This piece on lessons learned from the handling of the pandemic by Zeynep Tufekci is sobering, particularly since I really doubt we will doubt we will do anything differently. It’s long, so read the whole thing if you can. Here are just a couple of her observations:
As the pandemic enters its third year, we must consider those moments when the river branched, and nations made choices that affected thousands, millions, of lives.
What if China had been open and honest in December 2019? What if the world had reacted as quickly and aggressively in January 2020 as Taiwan did? What if the United States had put appropriate protective measures in place in February 2020, as South Korea did?
To examine these questions is to uncover a brutal truth: Much suffering was avoidable, again and again, if different choices that were available and plausible had been made at crucial turning points. By looking at them, and understanding what went wrong, we can hope to avoid similar mistakes in the future.
What happened after China covered up: The world failed to heed warnings and take action.
On Dec. 30, 2019, ProMED, a service that tracks infectious disease outbreaks globally, warned of “unexplained pneumonia” cases in Wuhan. The veteran infectious disease reporter Helen Branswell shared the news alert on Twitter the next day and said it was giving her “#SARS flashbacks.” That same day, Taiwan’s Centers for Disease Control — with its close contacts on the ground in China — fired off an email to the W.H.O. with its concerns that patients were being isolated in Wuhan — a clear sign of an outbreak with person-to-person spread.
On Jan. 11, 2020, a Chinese scientist bravely allowed an Australian colleague to upload the virus’s genome to a gene bank, without official authorization. This meant that the whole world could now see this was a novel coronavirus, closely related to SARS. The next day, the scientist’s lab was shut down.
Doubts over whether the virus was capable of spreading from person to person should have been swept away in mid-January 2020 by reports that a woman in Thailand and a man in Japan had tested positive without having been to the Wuhan seafood market that Chinese authorities had said was the center of the spread. Meanwhile, despite such clear evidence of the virus’s transmissibility, the number of cases that China reported remained at 44. (We’d later learn that medical professionals weren’t even allowed to report cases that weren’t connected to the seafood market.) Yet the W.H.O. kept repeating China’s line that there was no evidence of human-to-human transmission.
It wasn’t until China shut down Wuhan on Jan. 23, 2020, that the rest of the world could see how serious the threat was — even then, the global response remained feeble.
What could have happened: The world sees through China’s deception and takes action.
How could nations have gotten around China’s smokescreen? They could have done what Taiwan did.
On Dec. 31, 2019, the same day Taiwan officials sent that email to the W.H.O., they started boarding every plane that flew there directly from Wuhan, screening arriving passengers for symptoms like fever.
“We were not able to get satisfactory answers either from the W.H.O. or from the Chinese C.D.C., and we got nervous and we started doing our preparation,” foreign minister Joseph Wu told Time magazine.
Masks were rationed, to ensure there were enough for the entire population, and were distributed to schools. Soldiers were put on production lines at mask factories to increase supply. The country quickly allocated money to businesses that lost customers and revenue.
For most of 2020, Covid was rare in Taiwan. On 253 consecutive days that year there were no locally transmitted cases there, even though there had been extensive travel to China, including Wuhan, before January 2020. With extensive testing and tracing, they squashed two major outbreaks — one that started in March 2020, and more impressively, a major outbreak of the more transmissible Alpha variant in summer 2021 — bringing local cases back to zero. That shows what was possible with an early and robust response.
Taiwan has suffered 853 deaths. If the United States had suffered a similar death rate, we would have lost about 12,000 people, instead of nearly a million.
Taiwan shows that even in early January, there was enough information to be concerned about the virus, and the potential to suppress any outbreak.
What happened after the outbreak went global: The real contagious threat was ignored.
On the precipice of a pandemic, too many important officials failed to understand how the virus was spreading, despite emerging evidence, keeping them from effectively limiting its spread and costing thousands of lives.
On Feb. 3, 2020, the cruise ship Diamond Princess was ordered to stay in Yokohama harbor, in Japan, two days after a passenger who had disembarked in Hong Kong tested positive for Covid. After 10 other people on the ship were found to be infected, the ship was quarantined. Eventually there would be 712 cases, about 19 percent of those on board, with 14 deaths.
Nine public health workers attending to the ship were infected. It seemed quite unlikely, the Japanese virology professor Hitoshi Oshitani noted, that all these professionals with expertise in infection control had failed to take the recommended precautions.
At that point the guidelines from the W.H.O. and the Centers for Disease Control and Prevention were based on the assumption that this virus was spread by large droplets from the nose and mouth that quickly fell to the ground or to surfaces, because of their size. People were advised to keep enough distance from others to stay out of the range of these droplets, and to wash their hands in case they picked them up from surfaces.
If the workers became infected despite those precautions, and if passengers were infected even when they were quarantined, Oshitani suspected that the virus was probably spread by airborne transmission of tiny particles — aerosols — that could spread more widely, float around and concentrate, especially indoors.
This case for aerosol spread strengthened after 61 people attended a choir practice in Skagit, Wash., on March 10, 2020. The church followed droplet-based guidance by propping the door open so nobody would touch the door knob and avoiding handshakes or hugs. No one was six feet in front of the person suspected to have been the single initial source. Nevertheless, 52 people — 85 percent of those present — became infected.
Many Western experts, including in the United States and Europe and at the W.H.O., discounted these and other evidence of airborne transmission. Countries like the United States did not require masks to limit airborne spread but worried instead about germs spreading on people’s mail and groceries.
