14 Lessons for the Next Pandemic

A year. More than 500,000 dead. What did the United States do wrong in dealing with Covid-19? What needs to be reconsidered? We asked scientists, public health experts and health care lawyers to tell us about mistakes, missed opportunities and oversights – and how we can prepare for the next pandemic. Answers are edited for length and clarity.

Prepare for what we cannot imagine

We must overcome our collective failures of imagination. Covid-19 surprised us. We have been planning a pandemic similar to the viruses we already know for decades. We had no face masks, mass tests, home assignments, politicized decisions, or devastating racial differences planned. Looking ahead, we need to prepare for a much wider range of threats.

Lauren Ancel Meyers, epidemiologist at the University of Texas, Austin

Put science first

Inaccurate information and indecisive actions by the US government resulted in a catastrophic failure for the country. From the start of the pandemic, President Trump said that this virus will go away and that we don't need to take any precautions. There was mockery and social distancing. The Centers for Disease Control and Prevention issued faulty primers that delayed early efforts. And the strict limitation of tests – only to those who had traveled to China – delayed detection significantly. Hospitals have had to get their Covid tests approved by the Food and Drug Administration, even if they exactly do the C.D.C. Protocol. Reagents for testing were quickly used up nationwide. To prepare for the next pandemic, government must put science and data above everything.

Akiko Iwasaki, professor of immunobiology at Yale University

Find out who is given priority

Think about ways to assign vaccines early and deploy them in states so they can put them into action right away. The C.D.C. came out with their recommendations in December, just days before the vaccines were approved. But since last August, when the allocation plan devised by the National Academies of Science, Engineering, and Medicine was published, two principles of overall strategy have persisted: when vaccine supplies are limited, seek mortality and preserve the health system. Mortality is irreversible. These are principles we should think about during the break before the next storm. In our field we call it "the inter-pandemic".

Saad Omer, director of the Yale Institute for Global Health

Don't leave it to the states

We have been voted the world's best prepared country for the pandemic by Johns Hopkins. The lesson we learned is that what the answer is also very important.

In a country with the characteristics of the United States, which has 50 individual states with over 330 million people – and when you have a pandemic that is highly communicable and doesn't care about borders between one state or another – there are certain similarities who have favourited a certain amount of cooperation, cooperation and synergy between the federal government and the federal states. Some states just ignored the guidelines and just jumped right over them – to go where they wanted to. That is not a recipe for success.

Dr. Anthony S. Fauci, Director of the National Institute for Allergies and Infectious Diseases

Stop mixed messaging

We need a strong, coordinated, science-based federal response to take the lead in a national test plan. We need a public health guide to states rather than just leaving it to them. Having this patchwork quilt of various public health guidelines really didn't help, and it also sent the message that we didn't really know what was going on – or what was going to work.

The obvious was the mask problem – having a consistent message on masks. The virus does not preferentially select people to be infected because of their political party. We're all in the same boat.

Linsey Marr, airborne virus movement expert, Virginia Tech

Invest in the numbers

The underinvestment in public health has been a massive vulnerability for an effective response. We really needed accurate data to be able to make predictions – that would allow us to control the intervention that would determine the impact. There are pretty sophisticated data systems for banks, media, etc., and we haven't made those leaps in public health.

Anne Schuchat, deputy director of the C.D.C.

Be nimble in providing treatment

The most resilient health systems have been those that actually understand how to keep people healthy and take risks – rather than in the fee-for-service environment. This is where you can actually take full clinical and financial responsibility for a population. And then you can make all kinds of super interesting, nimble, innovative decisions like telemedicine and home hospital and all the other great tools that volume-based systems really aren't ready for.

Dr. Marc Harrison, executive director of Intermountain Healthcare, which operates hospitals, clinics and a health plan.

Do not let race and class determine who lives and dies

What we have learned relates specifically to the social determinants of health – the conditions in the places where people live, study, work and play – and how these can dictate health outcomes. This was a very academic type of subject. In the past people said, "yes, yes, poverty, poverty, poverty" but they didn't understand the concept. The virus has really brought it to the fore in a very graphic way, with racial and ethnic minorities so much more affected. It has become very clear that the country's health really depends on addressing these social determinants of health. And I see the difference in the health department and the difference in the government and even the news media, which is a good sign for the future.

