30 years of fighting destined to stop the pandemic

In hindsight, it is difficult to re-watch the video and read the Trudeau Cabinet Minister ’s talk, and speak to reporters during the entry and exit of the “Question Period” on March 10, without fear and frustration .

A journalist trapped by the prime minister enters the temporary lower chamber of the parliament ’s western district. "On the subject of COVID-19, many Canadians came back from overseas. They were surprised to see that the airport had almost no problems and almost no posters. Was there any slack?"

"On the contrary," Justin Trudeau answered . "We are providing Canadians with all necessary instructions to ensure safety. We are confident in people ’s efforts because we are providing them with the necessary information.

Less than a week later, Nova Scotia and Albert The terrified provincial government and the mayor of Montreal will start sending their employees to the airport to make up for the failure of the federal government.

Foreign Minister François-Philippe Champagne said that he and The Italian colleague was on the phone, and the Italian colleague was being hit by the worst outbreak of coronavirus to this point. This must have cheered up another reporter's ear. "Are you thinking about something similar to Italy?

"No, no, no, no," Champagne said. "The situation in Italy is completely different from the situation we are in." Is he careful when traveling to avoid infection or spread the infection? He said: "I want to pay more attention, but you know, this is shaking hands in my DNA."

Nine days later, Champagne announced that he had isolated symptoms after mild symptoms after international travel. Fortunately, he tested negative for the virus. On March 10, Italy passed 10,000 cases of the diagnosed virus There were 631 outbreaks, and 631 people died. Canada will pass these two numbers within 31 days.

In the speech of the Minister of Health Patty Hajdu, a reporter coughed. There were nervous laughter everywhere, Hajidu reminded Everyone, it is safest to cough to the elbow and stand at two meters. No one is doing it in the hall of the House of Commons. She added twice: "But I also want to remind Canadians that the risk is very low now.

A briefing prepared for Hajidu that day was distributed to the House of Commons Health Committee, and the statement about low risk is exactly the same. The memo points out that there are only 12 cases of COVID-19 in Canada. But this is not true. In fact, as of March 10, there have been 97 cases. An elaborate government agency is providing the Chief Minister with increasing public health crisis information, which has been out of date for two weeks.

March 10 is Tuesday. On Thursday evening, Trudeau had expected the town's prime ministers to hold their first ministerial meeting. The first draft of the agenda has been sent to the prime ministers of the provinces, put on hold by Maclean at all 25-minute meetings on Friday and Friday to discuss the coronavirus, followed by an equal or longer meeting to discuss the February protests on rail transport Interference; economic competitiveness; climate change; northern priorities; and health care. A confused reporter asked around: As the crisis develops, is the agenda definitely changing? Provincial sources say no.

There will eventually be no meeting. The prime minister began to cancel flights. Trudeau announced on Thursday that he was isolating himself after his wife Sophie returned from London with a fever. Last Friday, her diagnosis was positive. The House of Commons passed three bills without reading them and adjourned the meeting indefinitely. The rest is the story of your own life, because that's when almost everyone in the OECD starts to work from home and avoids neighbors.

Nevertheless, you will be disappointed or at ease. The memory is still fresh, and the steps are faltering. This is not a story of trying to push Justin Trudeau to a global pandemic. "Severe Acute Respiratory Syndrome Coronavirus 2", which uses the beast's official name, has skipped many international firewalls before it begins to cause serious damage to Canada. Next to Donald Trump ’s United States, the most failed example of institutional failure and leadership abdication occurred, with a much higher proportion of labor costs than Canada.

The grim insights afterwards found that people are easy to find signs of slack. over.

Two days are dedicated to the March 10 problem period, not for hard-working opposition attempts to take action in the federal plan to contain the epidemic, but for a bleak game of blame to deal with a more serious budget deficit Case. Later, Ontario Prime Minister Doug Ford told Spring Break tourists "have fun" and "go away".

