Many U.S. health experts underestimated the coronavirus — until it was too late
A patient is admitted to the intensive care unit to be intubated and put on a ventilator at the Providence Saint John Health Center in Santa Monica. (Francine Orr / Los Angeles Times)
A year ago, as Americans finished their vacation shopping and finalized travel plans, doctors in Wuhan, China were battling a mysterious outbreak of pneumonia for no known reason.
Chinese doctors began to fear they would be witnessing the return of Severe Acute Respiratory Syndrome (SARS), a coronavirus that emerged in China in late 2002 and spread to 8,000 people worldwide, killing nearly 800 people.
The disease never took hold in the US and disappeared by 2004.
But SARS cast a long shadow that showed how many nations - and US scientists - were reacting to its far more dangerous cousin, the novel coronavirus that causes COVID-19.
When Chinese officials announced that their pneumonia outbreak was caused by another new coronavirus, SARS-hit Asian countries knew what to do, said Dr. Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security. Taiwan and South Korea had already learned the importance of a quick response, which included extensive testing, contact tracing and isolating infected people.
In contrast, the US had learned the wrong lessons.
The 20 years of happiness in this country with emerging pathogens - including not only SARS, but also the relatively mild H1N1 pandemic, the respiratory syndrome in the Middle East, Ebola, the Zika virus and two strains of bird flu - gave us a “false sense of security “", Said Adalja.
Many leading infectious disease specialists underestimated the rapid outbreak in the first few weeks and months, assuming the US was largely unharmed again. American hubris prevented the country from responding as quickly and effectively as Asian nations, Adalja said.
For the first two decades of this century, "there were many fire alarms without fire so people ignored this one," said Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law in Georgetown, who recognized that he had the virus in the United States first weeks underestimated.
In January, Dr. William Schaffner was one of many who warned that the real danger to Americans is the flu, which can kill up to 61,000 Americans a year.
"Coronavirus will be a slip on the horizon by comparison," said Schaffner, professor of preventive medicine and health policy at Vanderbilt University Medical Center. "The risk is trivial."
Dr. Paul Offit, who led the development of a rotavirus vaccine, predicted that the coronavirus, like most respiratory diseases, would fade over the summer.
"I honestly can't imagine that it would do even a tenth of the damage that influenza does in the US every year," said Offit Christiane Amanpour when appearing on PBS on March 2nd.
Caitlin Rivers, an epidemiologist and assistant professor at the Johns Hopkins Bloomberg School of Public Health, was concerned - and tweeted - about the novel coronavirus from the start. However, she says public health officials are trying to balance those fears with the reality that most small outbreaks in other countries don't typically turn into global threats.
"If you cry wolf too often, people will never pay attention," said Mark Wilson, epidemiologist of the University of Michigan School of Public Health.
Many experts have been victims of wishful thinking or denial, said Dr. Nicole Lurie, who served as Assistant Secretary for Preparedness and Response during the Obama administration.
"It's hard to think of the unthinkable," said Lurie. “For people whose focus and fear was bio-terrorism, they had a worldview that Mother Nature could never be such a bad actor. If it wasn't bio-terrorism, it couldn't be that bad. "
If more experts had seen what was coming, the nation could have been far better prepared. The U.S. could have had a head start in manufacturing personal protective equipment, ventilators, and other consumables, said Dr. Nicholas Christakis, author of "Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on Our Lifestyles".
"Why did we waste two months that the Chinese essentially bought for us?" asked Christakis, a doctor and sociologist at Yale. “We could have put billions of dollars into testing. We could have had better public news than we were attacking. ... But we weren't prepared. "
Dr. Anthony Fauci, the nation's leading infectious disease official, is not that critical. He said there was no way for scientists to predict how dangerous the coronavirus would become, given the limited information available in January.
"I wouldn't criticize people who said there was a pretty good chance it would turn out to be SARS or MERS," said Fauci, director of the National Institute of Allergies and Infectious Diseases, noting that this was "a reasonable one Was assumption. " ”
With hindsight, the solutions are always clearer, Fauci said, adding that health officials lose credibility if they react to every new germ as if it were a national disaster. He has repeatedly said that scientists need to be humble enough to realize how little we still know about this new threat.
"You can say we should have closed things much earlier because of the quiet spread in the community," said Fauci. “But what would the average man or woman on the street have done if we had said,“ You have to close the country on three or four cases? '”
Scientists say their response to the novel coronavirus would have been more aggressive had people realized how easily it spreads even before infected people develop symptoms - and that many people remain asymptomatic. "For a virus to have a pandemic potential," said Adalja, "this is one of the greatest assets it can have."
Although the coronavirus has a lower death rate than SARS and MERS, its ability to spread silently makes it more dangerous, said Dr. Kathleen Neuzil, director of the Center for Vaccine Development at the University of Maryland School of Medicine.
