ZEYNEP TUFEKCI: Learning from mistakes. Here's how millions of lives might have been saved from COVID-19
Friday, March 11, 2022 -- We cannot step into the same river twice, Greek philosopher Heraclitus is said to have observed. We've changed, the river has changed. That's very true, but it doesn't mean we can't learn from seeing what other course the river could have flowed. 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.
Posted — UpdatedWe cannot step into the same river twice, Greek philosopher Heraclitus is said to have observed. We’ve changed, the river has changed.
That’s very true, but it doesn’t mean we can’t learn from seeing what other course the river could have flowed. 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.
Our information about what happened when the coronavirus apparently was first detected in Wuhan, China, in December 2019, remains limited. Reporters working for Western media have been kicked out, and even local citizen journalists who shared information during the early days were jailed. But evidence strongly suggests that China knew the danger long before it told the world the truth.
At that point, the virus had had weeks to spread far beyond China’s borders and was beginning to establish outbreaks globally. A pandemic was on its way.
China could have notified the World Health Organization sometime in early to mid-December that it had an outbreak of a previously unknown coronavirus similar to the dreaded SARS pathogen, and immediately sequenced the virus and shared the genome, allowing tests to be developed. The rest of the world would have had to act, too. Governments could have made sure tests were immediately developed to find as many cases as possible. Health authorities could have isolated infected people and traced and quarantined their contacts. Travel restrictions and testing could have been put in place to prevent the spread outside China.
It may seem like a fantasy to suggest that the outbreak could have been extinguished before it became a pandemic, but later outbreaks of this virus were contained. This first wave could have been, too, and the pandemic might have been completely avoided, saving millions of lives and much suffering.
On Jan. 11, 2020, a Chinese scientist bravely allowed an Australian colleague to upload the virus’ 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.
How could nations have gotten around China’s smokescreen? They could have done what Taiwan did.
On Dec. 31, 2019, the same day that Taiwan officials sent that email to the WHO, they started boarding every plane that flew there directly from Wuhan, screening arriving passengers for symptoms like fever.
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 1 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.
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% of those on board, with 14 deaths.
At that point the guidelines from the WHO 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, Washington, on March 10, 2020. The church followed droplet-based guidance by propping the door open so nobody would touch the doorknob and avoiding handshakes or hugs. No one was 6 feet in front of the person suspected to have been the single initial source. Nevertheless, 52 people — 85% of those present — became infected.
Many Western experts, including in the United States and Europe and at the WHO, 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.
It was also assumed that only people with symptoms — like fever — would be infectious, even though evidence to the contrary had emerged early.
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 CDC and the WHO initially recommended masks only for the sick.
Another crucial misstep was the failure to recognize the virus’ 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 barks, 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.
Americans, on the other hand, were disinfecting their groceries, and the WHO kept emphasizing hand-washing and social distancing, or remaining 6 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.
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 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 into fewer than 7,000 deaths from COVID in 2020. Instead, estimates place the number of deaths at more than 375,000.
The greatest scientific achievement of the pandemic may have been the speedy development of safe, effective vaccines.
On May 15, 2020, the United States began Operation Warp Speed, which financed the development of six vaccine candidates. Five of them quickly proved to be highly effective — not at all a given. The first to deliver spectacular results was that produced by Pfizer and BioNTech. Moderna’s quickly followed.
Supply was an immediate problem. Pfizer initially estimated it could make as many as 1.35 billion doses in 2021 — enough for about only 8.5% of the world’s people to get two doses. Moderna, a much smaller company, wasn’t expected to exceed that. AstraZenaca’s vaccine, too, would not cover the gap quickly enough.
There also was too little commitment to how vaccines could be distributed fairly around the world.
Then, in a largely unanticipated plot twist, dangerous variants of the coronavirus started emerging in late 2020 — alpha, delta and then omicron.
Widespread earlier vaccination could have helped limit the possibility for these variants emerging. Plus, many variants may have arisen through persistent infections in immunocompromised people — like those who have untreated HIV, another terrible legacy of global health inequity.
Political leaders in wealthy countries should have brought together vaccine manufacturers to arrange conditions and deals that can likely be struck only with government prodding: sharing manufacturing facilities, training experts, sharing intellectual property. Technology transfer to poorer countries could have achieved the ultimate goal: a world with many countries that can produce effective vaccines. Existing vaccine manufacturers could still profit handsomely — especially considering they, too, benefit from publicly funded research.
Countries may want to first vaccinate their own citizens, even those at much less risk. But to save the most lives, priorities should have been set globally. Health care workers, the elderly and those at high risk throughout the world should have gotten the first vaccinations.
A few countries like Canada and Britain did lengthen the interval between doses as a strategy to protect more of their citizens — to great results. More of their vulnerable population got protected quickly. Plus, longer intervals, as some immunologists had predicted earlier, still left people protected — the unusually short three- and four-week period between the two initial shots had been put in place partly to speed up the trials. In the United States, though, such adaptive strategies could not be studied or rolled out.
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 past 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.
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