Four days after Ford reported the coronavirus to the media at Queens Park in Toronto on March 11, 2020 [Cole Burston / Bloomberg / Getty Images]

New York City Mayor Bill de Blasio (Bill De Blasio) 's predecessor spent 20 years dealing with sudden and shocking chaotic consequences. He worked on YMCA on the park slope as if nothing had happened. Jonathan Rose, a former senior assistant at De Blasio, tweeted that the mayor ’s trip to the gym was “frustrating. Self-involved.

You do n’t even need to pay attention to politicians to find limited examples of insight. On March 9, the day before the ministers quarreled in Ottawa, the Globe and Mail published an insightful article by Richard Schabas. Richard Schabas is an Ontario The provincial chief health officer for ten years, so it seems to know only one or two things. The title of this article is "strictly by number, coronavirus has not been recorded as a terrible global crisis. "The tired tone of entertainment continues throughout the process. COVID-19 is" an incredible contraction pandemic. "Shabas wrote:" Is COVID-19 a global crisis? "

Once humanity, the scale of economic and social disasters became apparent. In the second half of March, journalists can browse academic records to find examples of attempts. This is a movement. Researchers and public health officials warned the government that such things might happen.

The New York Times reported on a months-long simulation conducted by the US Department of Health and Human Services from January to August last year. Imagine a respiratory virus that appeared in China and spread through air traffic to reach the United States. The code-named "Crimson Infectious Disease" simulation found the struggle between the federal departments, the brutal competition in medical equipment among the states, and the hasty implementation of social medical equipment.

The Globe and Mail discovered a 2006 “Panadian Health Department Pandemic Influenza Plan”, which was prepared with strong support from the federal and provincial governments. Co-authored by Theresa Tam, the future Chief Public Health Officer of Canada, and promoted under the heading: "Ottawa had a script similar to the coronavirus pandemic 14 years ago. What went wrong?"

These unwarranted early warnings can certainly be asked. However, when I started reading the academic literature on emerging diseases, I found that these simulations and plan drafts were too much. Before finishing this story, we will discuss some more. In hindsight, everyone seemed to have lost the opportunity to defend against disaster.

As a unique discipline, imagination and attempts to counter strange new infections have been around for thirty years. The term "emerging virus" was coined in 1990. Researchers and governments are committed to understanding these unfamiliar threats, developing a global early warning system, and developing an international rulebook that triggers government responses. The authorities have sufficient opportunities to test their response to the annoying real world reaction. SARS broke out in Toronto in 2003; swine flu broke out in Mexico in 2009.

Finally, it didn't help much.

Kenneth Bernard (Kenneth Bernard) is a retired major general of the United States Public Health Agency, to senior rank and uniform officials until the surgeon. He conducted a pandemic preparedness under the leadership of Presidents Bill Clinton and George W. Bush. He said in a telephone interview: "What you are seeing now is not the result of a large amount of intellectual investment to respond appropriately." "What you are seeing now is, 'Oh, my God. What's going on? We must Close everything until we can figure it out. 'This is not a complicated intellectual response. That is' 'The ship is sinking, plugging holes'.

"It is very important to see this. I mean, this is not what people plan to do. "Here, he stopped and smiled bitterly." Shut down the world economy, make millions of people unemployed, and reduce our GDP by 15%. This is not a good plan idea.

***

In the decades after its establishment in 1948, the World Health Organization has focused on familiar, idle work. For centuries, diseases that have killed tens of millions of people, especially in developing countries: cholera, plague, yellow fever, smallpox. These tools are often (and still are) unremarkable: vaccination, hygiene, mosquito and mouse control. Progress is slow-the disease is always larger than the doctor can call a larger army-but it is often measurable. In 1980, the World Health Assembly announced that smallpox had been eradicated.

