The United States was just as dangerously unprepared to combat a coronavirus pandemic in 2020 as it was back in 2015, former U.S. Sen. Joe Lieberman noted in the opening remarks of the Bipartisan Commission on Biodefense’s virtual meeting on Tuesday, setting the tone for a critical examination of the nation’s COVID-19 response.
The event, “COVID Complexities: Converging Threats, Fractured Resources,” gathered experts from across the country to address various aspects of the ongoing pandemic, but perhaps no panel captured the ongoing, on-the-ground struggles better than an examination of emergency management and hospital preparedness.
The session gathered Jared Moskowitz, director of the Florida Division of Emergency Management; Dr. Dan Hanfling, vice president of technical staff at In-Q-Tel and an attending emergency care physician at Inova Fairfax Hospital; and David Mitchell, president of the International Association of Emergency Medical Services Chiefs, to discuss the issue.
What all three experts made clear was that the U.S. has, on some level, failed in its response to an unprecedented disaster — and politicization of the crisis hasn’t helped. For Moskowitz, the issues coalesce around hospital capacity and a need to guarantee a self-reliance that has been missing for many years. For Hanfling, the issue is a lack of data. And Mitchell said the problem remains an inability to plan beyond the short term.
“We have to be somewhat self-reliant,” Moskowitz said. “This is the first time in history that all 50 states are under the same emergency. I’m not just competing against all the other states, I’m competing against every other country except Antarctica.”
To change that would require federal action. That said, for health providers and emergency managers, the supply of personal protective equipment (PPE) has become a less urgent issue. Despite problems early on, equipment supply lines have largely stabilized. In Florida, the issue has become one of staffing and expanding to meet the needs of rising cases.
Communication has also proven to be a major concern.
Moskowitz admitted that some challenges could have been avoided if President Donald Trump would tell Americans to wear masks.
“If you had told me masks would be the political football of 2020, I would have lost that bet,” Moskowitz said. “We can have mask mandates, but if a significant portion of the population doesn’t want to wear them, has an alternative fact just when it comes to wearing a mask, that’s a significant problem for us.”
If people don’t adhere to safe phasing, he noted, then it wouldn’t matter if a state opened early or late — the efforts at security wouldn’t work.
Meanwhile, Hanfling painted the picture of a national system of hospitals forced to bear the burden of reporting, without a viable national reporting system in place. The Centers for Disease Control and Prevention (CDC) had a reporting system, but now hospitals are supposed to report data directly to the Department of Health and Human Services (HHS). Either way, little has come of the data collected. No dashboard concretely compares what states are experiencing now compared to normal volumes.
“There’s more guesswork than there is certainty,” Hanfling said. “HHS paid millions of dollars for a contract that was supposed to get data directly from health records. It doesn’t.”
What the country needs, in the doctor’s opinion, was to put in place models of reporting and tracking up to the task of addressing large-scale emergency events. They need to be able to track supplies and provide rapid analysis and reporting. Real-time situational awareness is key, because right now, the U.S. is essentially flying blind.
The crisis could present an opportunity. With a concerted push, lawmakers could move things like artificial intelligence-powered symptom checkers and digital health tools to take the pressure off hospitals. Little of this would matter, though, if people don’t collaborate. Hanfling called for region-to-region medical consultation and other communication pipelines to get states to better help one another weather crises and deal with strain.
Hanfling also chastised the administration’s decision to pull back from global health partners such as the World Health Organization. All a withdrawal from WHO would do, in his view, is undermine a coordinated health strategy.
Mitchell highlighted some of the costs of these failures. Agencies are only able to plan for supply about two weeks out, he said. In addition, EMS call volumes are down 26 percent nationally — when their primary means of reimbursement is for transportation to emergency rooms. Agencies have been left to foot bills with the hope that somewhere down the line they might be paid off. This has left private communities at particular risk.
Meanwhile, healthcare workers and support staff across the spectrum remain at the highest risk of infection. EMS in particular is in need of restructuring under a more robust national system, Mitchell said.
“Only being able to plan out two weeks ahead puts EMS agencies in a battle cadence — it’s something unsustainable in the long run,” Mitchell said. “We’re constantly going to be nervous about running out. Our workforce is not going to have the confidence we’ll be able to protect them.”
The panelists agreed there were federal shortcomings. Responses in the future should be state-focused, Moskowitz said. The federal government, in his view, is there to write the check, not to provide resources. The larger the bureaucracy, the slower responses get.
“The federal government is too slow,” Mitchell said. “We at the state can do it much faster. This doesn’t mean there isn’t a role for them. They have to help with remdesivir — that isn’t something the states can do. But if you said to me, should we federalize this response in general? Should all things be federalized? Everything would happen slower. Period.”
Mitchell echoed the sentiment, arguing that there are things the federal government needs to do, including procuring enough PPE for localities. But the things many people expected the federal government to do, it either did halfway or not at all. That led him to conclude that a larger unified plan is needed, but it should be up to state and local governments to execute it.
However, Hanfling said that with events as complex as this pandemic has proven to be, only the federal government has the ability for coordination, consistency and messaging based on the science available. The country never exited the first wave of disaster precisely because it was left to states that had 50 different responses to the pandemic.
“The only thing to get through this is science and trust,” Hanfling said.