US ignored its own pandemic playbook created years ago to tackle coronavirus-like health crisis
The US is leading and not in a good way. The country has surpassed all other nations in the reported number of confirmed cases as well as deaths, but it is not leading in its pandemic response. Many experts say this will probably go down as the worst public health disaster in the history of the US. And this is despite the US having a pandemic playbook, which was created several years ago to deal with health crises exactly like the current one.
The 69-page National Security Council document, reported by Politico, laid out a complete set of strategies and checklists for dealing with an outbreak or a pandemic. While hospitals and healthcare workers are now scrambling for something as basic as personal protective equipment (PPE) to deal with a highly infectious COVID-19 disease, based on the playbook recommendations, the government should have started getting PPE like masks and gloves at least two months ago. The COVID-19 disease was declared a public health emergency of international concern on January 30 by the World Health Organization (WHO), and it was later declared as a pandemic.
The playbook stresses that given that information on nature and spread of the disease may not be readily available, it is critical to determine early on what medical material is needed to treat this disease and what supplies are needed to protect healthcare workers and others who are in contact with patients.
"Is there sufficient personal protective equipment for healthcare workers who are providing medical care?" the playbook instructs as one early decision that officials should address when facing a potential pandemic. "If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?" it asks.
Multiple reports and scientists have repeatedly said that the US response has been abysmal and the country was ill-equipped in terms of personal PPE, intensive care unit beds and mechanical ventilators. "That doctors and clinicians are succumbing to the virus is beyond a tragedy, as many of these dedicated individuals are dying unnecessarily, as a result of the no-testing and no-PPE fiascos... Perhaps what we in the medical community will remember most is how our country betrayed us at the moment when our efforts were needed most," wrote Dr Eric Topol, Director and Founder, Scripps Research Translational Institute, in Medscape.
Over 368,440 cases have been reported from across the US and at least 10,980 have died in the COVID-19 pandemic, shows the John Hopkins tracker.
The book is officially called the "Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents". Based on lessons learned from the 2014 Ebola outbreak and heightened monitoring of the MERS-CoV and Zika outbreaks that followed, the "international assistance and response checklist" was developed to identify key questions, US government interagency partners and decisions to guide possible measures during a largescale infectious outbreak.
"The goal of the playbook is to assist US government experts and leaders in coordinating a complex US government response to a high-consequence emerging disease threat anywhere in the world with the potential to cause an epidemic, pandemic, or other significant public health events, by providing decision-making tools," says the playbook created in 2016.
It asks key questions at each stage of a health crisis — normal operations (no unusual disease outbreaks), elevated threat, credible threat and public health emergency of international concern (PHEIC). The booklet also lists key decisions to be taken at each stage and key questions one should ask "to inform the key decisions that can be made and actions that can be taken".
From disease characteristics and contract tracing capability to the ability to prevent and deliver medical interventions — these are questions asked at every point, from the beginning when it is recognized that the disease poses an elevated threat. This implies an infectious disease outbreak with high mortality/morbidity/public health consequences; and high transmission or outbreak potential.
In the playbook, as part of the proposed strategies, for example at the credible threat level itself — confirmation of multiple human cases anywhere or determination of a significant potential for a public health emergency — experts say key questions must be asked on transmission rate, confidence on case detection rate and robustness of contact tracing. The other critical questions are if the diagnostic capacity is keeping up, assessment of the strength of control measures, if the public health infrastructure is keeping up with the cases as well as future assessment capacity, and funding options, among others.
As part of an early response strategy, the playbook assumes that the US government will use all powers at its disposal to prevent, slow or mitigate the spread of an emerging infectious disease threat by limiting disease spread, mitigating the impact of illness, suffering and death, and by sustaining critical infrastructure and key resources in the US.
It calls for a "unified message" from the federal government, and stresses that the "American public will look to the US government for action when multi-state or other significant events occur."
The experts say at the credible threat level stage, response strategies should also ask questions on transmission rate, appropriate disease surveillance, case detection confidence, to what extent quarantine and isolation have been implemented, the strength of contact tracing and diagnostic capacity.
At the level of a public health emergency, the response recommendations call for checking diagnostic capacity and stress on determining the key federal messages. It also calls for early coordination of risk communication through a single federal spokesperson. US President Donald Trump has often contradicted his own advisers during briefings. The key decisions at this stage, says the playbook, is to determine the need for public health support personnel, diagnostic personnel teams and resources, and coordination of workforce protection activities, including PPE determination, among other measures. Prioritization and allocation of funding is another important recommendation.
According to Politico, the Trump administration was briefed on the playbook’s existence in 2017 as per "four former officials". "But two cautioned that it never went through a full, National Security Council-led interagency process to be approved as Trump administration strategy," it says.