But there are new diseases. With the mutation of the virus and changes in human development, the landscape has always existed, thus providing new opportunities for old insects. But in the 1970s, such incidents occurred more and more frequently. Rift Valley fever killed hundreds of people in Egypt in 1977 and Kenya in 1998. Dengue fever is a mosquito-borne virus that may have a history of thousands of years. During World War II, dengue fever dispatched troops through the South Pacific discovered a large number of new human hosts. The Hantaan virus killed hundreds of American and North Korean soldiers during the Korean War.

But the outbreak that changed everything was HIV. By the end of the 1980s, tens of thousands of known cases of AIDS, and the increasing number of deaths, until today, more than 30 million people have died. When the HIV spread in North America and Europe, it shocked public health officials and medical researchers, who began to wonder what infectious diseases might happen next.

In May 1989, the National Institutes of Health funded an "Emerging Viruses: The Evolution of Viruses and Viral Diseases" in Washington, D.C. The purpose of which is to discuss the causes of all new errors, find their systems early and reduce The mechanism that slowed its progress. But Joshua Lederberg ’s opening keynote gave a foresight to pessimism.

Lederberg proved in 1958 that bacteria can mate and exchange genes. He won the Nobel Prize in Medicine in 1995. He has served as the scientific adviser to the President of the United States in various capacities since 1950, when research and development helped consolidate the status of the United States as one of at least two outstanding global superpowers. [19659002] "Someone may say that AIDS keeps us alert to new viruses," Lederberg said. "I hope that is true. Others say that we are much better than sitting down and waiting for an avalanche. I am afraid this view is closer to public policy and the response of the world's major health institutions, and even today, it is closer to the prospect of sudden illness.

The organizer and chairman of the conference is Stephen S. Morse (Morse) is now a professor of epidemiology at Columbia University. Morse coined the term "emerging virus" for the source of these new diseases. Sometimes, these viruses are indeed new viruses, which are the products of rapid and continuous mutations, because these original genetic material mutants form countless scattered copies of themselves in the host body.

"Surprisingly, the occurrence of diseases often It is caused by human behavior, "Morse wrote in a 1995 paper that the viruses are ancient, but they are only growing. Published by the Centers for Disease Control, new infections occur. The population is growing Quickly expand into new land and innovate new ways of building, farming and fighting, the more frequent new or unfamiliar infections appear. Morse writes: "Perhaps most surprisingly, pandemic influenza seems to have originated For agriculture, it is a comprehensive duck-duck farming in China. "Waterfowl are usually hosts for influenza viruses that do not harm humans. Pigs can be infected with human and avian influenza. Raising pigs and ducks together is an effective method to spread new influenza viruses from birds to people.

However Influenza expert Morse almost ignores the threat of other pathogens. AIDS may come from Zaire. Trouble may come from anywhere. He wrote: "If we want to protect ourselves from emerging diseases, it is essential The first step is to monitor global diseases to give early warning.

A member of an AIDS activist group protested at the Food and Drug Administration headquarters in October 11th, 1988, Rockville, Maryland, USA (Catherine McGann / Getty Images)

Government interests vary It ’s uneven, and the scientists themselves created the early warning system. In 1994, a virologist named John Payne Woodall launched a monitoring of emerging diseases under the auspices of the American Federation of Scientists. Plan, the plan is ProMED. Woodall died in 2016. StephenMorse was one of his colleagues who initiated ProMED. The project was originally composed of a network of 60 hospitals and research institutions all over the world, these networks can discover new epidemics, Identify its possible cause and spread it widely.

This is a small attempt. In 1994, it was not even obvious how the fledgling trap line would communicate. Morse recalled in a telephone interview in New York: "Russians There are fax machines, but they have no money to fax paper. "The Japanese want to use Telex."

Finally, the group decided to use e-mail, which was a bold choice. At that time, if an organization was indeed connected, the acoustic telephone coupler was the preferred method of connecting to the Internet. "E-mail is a very Painful thing.

