From testing failures to downplayed virus risks to the disproportionate effect on communities of color, two Covid-19 experts emphasized at a Tuesday forum what is now a familiar refrain: The U.S. response has been fundamentally flawed.
“We had information and we discounted it,” said panelist David Williams, a professor of public health, African and African American studies, and sociology at Harvard. “We didn’t take it as seriously as we could have. I do think that we could have been in a better position than we currently are if we had acted promptly.”
Williams appeared at the hourlong virtual event held by the Kennedy Library Forums with STAT senior infectious disease reporter Helen Branswell and moderator Rick Berke, STAT’s executive editor.
By the time tests from the Centers for Disease Control and Prevention, the Food and Drug Administration, and others made their way to people in a large-scale way in early March, “the virus was very well-seeded in a number of places,” said Branswell, who has covered pandemics for nearly two decades, including the 2003 SARS outbreak while in Toronto.
“The horse was not only out of the barn, it was several fields away with foals of its own,” she said.
The U.S. is paying for these early missteps, Branswell said, and the ripple effects will be felt for quite some time.
“People make mistakes, but the lack of swift action to make up for it and to find a plan B, I think, really, was a very bad mistake,” she said.
Here are some highlights from the event.
How the virus was downplayed as a worldwide threat
Branswell said she was struck by remarks at a panel she participated in February with federal health officials, including Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. China had by then locked down the city of Wuhan — where the new coronavirus was first detected — and tens of millions of people were ordered to stay in their homes in an effort to stop the virus. Still, she recalled panelists saying they didn’t believe the virus would have the same effect outside of China.
“I just could not get my head around why people thought the virus would behave differently outside of China than it was inside of China,” Branswell said. “I was puzzled by the lack of urgency and the lack of speed in terms of response measures being taken.”
It was within a week of that panel that Iran reported an explosion of cases, followed quickly by Italy. “Indeed, the virus acts the same way wherever it goes,” Branswell said.
Williams readily admitted that he was among these early dissenters.
“In January, I knew [the coronavirus] was coming, but I likened it to the flu,” he said. “Initially, even though I am a professor in a school of public health — and chair of a department — I did not initially really acknowledge or appreciate the scope or impact of it,” adding, “I quickly learned my lessons, though.”
Branswell chimed in that she got many press releases at the time that were trying to make the point that the novel coronavirus was just like the flu — and that the flu was a more worthwhile virus to focus on. “I’ve written about the flu for 15 years. I take the flu very seriously, but this was not like the flu and it drives me crazy,” she said.
On the disproportionate impact on communities of color
Williams spoke passionately about a reality that has been apparent since the early days of the pandemic: Minorities in the U.S. and other countries, especially African Americans, have been infected with Covid-19 — and have been dying — at rates that far outnumber the percentage of the population these groups make up.
“Covid-19 did not create racial disparities in health,” he said. “It’s simply shining a magnifying glass on disparities that have existed for over 100 years.”
Williams emphasized that it was not just African Americans who were bearing the brunt of the pandemic and dealing with the negative economic impact of the crisis. Hispanic, Native American, and Pacific Islander communities have also been hurt, he said.
Branswell said there are similar patterns with other infectious diseases. “You see it time and again,” she said, citing the 2015-2016 Zika outbreak. The vast majority of babies born with microcephaly — the birth defect seen in babies born to Zika-infected mothers and which can cause developmental delays — were born in northeastern Brazil, which is among the country’s poorest regions.
To address the seemingly intractable trends, Williams said, governments need to work more aggressively toward equal access to high-quality medical care. Black people and members of other minority groups are subject to unconscious bias from health care workers and tend to receive poorer quality of care, he said.
“When we meet someone, in one-third of the time it takes to blink our eye, we focus on their social characteristics — and if there are those that, deeply embedded in our subconscious, they are negative stereotypes, beliefs, or assumptions, we will treat that person differently.”
And the tendency to succumb to these implicit biases is more likely to occur when health care workers are operating under pressure, are tired, or are highly stressed, Williams said.
“The context of Covid-19 creates some of the very conditions that scientific studies have shown for a long time maximizes the occurrence of these [behaviors],” he said.
On the uncertainty ahead
Most Americans, Williams said, seem to be aware of the risk involved with states opening back up, even though some have protested the distancing measures in place.
“I think most people take this seriously. The level of death and suffering we have seen — I haven’t quite seen anything quite like this in my lifetime,” he said.
This seemingly new normal — including the inability to come together for funerals, the scale at which people are dying, and the extended period of isolation — is also likely to bring on mental health challenges.
“People are grieving in ways that are not normal for human beings,” Branswell said. “It’s a time to be kind to other people. It’s a time to help people. It’s just incumbent on all of us to be aware that people are under stress.”
As far as daily life in the U.S. fully returning to how it was, the panelists didn’t have concrete answers.
“This could be a September 11, 2001 type of moment,” Williams said, referring to how the terrorist attacks two decades ago fundamentally changed the way we now fly. “There could be some precautions that are implemented that didn’t exist before Covid-19 that will stay with us.”
Asked about whether they would feel comfortable using public transportation again and going back to work in an office, both panelists urged patience and caution.
“My assumption would be that even when we do [return to offices], that we do it in stages,” said Williams. “This is a brave new world we’re in, until we have these vaccines. I don’t think there’s the option of no risk but we need to take all the steps we can to minimize risk.”
As far as whether the ever-important handshake, which is now taboo, will return, Branswell said that after the SARS outbreak nearly two decades ago, people talked extensively about bumping elbows and finding other ways to avoid handshakes, but none of that stuck.
Williams was more direct: “I suspect the handshake will be back,” he said. “It’s just such a part of our human interaction.”