People infected with SARS and MERS are not contagious until they start coughing and have other symptoms. "When people got sick," said Christakis, "they got pretty badly sick and went straight to the hospital and didn't go around to transfer it."
Based on their knowledge of SARS and MERS, which are also caused by coronavirus, doctors initially believed that they could contain the new virus by telling sick people to stay at home. In addition, it did not seem necessary for healthy people to wear masks. This prompted health officials, including U.S. surgeon General Jerome Adams, to admonish Americans not to buy up limited supplies of face masks that hospitals badly needed.
Many scientists were skeptical of early anecdotes of the pre-symptomatic spread. However, as evidence of pre-symptomatic spread accumulated, the Centers for Disease Control and Prevention changed their advice in April, urging Americans to disguise themselves publicly.
The CDC's initial advice against wearing masks was based on research found to be ineffective against the spread of influenza, Adalja said. However, new research has shown that masks reduce the transmission of the novel coronavirus, which mainly spreads via respiratory droplets but can move in the air as tiny particles.
Adalja said the US should have learned from its early stumbling blocks. Despite abundant evidence, many communities still oppose mask application or physical distancing.
"I am still amazed that we keep making the same mistakes," said Adalja. "It's almost like we're doomed to repeat this cycle forever."
There were experts who immediately recognized the threat posed by the novel coronavirus.
One of them was Dr. Daniel Lucey, Associate Professor of Infectious Diseases at Georgetown University Medical Center. In a Jan. 7 post on a website for the Infectious Diseases Society of America, Lucey referred to pneumonia as "Disease X," using the WHO term for a newly emerging pathogen that can cause a devastating epidemic for which there is none Tests, treatments or treatments gives vaccinations.
Adalja was another early voice of concern. He started blogging about the virus on January 20th.
"We had to react immediately, as if this would hit every corner of the world," he said. It was clear, "this was not a containable virus."
He would know. In 2018, he led a project to identify the characteristics that can turn emerging viruses into pandemics. He and his co-authors stressed the threat posed by certain respiratory viruses that use RNA as genetic material.
The more Adalja learned about the novel coronavirus, the more it seemed to embody the very kind of threat he had warned about: one with "efficient human-to-human transmission, a significant death rate in cases, the lack of an effective or widely available one medical countermeasure, an immunologically naive population, virulence factors that allow the immune system to be bypassed, and the way the airways spread. "
Although the CDC set the wheels of their response in motion early and set up an incident management structure on January 7, the agency botched its test approach. The outbreak quickly escalated, causing the World Health Organization to declare a health emergency on January 30 and the US to declare a health emergency the next day.
Adalja and other experts dismissed some of the Trump administration's early responses, such as quarantines and a travel ban to China, as "window dressing" that "wasted resources" and did little to contain the virus.
Lucey noted that misinformation from Chinese officials hampered the international response. "The Chinese government said there was no person-to-person spread," he said. "That was a lie."
When China announced on Jan. 20 that 14 health workers were infected, Lucey knew the virus would spread much further. When the number of infected health workers rose to 1,716 on February 14, "I almost vomited."
Dr. Barney Graham of the Vaccine Research Center speaks to President Trump and Dr. Anthony Fauci at the NIH Viral Pathogenesis Laboratory. (Evan Vucci / Associated Press)
At the National Institute for Allergies and Infectious Diseases, scientists had studied the protein structure of coronaviruses for years.
Researchers had developed a vaccine against SARS, Fauci said, although the epidemic ended before researchers could fully test it in humans.
"We kept the vaccine refrigerated," he said.
Dr. Barney Graham, deputy director of the National Institutes of Health's Vaccine Research Center, asked Chinese scientists to share the coronavirus genetic information. After the genome was published, Graham immediately got to work.
Although Graham's team was concerned about how to pay for the research, Fauci told them, "Don't worry about the money. I'll find it."
This work was instrumental in developing the two COVID-19 vaccines that are currently being rolled out nationwide.
Health experts hope the US will learn from its mistakes. For Dr. Tom Frieden, who headed the CDC during the Obama administration, is the most important lesson: "We can't be so unprepared again."
"This should be the most educational moment of our lives," he said, "in terms of the need to strengthen public health in the US and around the world."
Dr. Celine Gounder, an infectious disease specialist who advises President-elect Joe Biden, said given the number of novel viruses over the past two decades, it was likely that "pandemics will become more common." However, US public health funding tends to follow a cycle of crisis and neglect.
"We tend to invest a lot in this moment of crisis," said Gounder. “When the crisis fades, we've cut the budget. That makes us really vulnerable. "
Liz Szabo writes for Kaiser Health News, a nonprofit health news service. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
This story originally appeared in the Los Angeles Times.
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