ProMED has never developed a very short origin. However, because it provides global coverage, local analysis capabilities in hundreds of locations, and is free to everyone, it is still a valuable sentinel network. The notice on ProMED first shocked the world about the SARS outbreak in 2003, which was released by ProMED on December 30, 2019-about the chat sound on the Chinese social network Weibo-initially a new coronavirus was spread as a COVID The cause of -19 is outside China.

Rumors of a new global infectious threat are useful over and over again. But this is never enough. In a paper describing the introduction of ProMED in 1996, Morse wrote: "The resources available for emergency response worldwide are very limited." Without resources for response plans and implementation of these plans, the public will be at a loss.

It will take time for the government to understand this danger. Moreover, as a very strict rule, every new government must relearn this course.

You have seen Kenneth Bernard, an outspoken former White House official. His training and interest in infectious diseases made him a unique qualification for a series of national security jobs that he did not really understand at first. Throughout the 1980s, he worked in the CDC's International Viral Diseases Department. He studied international public health at the London School of Hygiene and Tropical Medicine, a school that can only exist in the predecessor of the global colonial empire. He had served as an advisor to the Peace Corps, and in his words, "basically a help desk official in charge of relations between the United States and the World Health Organization."

As this task was about to end, Bernard Bill Clinton ( Bill Clinton Minister of Health and Human Services Donna Shalala told Bernard to report to the organization. The National Security Council is opposite the White House.

"At first, no one knew why I was there," Bernard wrote in an article in the 2018 Washington Post. But in the end, Clinton's national security adviser "Sandy" Berger explained that compared to most wars, global health threats may kill more people and destroy more government power. Berger wrote that writing the disease as a "soft" problem, "turn a blind eye to hard reality."

It was obvious enough for Sandy Berger. Not so for his successor. George W. Bush took office in 2001 and closed the health and safety office established by Ken Bernard on the National Security Council.

Bernard worked with heart and lung transplant surgeon Bill Frist, a former Republican Senator of Tennessee. But he will not spend a long time in the wilderness, because in 2001, Al Qaeda terrorists killed thousands of people at the World Trade Center and the Pentagon, and then someone mailed anthrax spores across Washington, killing 5 people.

Suddenly, the link between infectious diseases The diseases and national security that Clinton occasionally sees are neon to Bush. Hostile enemies can provide weapons for infection. Otherwise, without human help, the infection may kill hundreds of thousands. Tom Ridge, the first secretary of the Department of Homeland Security, called Bernard back to the National Security Council, where he established a large, well-funded health care office.

Bush announced plans to start vaccinating American soldiers and civilians against smallpox. On December 13, 2002, in Washington, DC (Mark Wilson / Getty Images)

Therefore, when the United States released the National Pandemic Influenza Strategy on a dark red, white, and white background on November 1, 2005 》 The cover is blue with the opening letter of the president himself. "My American," Bush wrote. "In 1965, nature again brought us a formidable challenge: the possibility of an influenza pandemic."

Bush's strategy was closely followed by an implementation plan and a large budget to support it. By 2007, Morse was able to write that, contrary to "the typical characteristic of past plans was the neglect of optimism", there is now real progress. The Bush administration provided financial and technical assistance to WHO to improve surveillance. The example in the United States prompted other countries to develop their own pandemic plans.

But researchers are beginning to realize that if the vaccine is not ready and the antiviral drugs are not working, the only way to contain the outbreak is their so-called “non-pharmacological initiative” or NPI: physical measures to prevent spread, These include suspension of classes and business, coughing or sneezing into the elbow, etc. CDC has a plan document about NPI. It said that they need to be applied quickly, to maximize their effects, and to be layered, which means that multiple such measures need to be used simultaneously.

The Centers for Disease Control and Prevention can still be traced back to 2007, and people do not want any one. Extensive isolation will bring "huge challenges and social costs." But there is no reason not to do so. Just like during the influenza pandemic of 1918-19, local communities will still do the same. However, if left to their own equipment, towns and states will implement NPI in an “uncoordinated, untimely and inconsistent manner”. The CDC wrote that this would cost the economy as much as the planned isolated strategy, but the efficiency would be greatly reduced.

