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COVID-19 Highlights Weaknesses in US Emergency Preparedness: Public Health Watch

MAR 04, 2020 | BRIAN P. DUNLEAVY
We passed an unfortunate milestone earlier this week with the 100th confirmed case of COVID-19 in the United States.

However, as tragic as this global outbreak is, both in terms of its scope as well as its impact on human lives, there’s a good chance this crisis—if we can even call it that here, anyway—isn’t going to be the “big one” experts have predicted and feared for decades, but particularly loudly since the terrorist attacks of September 11, 2001.

It’s been since that time that greater attention has—finally—been paid to this country’s level of preparedness for significant health threats in which thousands or even hundreds of thousands of lives are affected, as opposed to dozens. This is not to diminish COVID-19, particularly for those who have been directly affected by it, but rather to point out that, when it comes to this disease, we’re not “there”—at least not yet.
Still, what we’ve seen to date from the federal government’s response to the outbreak doesn’t augur well for when/if we are “there”—whether it be because of COVID-19 or some other threat.

“I’m not so much concerned about COVID-19 specifically as I am about our preparedness in general,” Donald M. Berwick, MD, MPP, FRCP, president emeritus and senior fellow, Institute for Healthcare Improvement and former Administrator, Centers for Medicare and Medicaid Services, told Contagion®.

Berwick is quick to point out that he is a pediatrician by training, and not a “preparedness expert.” However, his history in government and his work in health care quality-related research garnered him an invitation to serve on an expert panel convened by the National Academy of Medicine and focused on “Enhancing Private Sector Health System Preparedness for 21st-Century Health Threats.” The panel’s work resulted in an article published February 6th in the Journal of the American Medical Association.

That paper just so happened to hit just as COVID-19 was hitting US shores and didn’t actually take into account the potential impact of the virus. Still, the types of threats the panel assessed broadly—infectious diseases, terrorist attacks, large-scale disasters, bioterrorism, among others—showed that the US has a lot of work to do to properly prepare, and we may be seeing evidence of some of these shortcomings in the outbreak response.

Berwick said he and his colleagues essentially looked at 3 types of crises exacerbated by threats of this magnitude. The first, a threat that causes a “demand surge” on the health care system—or many thousands of people requiring care in the aftermath of an event or series of events—would likely cripple our existing infrastructure and supply chain, as the concerns over the availability of a viable COVID-19 test at the local level arguably illustrate. The second, a threat posed by a major attack on infrastructure—Berwick uses the power grid as example—would expose the fact we don’t have fail-safe systems in place.

“You have to keep in mind that gas pumps work on electricity,” he said. “Water is pumped using electricity. This is a nightmare scenario, but an attack on our grid could disrupt supplies of gas and water, not to mention other vital supplies, for months.”

Now, imagine if these basic systems were disrupted at a time of crisis, such as after a large-scale natural disaster or during, say, a pandemic.

Berwick and his colleagues also found that communication between various stakeholders in the preparedness effort—government agencies, health care systems, private industry (big pharma, device manufacturers)—remains lacking. Networks for the sharing of information as well as supplies—such as, say, antivirals during an outbreak—are “not well formed,” Berwick said. There should be a “command and control center” set up to coordinate communications between different agencies and organizations, including the private sector, he added. Such a center doesn’t seem to exist, given the apparent disconnect in comments from various sectors of the government thus far during the COVID-19 outbreak.

Berwick said, “As of now, very few people have been affected by COVID-19. As tragic as it is, it’s relatively small scale.”

Unfortunately, that may not be the case with the next public health emergency—or even with this one, should it worsen.
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