When the history books are written describing the U.S. response to the impending threat of Covid-19, one thing will be certain: investment, foresight and planning— otherwise known as “preparedness”—to meet the looming threat coming to our shores was lacking, if nonexistent.
In a nutshell, the window of opportunity for containment—a coordinated government response, testing on a massive scale, prompt contact tracing along with quarantines— quickly pivoted to mitigation measures such as social distancing, hand hygiene, wearing masks, school and workplace closures and travel restrictions.
The ultimate outcome in terms of deaths, suffering, not to mention “excess deaths”—and now the devastating consequences of long Covid—tell the story of a country wholly unprepared, without a coherent strategy to address the safety of its 331 million people.
But experience gained just 5 years earlier during the Ebola outbreak could have been instrumental in helping us to craft our pandemic response, according to two global health experts who played key roles during the Ebola scare.
Dr. Syra Madad, Senior Director of the Special Pathogens Program at NYC Health + Hospitals, and Craig Spencer, MD, Associate Professor of Emergency Medicine, Director of Global Health in Emergency Medicine at New York-Presbyterian/Columbia University Medical Center, review lessons learned in their recent article they co-authored in the journal Lancet last month.
Their article, “The USA’s Response to the 2014 Ebola Outbreak Could Have Informed Its Covid-19 Response” makes it clear that heeding the lessons from managing disease outbreaks is crucial to improving future responses.
“Despite multiple warnings and the inevitability of infectious disease outbreaks, preparedness has been undervalued, underfunded, and largely treated as optional in the USA.” the authors write in the opening statement of their paper.
From SARS in 2003, H1N1 flu in 2009, to Ebola in 2014, the U.S. was given ample warning, they argue, that these outbreaks were not “one-off” events but “part of a looming trend.”
One key aspect is changing our mindset when approaching the concept of “preparedness”, or readiness and preparation to spring into action. What the authors emphasize is that preparedness is by definition proactive, while the way we typically respond to outbreaks is reactive.
This mindset advocates a transition away from a “just-in-time” approach to a “just in case” one that already exists in relation to military defense spending, bolstering counter intelligence and weapons stockpiles, further described by Madad and her co-authors in a recent piece published in Health Affairs. While no one questions expenditures for these entities for our national defense, the same rationale should apply for protecting the U.S. from emerging infectious disease threats, since these are integral for protecting the lives and economic well-being of all Americans.
“With Ebola, our strategy was containment with a limited number of healthcare personnel involved in the direct care of Ebola patients,” Madad explained. “With Covid-19, nearly every healthcare worker is on the frontlines and the strategy quickly pivoted to mitigation.”
She continued, explaining that “we’ve learned from Ebola that an outbreak in even the most remote areas of the world, still poses a threat everywhere. There are foundational elements in epidemic preparedness that should have been gleaned from our previous responses and subsequently applied to all future health threats, including Covid-19—this includes the need for speed and rapid emergency response with strong leadership.”
“We must take this moment and push the needle further. We can no longer be in reactive mode when there is a health threat, rather be in proactive mode and prevent a local hazard from becoming a global health crisis.” added Madad.
The key takeaways, outlined by Spencer by a post on Twitter, are the following:
- Outbreaks always expose the shortcomings in healthcare systems.
- Protecting the healthcare workforce should always be a top priority.
- Having a coherent national plan and collaborating with national and international partners are all vital to combating a pandemic
- Health experts must be placed at the forefront to educate the public.
- Training and hands-on real-life experience are critical.
What’s clear is that pandemic preparedness has not been part of our mindset in routine delivery of healthcare and the lack of such an incentive to weave it into the fabric of healthcare are clear. We need to change this paradigm, and “there must be specific federal funding allocated that is sustained in perpetuity to ensure biopreparedness,” the authors write.
As part of such preparedness, we must also focus not only protecting healthcare workers from contracting specific diseases, but remain focused on the psychological effects to themselves and their families of dealing with severe and prolonged mental stress in caring for critically ill patients.
“Healthcare worker safety goes beyond just physical safety. We must factor in and support staff with mental and psychological support,” added Madad.
Having a coherent national plan that is detailed and spelled out is essential from the outset of any pandemic response. This requires collaboration with national and international partners including the CDC, USAID (United States Agency for International Development), and the WHO, the authors explain. The goal is to work together in both containment and mitigation, but also to share knowledge, data, best practices, and lessons learned that can improve overall public health responses. Working together fosters a sense of shared common goals with the ability to improve outcomes for all nations.
Placing health care experts at the forefront to educate the public is critical during the pandemic. Risks must be addressed and communicated in a timely fashion, while combating misinformation and disinformation become a priority early on.
“Although the risk of Ebola transmission within the community in the USA was low in 2014–16, the public perceived the threat as much greater, requiring a coherent, one-voice approach from the federal government to better inform the public,” the authors write.
“Covid-19 is, however, a substantial public health threat with ongoing community transmission in the USA. Sharing conflicting information and largely politicizing the pandemic has led to greater loss of trust in science and life-saving public health measures with constant undermining of public health professionals,” they continued.
But having experienced public health professionals at the helm of the response to Covid-19—such as those with prior experience acquired from dealing with Ebola in West Africa—could have made a significant difference in our mindset and outcomes, the authors believe. Spencer, who coordinated the Doctors without Borders response in Guinea in 2014, explained that the lack of U.S. medical providers on the front lines in West Africa was tied to our poor outcomes, lack of preparedness, and sense of urgency when Covid-19 entered the U.S. in lately 2019/early 2020. Academic institutions and public health entities in the U.S. were less inclined to send faculty and staff, either for “logistic or legal reasons”.
“Had more Ebola-experienced providers been on the front lines during the early stages of the Covid-19 pandemic, we would have responded better, faster and more efficiently,” they concluded.
“The arc of pandemic history is very long, but our memory of it is often quite short. Even if Covid-19 has highlighted the need to invest in and prioritize pandemic preparedness, there is always the possibility that after this acute crisis fades, we’ll move on to the next one without fully reflecting on or implementing the lessons learned,” offered Spencer.
“One thing I hope Covid-19 teaches us is humility. There’s a lot that other nations – many using the lessons learned from outbreaks like Ebola—can teach us about preparedness and response. Just being ranked as the “most prepared’ country for a pandemic is useless if the whole system crumbles when a pandemic actually strikes,” added Spencer.
“Some will say it’s cliché or just a talking point for globalists, but every outbreak reminds us we’re not safe until we’re all safe, all around the world. Emerging pathogens aren’t done with us. It’s absolutely crucial that we prepare and respond together as a global community,” he concluded.