Another danger, and even greater danger, is that the Bush administration has started a sprint, but nature may prefer a marathon. If the next outbreak is not a year, but a decade, what should I do? "Perhaps the most important It ’s sustainability, ”Morse wrote.“ The public will eventually lose interest in the imminent threat that is about to occur.

Canada has experienced almost the same thinking process at the same time. In the United States-inspired simulation, part of the reason is fermentation after 9/11. But so far, the bigger stimulus is a short, terrible outbreak, which makes A generation of public health doctors feel their reaction: SARS broke out in Toronto in 2003.

SARS is a terrible test, but to some extent, it predicts what a great prediction. Coming soon: new from China Influenza caused by a new coronavirus, which is spread by sneezing and coughing. When the WHO advises not to travel to Toronto unnecessarily, Toronto city authorities fought fiercely to contain the outbreak and economic shock. Eventually, the virus 44 people were killed.

David Naylor was the head of the Department of Medicine at the University of Toronto, when Jean Chrétien ’s Minister of Health Anne McLellan appointed him to lead The investigation of the outbreak of SARS. He will continue to serve as the president of the university. Naylor ’s report “Learn from SARS The Update on Public Health in Canada calls for comprehensive reforms to enhance Canada ’s ability to respond to future outbreaks. Its core recommendation is to establish a new Canadian public health agency. That was followed. The rest of the report is much less.

It seems Naylor did not see it coming. In 1993, HIV led Health Canada to organize a meeting of Canadian and international experts on emerging infectious diseases in Lac Tremblant, Quebec. The earlier meeting called for “surveillance and control of emerging and recurring The national strategy for infection ”and“ the ability and flexibility to investigate outbreaks. ”Ten years later, Naylor wrote bitterly:“ A lot of similar recommendations are repeated in our report. "

The system envisaged by Naylor and his colleagues will be strongly supported and ready at any time-" SARS shows that we have been in a short course of development away from serious epidemics ", and continue to check. Such in Canada In the United States, the role or communication that needs to be clarified will be interrupted. The report calls for “a comprehensive procedure for outbreak management, and then conduct training exercises to test the procedure and ensure a high degree of preparation. "

A hospital worker stood at the entrance of the Toronto General Hospital, wearing clothes to prevent the onset of SARS. April 28, 2003 (David Lucas / Getty Images)

For a while, Momentum during the outbreak of SARS in Canada continues. Prime Minister Paul Martin appoints Carolyn Bennett as Canada ’s first Minister of Public Health. At the end of the Canadian government ’s short term, Canada ’s Public Health The Bureau is ready to start work. In the fall of 2006, one of its first products was the 550-page report “The Canadian Pandemic Influenza Program of the Health Department” published by the Globe and Mail in March this year. [19659002] This is a very comprehensive document. Health care personnel are told to detect “non-traditional sites” such as schools, gymnasiums, and day care centers a long time in advance, in order to prevent the health care system from being overloaded. There are separate targets for indigenous communities There is a list of plans with a clear warning in the title: "The healthcare system may be overwhelmed. "The usual supply line will be interrupted." "It may not be possible to obtain a pandemic vaccine." "And for readers who think the whole story is about what has happened rather than what might happen next," Popularity will happen in the form of waves. " "

However, the most important words in the document may appear on the copyright page in exquisite words." The plan is for reference only to support the consistent and comprehensive plan of the government and other stakeholders. " "

It is not enough to make a plan. The government needs to develop habits through practice and thorough self-assessment. As time passes, other more familiar government habits gradually become a reality.

