recommend non-medical facemasks [57]? Importantly, why didn’t the Task Force call for the Defense Production Act so everyone could obtain N95 or similar respirators, shown to reduce the spread of respiratory viruses, and found protective in reducing SARS-CoV 1 and 2 [58,59,60]?
Without the vast resources of the U.S., countries including Venezuela and Vietnam imposed mandatory mask-wearing before the CDC recommended untested and unregulated cloth face coverings [61,62]. Why did this take so long? Why weren’t facemasks regulated?
In the early months of a pandemic, fatality rates are challenging if not impossible to predict [63]. So, why did CDC Director Drs. Robert Redfield and Fauci expect Covid-19 deaths to be 0.1%, similar to influenza [64]? About three months later, the case fatality rate was 35 times higher than their estimate and remains much higher today [65].
When President Trump suggested studying ingestion or injection of household disinfectants to treat Covid-19, there was no pushback by Task Force Coordinator Dr. Deborah Birx [66,67]. She sat silent. When questioned about Trump’s request, Federal Drug Administration (FDA) Commissioner Stephen Hahn stated, “I certainly wouldn’t recommend the internal ingestion of a disinfectant”[68]. Why didn’t the FDA leader warn Americans not to drink poison rather than say he didn’t recommend drinking household disinfectants?
At the end of June 2021, CDC Director Rochelle Walensky informed the public that vaccinated Americans don’t require masks as they were safe from Covid’s delta variant, contrary to the World Health Organization’s guidance [69]. Although her recommendation was later revised, why did she initially misinform Americans [70]?
Adding to pandemic revisions is the confusion over booster vaccinations [71]. The Biden Administration announced booster availability on September 20th [72]. The CDC Director supported this [73]. However, FDA advisors voted to restrict booster use for specific groups [74]. Then, CDC’s advisors called for even more restrictions than the FDA [75]. CDC Director Walensky overruled her advisory panel, aligning with FDA recommendations [76]. Why didn’t the FDA, CDC, and White House produce one understandable initiative about boosters?
Besides federal mistakes, many governors failed to institute mask mandates, which led to excessive infections [13]. Some governors, including Ron DeSantis (Florida) and Greg Abbott (Texas), retaliated against school districts’ attempts to prevent Covid by mandating facemasks [77,78]. Facemasks have been the best protection for non-immunized children under 12 who could not receive vaccinations and those who are immune-deficient until November 2021, when vaccines became available to 5-11-year-olds [79]. The current Florida ban on school-mandated facemasks corresponded to a 1,000% increase in childhood hospitalizations [80]. Why would any governor act against prudent public health recommendations?
The U.S. response to the pandemic has been abysmal. Other countries had the same scientific information with better outcomes [1]. Moreover, the White House and CDC’s frequent strategy changes may have fueled American skepticism of vaccines and mask-wearing [81]. As David Axelrod, President Obama’s former advisor, wrote regarding the CDC, “the C clearly doesn’t stand for communications” [82].
Today’s America has suffered more deaths due to Covid-19 than the America of the 1918 flu pandemic [83]. That was when no one knew the pandemic’s cause, and antibiotics weren’t available to treat accompanying bacterial pneumonias [84]. Medical and scientific advisors should never downplay disease, make unfounded predictions, or avoid publishing evidence. The backbone of science is the willingness to admit you are wrong and abandon ideas that don’t work. Given the magnitude of America’s disastrous response, the United States should convene a panel of esteemed international and non-government scientists to help us learn from our mistakes. Otherwise, we will gain little or nothing from this colossal public health tragedy.
References
Article Type
Commentary
Publication history
Received: November 16, 2022
Accepted: December 01, 2022
Published: December 05, 2022
Citation:
Linn Goldberg, Louis Speizer (2022) The U.S. Must Learn the Lessons of Its COVID-19 Response Failures. Clar J Infect Dis Ther 03(02): 258–263.
Linn Goldberg, M.D1* and Louis Speizer, Ph.D2
1Oregon Health and Science University, Portland, Oregon, USA
2Managing Partner, Griffing Speizer and Partners LLC, USA
*Corresponding author
Linn Goldberg, M.D,
Professor Emeritus,
Oregon Health and Science University,
Portland,
Oregon, USA;