Learning the lessons from Covid

So, what - if anything - can we learn from our handling of the Covid-19 pandemic? I’ve been speaking to Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Michael has advised President Joe Biden on Covid-19 and has argued that we need to ‘learn the critical lesson of humility’ from the coronavirus pandemic. Chris Smith began by asking him to explain what that means...

Michael - As much as we as scientists want to believe that we fully understand what is happening around us from a scientific standpoint, and that in fact we have the tools to make accurate predictions about what will happen, that's just not the case. And I think this virus has laid that open in a very public way. For example, how many people even anticipated that this pandemic might last three years as opposed to just a few months? Or what might happen with immunity, either that from infection or from a vaccine. And so it doesn't mean you can't make conclusions or draw conclusions from what you know, but you always need to do it with a great deal of humility, saying, this is what I know now, but I don't know what this will mean in the weeks and months ahead.

Chris - Do you think that people lack humility about it then? Because many countries are holding Covid inquiries. In the UK, just this week, we've launched our Module 2, looking at the early responses that went on during Covid here in the UK. People do seem to be in receptive learning mode in the aftermath.

Michael - I think this is critical right now: to go back and do the kinds of reviews that are happening in the UK. I wish they were happening here in the United States. It's not because we're trying to point fingers or lay blame or find people to whom we can attribute accolades. Rather, it's all about what will we be like in terms of preparedness for future pandemics. This is not the last pandemic, and future pandemics could be much worse. If this were a 1918 like pandemic, the number of deaths would've been at least four to five fold higher. When we look at the possibility of another coronavirus infection causing the pandemic (we've already had two viruses, SARS and MERS, which appeared in 2003, 2012) and fortunately those viruses were not very infectious relative to the current coronavirus, but they killed anywhere from 15 to 35% of the people that got infected as opposed to today, less than 1%. There's nothing to say that in the future, the ability to be transmitted and the ability to cause severe illness and death won't match up together. And so we need to be better prepared for future pandemics. And the one way we can learn about how to do that is, what are the lessons learned from this pandemic?

Chris - Is there not, though, a disconnect between what the politicians want, what they're prepared to spend money on, and what the scientists, the epidemiologists, the public health fraternity, are advocating for? Because, just looking at my lecture notes that I delivered for the medical students at the University of Cambridge back in 2007, a lot of what I said about emerging infections in those lectures I gave came true. And I wasn't the only one saying it. Many, many people were trying to say to the government, we need better preparedness. But they weren't listening because they were largely, I think, looking at this statistically and saying, "Well, look, pandemics happen roughly every 30 or 40 years. What's the chances of this happening in my political cycle when voting for me counts?" Much lower. So I'm going to put that to one side. Do you not think that's a problem?

Michael - I think it is a problem and I think you've really put your finger on it. First of all, we have to understand that the potential for future pandemics to occur more frequently is very real. We have 8 billion people on the face of the Earth. Roughly one out of every eight people who's ever lived is now on the face of the earth. We need food to feed that population, which means we have a very different world full of food production animals, using bush meat from the jungles and the forests of the world and so forth. And so there's just a much greater likelihood of a crossover of a virus from the animal world or other humans to causing a future pandemic. And I think that those will still continue to be largely influenza and coronaviruses which will do that. We could have another pandemic 5, 6, 7 years from now and maybe earlier. So it's not 40 years off. I think the second thing is we do have to help people understand why we need to invest. And if you look at the economic cost of this pandemic, forget about the painful number of illnesses and deaths that we saw, just look at it as an economic impact: investing in preparedness is a very cost effective thing to do. And I think the final point to make on that is that we do make these decisions all the time in other ways. For example, one of the most well-funded fire departments in our state of Minnesota here in the United States is at the Minneapolis St. Paul International Airport. And since the conception of the airport, we have not had one major plane crash on the actual reservation at the airport. And yet we would not run that airport for a moment without that extensive fire department because they need to be there and ready to go should a plane crash. In a way, that's what we're like right now. We can tell you that at any moment another pandemic plane could crash and we need to be prepared for that, just like we support fire departments in settings like our airports, we need to be supporting public healthcare preparedness in ways that we have not yet really understood.

Chris - What should the shape of that preparedness be? There's going to be an international preparedness and a domestic preparedness, and that may differ a bit around the world, obviously, but what's the broad shape of that?

Michael - Well, the first thing that we have to understand is what really can make a difference in a pandemic. I've just finished a new book coming out this next year on lessons learned and one of the things that I review in some length are the non-pharmaceutical interventions, the idea of lockdowns, the idea of mandatory testing or mandatory vaccination, the idea of what we do with schools and so forth. And I think there's a lot to be learned there about what didn't work. I was never a supporter of the classic concept of lockdowns because, early in the pandemic, I made the prediction that this could easily last three years or more. And in the case of the United States, I predicted we could have over 800,000 deaths in March of 2020. Not a popular statement at the time. And, in fact, lockdowns are the idea of temporarily keeping you from the virus and the virus from you. But it doesn't at all apply if we're going to do this for three years. People can temporarily shelter in place and reduce their contact, but for three years? Remember, this is a zero sum game in the end.

Chris - That's effectively the game that China have tried to play and it doesn't work.

Michael - Exactly. Within two months after relaxing their stringent requirements, they had 120 million new deaths occurring in China from this. So it's exactly that. And so my whole point has been, this doesn't mean we don't try to flatten the curve, which is a different concept where healthcare facilities are being overrun with numbers of patients. Can we slow down transmission? So instead of having a thousand new patients this week, we have a thousand new patients over the next two months, that type of thing, but not a lockdown. And I think that's the kind of thing that we need to have: a really thoughtful discussion, an understanding of what did we accomplish? What didn't we? Again, not to point fingers or to lay blame, but to say, "Do we want to do that again?" Or, "What should we do again?" I kept hearing people talk all the time about how long it would take to get those first doses of vaccine out, and I think that's a very important mark, but even more important is how long will it take to get the last dose of vaccine out? Meaning, who in the world doesn't have access to it at that point? And we didn't really do that at all. We saw many areas of the world that never had access to vaccines in the first few years of the pandemic. I think these are all the kind of lessons we want to really take to heart. And that's where our trust will come from if we have a very transparent and we have a very open and honest discussion, a review of what did we do? What could we have done differently, what could have been done better? What really worked? And I think that would really help us both with the trust issue and it would make us better prepared for the future.

Chris - Do you think we are better prepared for the future? If Covid mark two came tomorrow, do you think that we would rinse and repeat and make all the same mistakes again, or have we learned the hard way and we are now going to handle it so we are much better prepared and it will be over in a flash next time?

Michael - I think your concept of rinse and repeat is a very important one. I actually really like that visual. The challenge we have is that it's not just what we do, but what will the public do with us? And I believe we're in worse shape right now than we were in 2020 because we have lost the trust of much of the public around making recommendations from a public health perspective. And again, public health is one of those activities where it is critical to have the participation and the support of the public in whatever you're going to do in terms of trying to avoid infections, reducing serious illness, hospitalisations, and deaths. And so to me, I am more concerned right now that in this era of anti-science, where the most important thing some groups can do is just demonise the personnel in the public health or medical community trying to save lives. It seems if that were something we talked about 5 to 10 years ago, nobody would have believed it. You know who the bad guys are. And so that's something we have to overcome for the next pandemic.