***

"When I was Minister of Health, I was shocked that I would attend an international conference," Jane Philpott's Justin Trudeau's Health from 2015 to 2017 The minister said in a telephone interview. "[the agenda for] Every international health ministers meeting is prepared for a pandemic. Or at least everyone I've been to. I went to the G7, G20, Commonwealth, OECD.

Half a day is serious real estate at any international conference. This indicates that priority should be given to planning for a serious epidemic. Philpott's memory is accurate. The first item in the communiqué of the G7 Health Ministers ’Meeting held in Kobe, Japan in 2016 was to prepare for a global public health emergency.

At the G20 Health Ministers ’Meeting in Berlin eight months later, the ministers carried out a careful simulation-responding to the outbreak. They showed them a video recording of archived videos of smallpox patients and Ebola crew members wearing goggles and rubber uniforms. "Fear. Panic. Free fall," the voice in the video declared. "Where will the next epidemic occur? What price will we pay?" A 40-page manual guides the ministers through a series of decision-making activities.

But then they all went home. When Philpott returned to Canada, neither the MPs in the House of Commons nor the reporters in the lobby outside exerted pressure on her infectious disease plan. "I do n’t think Canada is a government in which when the Minister of Health returns from the International Conference of Ministers of Health, the media or anyone else is eager to know what you are talking about. Or what you will learn here

This is what every member of Maclean with public health experience has in common in the comments: In the long run, there has never been too much political motivation to concentrate on planning to cause an infectious outbreak. At some point, People will feel the danger, but when the authorities expect the danger to happen, there will be very few outbreaks. Eventually, for human reasons, people will pay attention, as experts often warn.

Pierre-Jeril Forest Dean of the School of Public Policy at the University of Calgary. Prior to that, he was in charge of the Institute of Health and Social Policy at Johns Hopkins University in Baltimore and operated pure Pierre in Montreal. · Pierre Trudeau Foundation (Prince Trudeau Foundation). Prior to that, he founded Martin by Martin and Harper. Chief Scientist of Health Canada during the Public Health Bureau. He has been an informal adviser to a series of federal health ministers. He has been in contact with the health department working from 2004 to 2006, following the outbreak of coronavirus in February Spread, he was reminded that many officials are generally unfamiliar with the field of infectious diseases.

"Forrest said that the science of the federal health department is" very narrow. " “It ’s almost non-existent in Health Canada, and it ’s also narrow in [Public Health]. They do n’t know who to follow on Twitter. They do n’t know which experts in the US to contact to understand how they should respond. They have everything. No. Partly because of capacity issues. This is not their fault. This is the fact that we have allowed the agency to invest in very different activities from the beginning. "

After all, public health agencies bear countless responsibilities. Often, it helps guide people to fight obesity, smoking, malnutrition and sedentary lifestyles-whether or not this year's pandemic is a real threat to well-being. PHAC has also been busy with a wave of opioid overdose deaths for five years, which has severely affected Canada and the United States. As of mid-April, opioids have killed 10 times more Canadians than coronavirus since 2016. Bed bugs kill people faster, but drugs do harm longer. When Philpott appointed Theresa Tam, who was actually an infectious disease expert, to lead PHAC in 2016, the only specific health challenge mentioned in the press release was opioids.

And public health institutions are not even in the center of opioids. Forrester said that is the view of most federal health ministers. "When they are appointed, they tend to think they are ministers of the Canadian Health Act," which requires universality and public access in the provincial health system in exchange for federal transfer payments. "They think they are responsible for health care in Canada.

Justin Trudeau has so far given his three health ministers (Philport, Guinette Petipas Taylor and Hay) Du) The mandates are all public. This makes it difficult for them to understand their real mission. Their constitutional responsibility is public health. No one mentioned preparing for an outbreak of infectious diseases. But this is hardly the Liberal Party ’s supervision. There is no mention of pandemic precautions on the federal conservative platform in 2019. In the 2015 and 2019 elections, there were a total of nine federal leaders ’debates. The reporters did not ask any questions about doing for the global flu outbreak. The question of preparation.