After more evidence, and organized attempts by hundreds of aerosol scientists, minor course corrections started later in 2020, but they were halting, incomplete and underpublicized. For example, it wasn’t until December 2020 that the W.H.O. started recommending that masks be worn indoors regardless of distance, and even then only if the space was poorly ventilated, and it wasn’t until December 2021 — two years after it all began — that it recommended highly protective masks for health care workers.
It was also assumed that only people with symptoms — like fever — would be infectious, even though evidence to the contrary had emerged early.
On Jan. 26, 2020, the Chinese minister of health gave a news conference warning that people without symptoms could transmit the virus. The same week an article in The Lancet had documented a case in which infection was visible in the lungs of a patient who had shown no symptoms. An article published in the New England Journal of Medicine, also the same week, noted cases presenting only mild symptoms, with the authors stressing that this would make it easy to miss them. Multiple reports from German scientists soon disclosed similar conclusions based on cases there.
However, many health authorities ignored, denied and even belittled evidence of spread without symptoms. It took until well into March for officials in the United States, for example, to accept that people without symptoms could be infectious.
The failure to acknowledge this type of transmission meant that the urgency for mass testing wasn’t realized and the virus spread silently, without critical precautions being taken, until explosive growth occurred in places like New York City. The need to identify and quarantine people who had come in contact with those who were infected was considered unnecessary and alarmist in the United States. The C.D.C. and the W.H.O. initially recommended masks only for the sick.
Another crucial misstep was the failure to recognize the virus’s dominant pattern of spread, in large bursts.
That February, Oshitani and his colleagues concluded that a vast majority of infected people didn’t transmit at all, while a small number of individuals were superspreading, in closed indoor settings like restaurants, night clubs, karaoke bars, gyms and such — especially if the ventilation was poor. They developed new approaches to trace infections to their origin, to find cluster transmission and thus look for other cases.
What could have happened: Officials put in place effective and early mitigation strategies.
The rest of the world could have understood the virus as Japanese officials did. Based on their understanding, which was arrived at in February 2020, that Covid was airborne, spread without symptoms and driven by clusters, by early March they were recommending mask-wearing, emphasizing the need for ventilation and advising the public to avoid the three Cs: closed spaces, crowded places and close-contact settings.
Americans, on the other hand, were disinfecting their groceries, and the W.H.O. kept emphasizing hand-washing and social distancing, or remaining six feet apart. Japan has had about 25,000 Covid deaths, which would be the equivalent of just under 66,000 in a country the size of the United States.
Mass testing could have detected people who were infectious before they even knew they were sick and sometimes those who never had symptoms at all. Ventilation and air filtration could have kept indoor spaces safer.
Instead of closing parks, activities could have been moved outside weather permitting, since natural ventilation more effectively dissipates the virus. The key role of masks would have been understood earlier, along with the benefits of higher quality masks. Rather than wasting money on plexiglass barriers — which can’t fully block aerosols and can even create dead zones for ventilation, increasing infection risk — schools would have begun updating their ventilation and HVAC systems, and installing HEPA air filters, which can filter viruses. Japan’s cluster-busting strategy could have been adopted.
Also, even though epidemics are easier to suppress with early action, it’s silent spread and superspreading that make a timely response even more important, as shown by South Korea’s early response.
South Korea experienced major superspreading events in February 2020, including one in a secretive church that accounted for more than 5,000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.
South Korean officials sprang into action, rolling out a mass testing program — they had been readying their testing capacity since January — with drive-through options and vigorous contact tracing.
South Korea beat back that potentially catastrophic outbreak, and continued to greatly limit its cases. They had fewer than 1,000 deaths in all of 2020. In the United States, that would translate to fewer than 7,000 deaths from Covid in 2020. Instead, estimates place the number of deaths at more than 375,000.
She concludes with this:
What needs to happen
When the pandemic is over, the temptation will be to move on and reclaim what had been normal life. For individuals that will be fine. But the cracks revealed in our governments and public health institutions by two years of inertia, mistakes and resistance to evidence make it crucial that a broad, tough dissection of what happened take place if we are to choose the correct course in future challenges.
National and international commissions need to help us see where we went wrong, without scapegoating, and how to respond to future outbreaks, without defensively excusing what public health authorities and national leaders did this time, even if well-meaning. In some countries, it would be easy to focus only on political leaders like President Donald Trump, who severely damaged America’s response. But top public health officials, high-level scientists and state governors made many missteps along the way. At a time of growing international distrust we need to work to increase trust and mutual cooperation. We need to better understand how to rapidly incorporate evidence into scientific policy and to better understand human response to such major, complicated events.
If we can do that, to save lives and ease suffering in the future, it will not make up for all the loss and hardship we have endured in the last two years. But we can at least say we did our best to learn from it, and let that be the one positive legacy of all this.
The congress just removed all COVID funding from the omnibus spending bill for 2023. The Republicans refused to participate en masse unless states were forced to return any unspent money from previous relief bills (and there was only a small handful that agreed even then) — and the Democrats from those states balked so that’s that.
What are the chances the US and the world does any of what Tufecki suggests? As far as I can tell the decision has already been made that we are going to tolerate hundreds of thousands of deaths any time a COVID-19 variant or even a new pandemic comes along. It’s every man for himself. (Thank goodness for the vaccines.)