It is now becoming apparent that governments around the world have long had considerable knowledge about the risks of a coronavirus type pandemic and have had studies that accurately predicted the shortcomings in their health care systems that would hamper their ability to fight such a pandemic.
The tragedy is that many countries failed to act on this knowledge and make the changes needed in their pandemic preparedness to keep their poupulations healthy.
Earlier in the week, the New York Times reported on “Crimson Contagion” a simulation conducted by the US Department of Health and Human Services last year in Washington and 12 states including New York and Illinois.
“Crimson Contagion”, which imagined an influenza pandemic, was simulated by the US Department of Health and Human Services in a series of exercises that ran from last January to August.
The United States, the government organizers realized, did not have the means to quickly manufacture more essential medical equipment, supplies and medicines, from antiviral medications to needles, syringes, N95 respirators and ventilators.
Most importantly, there was no plan to ramp up testing quickly and no clear sense of which level of government would be in charge of the testing ramp-up.
The tragedy of “Crimson Contagion” was that the US government didn’t act on the recommendations of the simulation. The planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress. This, in turn, left the US with funding shortfalls, equipment shortages and disorganization within and among various branches and levels of government when it came to rollling out a testing program.
The result? As of Tuesday morning the US had 43,000 active coronavirus cases and as of late Monday evening, there were 10,000 new cases reported in just one day.
Congress was briefed in December on some of these findings of “Crimson Contagion”, including the inability to quickly replenish certain medical supplies, given that much of the product comes from overseas.
These concerns turned more urgent at a hearing on Capitol Hill last Thursday, as lawmakers peppered the Department of Health and Human Services officials with questions that sounded almost as if they had read the script from the fictional exercise, reflecting the shortage of respirators and protective gear as well as the painfully slow role out of testing.
Similar studies have been prepared for governments around the world and most have come to the same conclusions. Moreover, the World Health Organization developed a comprehensive strategy to deal with pandemics in its 2005 International Health Regulations (IHR) which granted increased powers to the World Health Organization (W.H.O.). Those 2005 reforms were the result of the failure in China to stop the spread of the SARS virus.
Tragically, most countries ignored the W.H.O. regulations in dealing with the coronavirus as they did their own studies – especially when it came to having the capacity to roll out wide-spread testing at the early stage of the pandemic.
Why early testing is the key to stopping a pandemic
The North America wide shortage of coronavirus test kits is not just a disgrace, it is emblematic of nations totally ill prepared to fight a deadly pandemic. Right now, with so little testing, we are shooting in the dark when it comes to our control efforts. It’s the equivalent of a surgeon trying to do an operation with the lights off.
Why is it so critical for us to have a massive surge in testing at an early stage of an outbreak? People who are sick need to get the right diagnosis and clinical care. We know, for example, that if you are hospitalized with COVID-19, there’s a high chance you’ll need transfer to the intensive care unit.
People with mild symptoms who get tested can self-isolate and help stop the spread of the virus. If one person has the disease, medical authorities can then test those they have been in contact with (known as “contact tracing”). In other words, testing and contact tracing can help to break the chain of transmission.
As Dr Tedros Ghebreyesus, the World Health Organization’s Director General, says: “Find, isolate, test and treat every case, and trace every contact.”
Ghebreyesus went on to say “We have a simple message for all countries: Test, test, test. Test every suspected case. If they test positive, isolate them and find out who they have been in contact with two days before they developed symptoms and test those people, too.”
Tedros didn’t single out any one country, but U.S. public health officials and state and local leaders in the U.S., have heavily criticized the Trump administration and the U.S. Center for Disease Control for delaying and limiting who could get tested in the U.S.
Testing also allows clinics and hospitals to become better prepared, as they know how many cases to expect. And, crucially, testing helps the public health system know where the disease is, how it is evolving, and where to target their efforts to control it. It identifies the hot spots of infections.
Countries that have flattened the curve made testing widely and freely available at the first sign of the outbreak, using innovative approaches like mass drive-thru test centers. South Korea is the world leader in fighting the pandemic and has been conducting around 12,000-15,000 tests every day, and has the capacity to do 20,000 daily. While it is hard to get accurate estimates, the US Center for Disease Control (CDC) reports that only around 25,000 tests have been conducted in total nationwide by CDC or public health labs in the U.S.—compare this with the roughly 250,000 tests that South Korea has done to date.
And many experts are taking note from the radical testing regime put in place in the northeast Italian town of Vo Euganeo.
Vo, as it’s known, achieved international prominence on Feb. 21 when the death of one of its residents, a 78-year-old man named Adriano Trevisan, became the first known Italian – and European – to die of COVID-19.