Dr. Pablo Rodriguez, member of the government committee that directs Covid vaccine distribution in Rhode Island

If the government ignores the nature of systemic racism – if it does not recognize unequal access to health care and jobs – it essentially affects the lives and experiences of people with color. This leads to the really profound and appalling health inequalities that we have seen in this pandemic. So, if they fail to pay attention to employment, housing and education policies and access to health care during a pandemic, these inequalities essentially worsen exponentially.

Dr. Uché Blackstock, emergency doctor and founder of Advancing Health Equity, a healthcare advocacy group

The pandemic exposed the failures of America's fragmented, for-profit healthcare system. Medicare for All would allow us to address the social determinants of health with an emphasis on prevention, primary care and management of chronic diseases rather than specialized care. A resilient public health system would allow us to quickly implement the type of surveillance, tracking, tracking and data collection that is vital to responding to a pandemic or other emerging public health crisis.

Zenei Triunfo-Cortez, President of the California Nurses Association and National Nurses United

Don't be an ageist

The main lesson: This is what happens when we treat the elderly as expendable. There is definitely an element of ageism at work here that has really crept into the way the country has made decisions and promulgated guidelines. From the start of the pandemic, we knew that older adults and those with underlying health conditions were most at risk, yet ignored the fact that we could mitigate some of that risk with adequate testing, staffing, and appropriate personal protective equipment. And we just didn't. Older Americans and their carers were not properly prioritized until recently when vaccines became available. And what an amazing difference it was.

Katie Smith Sloan, president of LeadingAge, which represents nonprofit nursing homes

Communities also need to prepare

We need ongoing community capacity to deal with crises. We can't just rely on government and institutions. Our own community members must be consistently involved in systemic responses to crises.

Rev. Paul T. Abernathy, Pittsburgh neighborhood resilience project advocating color communities

Stop doing the edge treatments

There was so much uncertainty about how to treat patients in the first few months, but we realized that it is best to stick to the basics of critical care medicine, including ventilator settings, amount of sedation, and intravenous fluids. Whether Covid-19 or the next virus pandemic – just trust what we know as the basis for patient care – and don't let yourself be distracted by the search for marginal or alternative interventions.

Dr. Gregory S. Martin, critical care specialist at Emory University

Let teenagers be teenagers

Children need to be with children and lead a structured life. Social isolation is especially challenging for teens and may affect their maturation. Those who found themselves in safe social settings and had at least one hybrid school experience done better than those who couldn't.

Marsha Levy-Warren, adolescent psychologist and clinical associate professor at New York University

The China problem

It is clear that the Chinese government suppressed information about this virus and the officials did not want the information to come out. China aside, we really need a bigger talk about working together as a global community for future outbreaks. The nationalization of the responses was, in my opinion, incredibly damaging.

Angela Rasmussen, a virologist at Georgetown University

The government must treat personal protective equipment manufactured abroad as a national safety issue. This was a pretty mild virus. Imagine if the death rate was 20 percent and China and Mexico had their P.P.E. Deliveries. The entire supply of masks would have collapsed.

Mike Bowen, co-owner of Prestige Ameritech, which makes N-95 masks

Look in the mirror and see who we are

Many people have had an awakening to the people who keep society going and whom we largely take for granted. But if you can discount the essential worker – the African American, the Latino, the Chinese immigrant who delivers your food – then think how easily you can discount any other human life.

If you are a person who believes that you have the right not to wear a mask, this philosophy cascades: I can't take care of the cashier in the supermarket or the train driver because I don't care about anyone. I'll go to the bar and do what I'm going to do.

This pandemic has shown us who we are with a clarity that is shocking to most people. It's hard to imagine that there are so many people in our country who really don't care about others. That is the most terrible thing, it takes your breath away and you can diagnose everything else that is happening in our society through this lens. That you could tolerate 500,000 deaths in less than a year is incomprehensible to me, that we are a nation so callous.

Dr. Reed Tuckson, Co-Founder of the Black Coalition Against Covid-19