But of course they did n’t: there are always obvious mistakes to be noticed. As a military commander, Dwight Eisenhower used to divide the mission into two dimensions, namely the urgency of the mission And importance. Urgent and important things-nationwide railroad protests, saving the North American Free Trade Agreement-always threaten to devour the government All attention. Urgent but less important things can be delegated to more subordinate personnel. The things that are neither urgent nor important can be ignored.

The things that are important but not urgent need to be written into a schedule , then guarded against encroachment. Too often they get swamped by today's crisis. This helps explain why ambitious politicians in Canada rarely learn French even though they know it would improve their viability for national leadership. They're too busy putting out fires. And it explains why federal officials so often seemed to be reading from an unfamiliar manual as they dealt with the coronavirus. It's because they were.

I called Kenneth Bernard, the guy who ran disease security offices in the Clinton and Bush administrations, because of that 2018 article he published in the Washington Post. It ran after Donald Trump and his national security advisor, John Bolton, shut down the Office of Global Health Security at the National Sec urity Council. Trump defenders say the capabilities of the office were simply shuffled elsewhere in government. People who actually worked with the office say it hasn't been the same since. “We worked very well with that office,” Anthony Fauci, the distinguished epidemiologist who advises Trump, told a congressional committee in March. ”It would be nice if the office was still there.”

But Bernard's point was that Trump wasn't the first to shut down such an operation. George W. Bush shut down Clinton's disease security shop, then opened his own after 9/11. Obama shut down Bush's operation, then opened his own, under a biologist and career national-security civil servant named Beth Cameron, after 2012.

This Groundhog Day pattern of erasing earlier gains must be frustrating, but Bernard believes it's human nature. “No one in the national-security realm likes dealing with public-health officials. They just don't want to do it. If they'd wanted to do it, they would have become doctors or epidemiologists. But national-security people like bi-national, confrontational politics. They like chest-thumping, big-boy stuff. They don't deal with little things like climate or human rights. ”

Bernard asked me whether I've ever had serious surgery done. No, I said, but family members have. “All right. Take the personality of your big-time surgeon and tell them that they're now going to become a pediatrician for six months. Can you imagine that personality sitting, talking to moms and screaming kids all day long? I can't. ”

He mentioned Bill Frist, the Tennessee Republican Senator he had briefly worked for.“ Bill Frist , he's a wonderful man. But, you know, he's a surgeon. 'I came, I saw, I cut, I cured.' That kind of thing. And the same thing goes on with the whole community of national-security people. This isn't their cup of tea. Planning for a pandemic is not a national-security person's ideal way to spend the day. ”

Sure, but most heads of government don't have careers in national security behind them. Clinton, Bush, Obama, Trudeau—they're civilians without a soldier's chip on their shoulder about public health . Why can't the pandemic experts hold those leaders' attention either?

"Public-health people have for years ruined their own advocacy," Bernard said. "And the way they did that was, in an attempt to be relevant , or to prove that they're relevant, they would tell their bosses, 'Look, these are complicated issues, these public-health issues. You need to have me in the room. I need to be the one who makes the decision. Because these are health issues, and you know, the average lawyer, politician, can't make these important decisions.' Which of course is bullshit. But the public health people kind of advanced that, because it made them more important in the room .

“What has happened is, when you take an issue and you tell this political person, the prime minister or the minister or whoever it is at the top, ‘This is a really important issue but you really can’t make the decision without my input because you really don’t understand this well enough,’ what do the people do at the top? They relegate the issue to a secondary place.”

“And the reason they do that is just human nature and psychology. ‘If it was important, I’d be making the decision. I’m the prime minister.对? So if you’re telling me that I should not be making the decision, you’re telling me it’s not important.’”

This sounds like more of a systemic analysis than simply chalking it up to the President of the United States being in the wrong job, I said.