In recent days, Vo, whose population is 3,300, has recorded no new infections even though other towns and and cities in the northern part of Italy are overwhelmed by rising caseloads.
Vo accomplished this through a highly aggressive mass testing and quarantine experiment that included asymptomatic residents. The program was overseen by Andrea Crisanti, an infectious diseases professor at London’s Imperial College who was working with the University of Padova, whose campus is close to Vo.
The vast majority of people infected with COVID-19, between 50 and 75 per cent are completely asymptomatic but represent a formidable source of contagion,” he wrote. “The isolation of asymptomatics is essential to be able to control the spread of the virus and the severity of the disease.”
Vo’s COVID-19 testing campaign was similar to the one used in South Korea. Again, South Korea, with a population of 51 million, about 10 million fewer than Italy’s, has reported only 91 coronavirus deaths – just 3.3 per cent of the Italian tally.
All of the residents of Vo were tested twice – once before the town went into quarantine with 10 other northern towns in late February, and once after. The tests gave Prof. Crisanti and his team a complete epidemiological picture of the town.
The first mass testing round found about 90 COVID-19 positive cases, about half of whom were asymptomatic. The infected residents, representing about 3 per cent of the town’s populations, were placed in strict isolation. Ten days later, another round of testing began and the infection rate dropped to 0.3 per cent.
In recent days, no new cases in Vo have been detected. The town’s success story, and the waning number of new cases in China, the original source of the pandemic, has triggered calls from doctors and epidemiologists to boost the testing rate and tighten up the Italian quarantine.
There also needs to be quick turnaround time in getting the results of the tests. On this, the Ontario government seems to be failing spectacularly.
According to the Toronto Star, Ontario’s daily confirmed and negative cases in the province — is roughly four days old or more due to a lag in test results officials are struggling to overcome.
That means provincial and city leaders and the general public are relying on relatively old information on the severity of the fast-moving pandemic when making decisions.
In addition, a Star analysis of the last 10 days of provincial data reveals the number of tests for which the province is awaiting results is steadily increasing. It appears from the numbers the current testing system in Ontario is being overwhelmed by demand. Tuesday, 2,728 samples were taken from Ontario residents, almost three times the number of samples taken the day before. Based on current data, the results of those tests will not be known for four or more days.
In addition to mass testing at an early stage, there’s one striking message from a new analysis of how Hong Kong, Singapore, and Japan were able to contain COVID-19. In all three locations, there was excellent communication and coordination between different government departments and between the central and regional governments.
In Singapore, for example, “there are almost daily meetings between Regional Health System managers, hospital leaders, and the Ministry of Health.” Clear COVID-19 plans and protocols are in place so that all key players at all levels of the health system know what they are supposed to do. There’s also explicit, detailed information given daily to the public on the state of the outbreak.
Unfortunately, in the US, the flailing Trump administration downplayed the threat from day one and Trump himself has stated many factually incorrect things about the virus. There is still no clarity on who is responsible for what. With very little clear and credible guidance from the federal government, cities, counties, and states have had to do their best on their own.
And in Ontario, the Star reports that the total number of positive COVID-19 test results is unclear due to discrepancies between the public information put out by the provincial health ministry and the numbers posted by individual local health units.
A Star analysis found that in some cases the numbers reported by the province and local health units match, but in others the numbers are off by as many as one, nine — or in Toronto’s case, 39 — confirmed cases.
The discrepancies are raising concerns that health practitioners and officials, as well as the public, may not be getting the full picture of how the virus is behaving. Experts say robust and timely data is crucial to planning an effective response to the pandemic.
Conclusion: Public health officials have the expertise to effectively fight a pandemic but need operational autonomy from politicians who want to cover-up
Here is what we have learned from the coronavirus pandemic.
The expertise exists in the World Health Organization (W.H.O.) and in many public health bodies throughout the world, to effectively fight a global pandemic and stop its spread.
However, at the international level, national political leaders feel free to ignore the advice of the W.H.O. and at the national and sub-jurisdictional levels (e.g. Canadian provinces), political leaders ignore the advice of their public health officials.
The solution is to empower the W.H.O. at the international level so that it can force countries to implement effective anti-pandemic measures (such as early stage mass testing) and to empower government public health officials so that they can act while their political overloads dither.
The expertise to have stopped the coronavirus at an early stage was there from the beginning but was bottled up in public health bureaucracies who couldn’t act without political permission.
That has to change.
Recent Canada Fact Check posts on the coronavirus pandemic include the role the World Health Organization should be playing in fighting the pandemic, a look at the impact of travel bans, and the role governments with an anti-science ideology have played in spreading the coronavirus,