Just projecting from the number of people already infected and being infected now, the virus will have killed at least 100,000 people in the U.S. by the end of the month. But we can get through this. It’s us against them – humans against the virus.
There are 10 plain truths we need to accept in order to move forward productively and effectively.
1) It’s really bad.
In New York City, it’s on the order of the influenza pandemic of 1918-1919.
2) As bad as this has been, we’re just at the beginning.
Until we have an effective vaccine, unless something unexpected happens, our viral enemy will be with us for many months or years. There is no magic bullet. Not travel restrictions. Not staying at home. Not testing. Not Remdesivir. All of those can help, but until and unless we have a safe and effective vaccine, there’s no single weapon that will deliver a knock-out punch.
3) We need to be guided by the data.
We need accurate and real-time monitoring to track trends in symptoms, emergency department visits, tests, cases, hospitalizations, deaths, community mobility, and more. We must work to find cases before they become clusters, clusters before they become outbreaks, and outbreaks before they become explosive epidemics that risk the lives of health care workers and others.
4) We will be able to begin to re-open as soon and safely as possible by basing decisions on data and creating a new normal
Sheltering in place is a blunt but effective weapon: it suppresses spread of the virus but inflicts severe hardship on individuals and the economy. After flattening the curve, the next step is to box the virus in by implementing four essential actions – test, isolate, contact trace, and quarantine. All are crucial; if any one is weak, the virus can escape and spread explosively again. If we do all of these four things well, even if we don’t have a vaccine, we can begin to return our society and economy to a more normal footing.
5) We need to find the balance between restarting our economy and letting the virus run rampant
We’re conditioned to think in dichotomies of A vs. B – but open vs. closed isn’t a true dichotomy. We need to think of this more as a dimmer dial than an on-off switch, with different gradations of open based on what we can do without undue risk. Many measures we’re seeing now – floor markings to denote safe distancing, requirements to use hand sanitizer before entering a building, capacity restrictions in restaurants and stores – may be with us for some time.
6) It’s crucially important to protect the health care workers and other essential staff who are the front-line heroes of this war.
They shouldn’t have to put their lives at risk to care for us.
7) We must protect our most vulnerable people.
Nursing homes and other vulnerable congregate settings house approximately 4 million people in the United States. Unless we take urgent action, at least 100,000 residents of America’s nursing homes will die in the next year, and there could potentially be hundreds of thousands of deaths in all congregate facilities, including among those who work in these locations. We must also act urgently to reduce the higher rates of infection and death among African American, Native American, and Hispanic people.
8) We must invest in a vaccine and therapeutics.
Governments and private companies must join forces to make massive, continued investments in testing and distributing a vaccine as soon as possible, ensuring rapid and equitable access in this country and around the world. Nothing else will enable life to get back to a pre-COVID normalcy.
9) We must heighten, not neglect, our focus on non-COVID health issues in order to increase personal and community resilience.
Underlying conditions greatly increase the risk of severe illness. We need to preserve health care services despite the pandemic. We must take steps to avoid people postponing care for strokes and heart attacks, delaying cancer diagnosis, or deferring essential preventive care because of fear of COVID-19. And there has never been a better time to quit smoking, get your blood pressure under control, make sure that if you have diabetes it’s well-controlled, and get regular physical activity.
10) We can never again be caught so underprepared.
It is inevitable that there will be future outbreaks. What’s not inevitable is that we continue to be so underprepared. The simple truth is that in our increasingly interconnected world, disease spread anywhere is a risk everywhere. If the world is safer, we will be safer here at home.
Future health and economic security can best be protected by changing the way we allocate funds to protect us all from health threats. We have seen the limitations that caps and sequestrations cause for discretionary funding. And we have seen that even mandatory funding doesn’t ensure stable support. We propose a new approach for specific public health programs that are critical to prevent, detect, and respond to health threats. We call this the Health Defense Operations (HDO) budget designation, and it would exempt critical health protection funding from the Budget Control Act spending caps so our public health agencies can protect us.
HDO programs should be required to submit a bypass professional judgment budget to Congress annually. The NIH submits three bypass budgets to Congress every year that explain the true resource needs for cancer, HIV/AIDS, and Alzheimer’s research. Likewise, Congress and the American people must understand exactly what is needed for our public health defense so that Congress can then appropriate the resources required to sustain the public health system we need to keep us safe. This investment can save millions of lives and potentially trillions of dollars. Sustained, baseline funding is the only way we will ensure we are prepared for the next pandemic. Responsible funding means protecting America, and we must also ensure accountability in our spending so that every dollar is used wisely.
Bill Murray is fated to relive the same fate in the classic movie, Groundhog Day. But we can learn from our mistakes. The horror that COVID-19 is spreading around the world can be a wake-up call so that in both the United States and globally we do everything in our power to both tamp down this pandemic and drive down the risk of future epidemics and pandemics. By investing in public health protection, we will honor those lost to this pandemic and protect those at risk from the next.
Dr. Tom Frieden is Senior Fellow for Global Health and the Council on Foreign Relations and President and Chief Executive Officer of Resolve to Save Lives, an initiative of the global health organization Vital Strategies.