“Yes, well, the guy is in the wrong job,” Bernard said. “He did a terrible job in the first month of this. He closed down travel from China, which was good. He continues, in every news conference you hear, to take credit for doing that. The problem was, he assumed that would solve the problem. Which is idiotic. The fact is, there was no chance to stop the influx of coronavirus into the United States. You couldn’t just close travel from Wuhan, that’s ridiculous. Look what happened. The East Coast of the United States got its virus from Europe. They’ve already shown that. The big New York outbreak came from Europe, not from Wuhan.”

Paramedics transport a patient with COVID-19 symptoms to a hosp ital in Paterson, N.J., on March 24, 2020 (Chang W. Lee/The New York Times/Redux)

What, concretely, could governments have done better? Bernard, Morse, Forest and others said it comes down to testing and contact tracing in the early days of the outbreak, when it was still possible to track individual paths of infection and contagion.

In the U.S., Bernard said, “The lack of testing was almost a crime against humanity. I mean, it’s just unbelievable, the problem of delaying and getting adequate testing coming out of CDC. How that happened—everybody can go back and try to point fingers at who screwed up. But the fact exists that in the absence of widespread adequate testing like they had in Singapore and South Korea and such, there’s just no way to control this without locking everybody down like we’ve done.”

“What data are you going to use to determine whether somebody needs to stay home or not? Or has the disease or not? I’m just flabbergasted at the incompetence of the people who were charged with rolling out a test for this.”

Stephen Morse, who has been working to build a global early-warning and response mechanism for 30 years, is amazed by how little international coordination happened in the early days of the outbreak. “With SARS there was a fair amount of global cooperation,” he said. “It was under the aegis of the WHO but a fair amount was self-directed, countries spontaneously working closely together. This has completely gone out the window with this event. Every country, including European countries in the EU, was essentially on their own. This was a great surprise to me.”

Kenneth Bernard said he’s less surprised. “No, it’s completely predictable. This was like, it’s going to happen sometime. I hope it doesn’t happen soon. And I hope when it happens it’s not bad. But we’re not prepared.”

Right up until the real outbreak began last December, people who worried abo ut outbreaks for a living were continuing to write their plans. On Oct. 18 at the Pierre, a luxury hotel across Fifth Avenue from Central Park in New York City, 15 global leaders from government, business and non-governmental organizations went through a four-hour role-playing exercise to simulate a global outbreak of a new coronavirus. The exercise, called Event 201, so thoroughly foreshadowed the current pandemic that it became popular later for conspiracy theorists to claim afterward that the event’s sponsors, including the Bill and Melinda Gates Foundation, had actually planned the catastrophe for evil purposes.

But paranoia isn’t actually needed here. In Steven Soderbergh’s 2011 movie Contagion, somebody asks Laurence Fishbourne’s CDC director whether it’s possible to weaponize bird flu. “Someone doesn’t have to weaponize bird flu,” he says. “The birds are doing that.”

After the Ebola outbreak of 2014-2016, the World Bank and the WHO jointly s et up a body called the Global Preparedness Monitoring Board, to examine whether the world was ready for the next outbreak. The board, at arm’s length from both of its founding organizations, is led by former Norwegian prime minister Gro Harlem Brundtland and by Elhadjh As Sy, Secretary General of the Red Cross and Red Crescent. It’s supposed to produce annual reports about pandemic preparedness.

The board’s first report came out last September and it was scathing. After three decades of reports and simulations, “current efforts remain grossly insufficient,” it said.

The people who spend their days studying the threat kept writing reports for political leaders. But a plan for deep cooperation among competitive jurisdictions against an unfamiliar infectious agent is of no use if it gets stuck in a filing cabinet. It’s like sending a Steinway piano and a book of Beethoven piano sonatas to the government every few years. If nobody studies and practices, that piano is never going to sound like Beethoven.

“Plans that don’t get funded and implemented and operationalized are shelfware,” Kenneth Bernard said. “They’re just term papers.”

 

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