Announcer: Experts agree that something like the COVID-19 pandemic may, unfortunately, not be limited to a once-in-a-century phenomenon.

In our increasingly interconnected world, novel pathogens can find human hosts anywhere on the planet and spread with a speed and scale never seen before, so if we must be preparing for future pandemics, what lesson should be learned from the COVID-19 experience-- lessons about public policy and lessons about the practice of medicine in a time of crisis?

This episode of "The Whole Truth" was made possible by the Commonwealth of Pennsylvania Department of Education, William and Susan Doran, CNX Resources Corporation, and NJM Insurance.

When the effect of the novel coronavirus first hit the world early in 2020, epidemiologists described it as a once-in-a-century pandemic harkening back to the Spanish influenza almost exactly 100 years before, but as we have learned to live with COVID-19 and faced enormous social and economic dislocations because of it, many experts in the field argue that we can't assume that it will be another century before such a challenge again arises.

Indeed we would be foolhardy to believe that in a more populated and much more interconnected humanity of the 21st century that we won't see the spread of additional new infectious diseases with some sort of regularity, so how do we prepare, and, first and foremost, what have we learned from the COVID-19 experience that might help us better prepare for such threats in the future?

Joining me are Dr. Kevin Mahoney, CEO of the University of Pennsylvania health Care System; Dr. David Fajgenbaum, associate professor at the Perelman School of Medicine; Dr. Jon Gleason, chief clinical officer at Prisma Health; and Stephen Northrup of Rampy Northrop Consulting.

How do you evaluate the research response to COVID?

We had a common enemy.

Everyone was pulling in the same direction.

It happens rarely in our history, but during that early time, people had theories.

They were being debunked.

Some were being pushed forward because they made sense, but there was rigor in the early days to the science around COVID-19, and it's just remarkable to me how much we found out as quickly as we did.

The other part of the beginning that was remarkable to me is, everyone forgot "novel" in front of "COVID."

This was the first time we saw this particular strain, and we went, again, from, "We're in this together," to, "Why don't you guys have a cure?

"How come you don't-- Why don't you know more about it?"

and I think we forgot that the why was-- Eisenhower: Well, why was that, because you identified, I would say, familiar strains of this thing or familiar characteristics or-- No.

I think Americans forget, and they get tired quickly, so they have public health deficit disorder, and they wanted a solution, but science takes time, and, you know, it takes rigor.

There must have been sort of an hour and a day where you realize that you were involved in a chase to try to get answers for something that nobody had answers to early on, so how would you evaluate the research effort from your point of view?

Yeah.

I think that what's been incredible is the amount of work that's been done from various academic medical centers all the way through companies.

It's really been almost like a machine gun approach where lots of shots on goal.

The challenge is, it hasn't always been coordinated, and so that's made it really hard to compare results from one group to another group because we're kind of all working independently, and if you ask about the hour and the day, it was Friday, the 13th of March, which was really when things started to shut down, and I remember thinking to myself, "I really hope some research group out there "will synthesize all the data, look for all "of the existing drugs that could be repurposed, maybe a group kind of like ours," and then I sat on it for a couple minutes and said, "Wait a minute.

Maybe we should just do it," and so that's when we launched the CORONA Project to try to synthesize the data.

How do things look from your point of view, the research effort?

I think the research effort also was remarkable.

I think one of the challenges was translating that research to the public and helping them to understand the scientific process, which is-- involves a lot of learning over time, and the evidence evolves in any scenario, particularly one where we have a global pandemic and it's a new virus, and so, you know, to me, one of the real challenges is, how do we translate the amazing work that was being done in every laboratory around the world?

Every researcher in the world was saying, "What can I do in my field of study to help solve this problem?"

because it is a problem for the entire human race, and so, you know, just an enormous amount of discovery that was happening and translating that to the public and helping them to understand that this is the healthy scientific process moving forward and that there will be things that we think are right today, but in two months, we're going to have a different opinion because the evidence is going to evolve, so, to me, that that's one of the real learnings from this, is, you know, how can we better communicate from the scientific community to the public at large.

Yeah.

We're going to be coming to lessons on this thing.

Stephen?

Northrup: David, something I think that's underappreciated is how fortunate we are that this pandemic hit us when it did and didn't hit us 20 years ago or even 10 years ago.

We have the ability today to sequence the genome of the virus and basically figure out what it is and how we need to attack it, and then we have the vaccine technology today that we didn't have back then, either, especially the mRNA technology, so if this had hit us 20 years ago, we'd be in a much worse place.

Eisenhower: How would you all, then, assess the early care effort, that is, the early response?

The medical profession, again, just remarkably across the globe, they were talking to people in Spain, Italy-- "What did you guys see?"

-- and bring it back and forth, so the treatment progressed quite quickly to monoclonal, to more therapeutics and less mechanical ventilation.

And how successful were the therapeutics, which is-- We spent a lot of time trying to eliminate the disease through vaccination.

There's been less stress on therapeutics, but in the days before vaccines, how effective?

I'll just use our mortality rate.

In the early days, our mortality rate would have been close to 20%, and by the end, it was less than 9% in our system.

Among hospitalized patients.

Hospitalized patients.

Thank you, David.

Yeah.

All right.

Well, do you have any measure of what percentage of-- I mean, that's a huge rate of-- Hospitalized patients 20%?

But, again, to my point of how quickly everybody learned, you know, we dropped into single digits quite rapidly.

Eisenhower: Now, how did these deaths unfold?

Was it pneumonia or-- Yeah, pulmonary failure and then also multiorgan failure, so COVID causes, of course, the lung issues we see but also affects organs throughout the body due to the cytokines, so excessive inflammation, and we launched this CORONA Project because early on, we all heard about hydroxychloroquine and a number of other drugs that many people were really excited about, us included, certainly.

What we learned pretty rapidly is that hundreds of drugs were being tried, In fact, now it's been over 600 different drugs have been given to COVID patients, and some of them work really, really well.

In fact, dexamethasone has probably saved the most lives in the pandemic-- tocilizumab, as well-- so there's a few that have saved a lot of lives, and there's a few that got the most public attention that, as we now look at the data, probably did not help anyone.

I think, also, it's not so much that educated guesses were what was taking place early on.

It was just, the evidence was evolving, the scientific method.

What you do initially is descriptive studies, and you observe what happens when a patient receives a medication, and that descriptive study then can lead to experimental studies called randomized clinical trials.

Those take some time, and so a lot of the early treatments were based on descriptive studies, giving medications that made sense to patients and then doing clinical trials, and that's the story, really, of how medicine develops the evidence over time, is that a lot of the ideas that come out of descriptive studies don't hold up to the scrutiny of a randomized clinical trial, and those treatments are then no longer propagated, but when you have a crisis like we had, we were going from descriptive study to treatment because we had hospital mortality rates of up to 20% and that was the right thing to do.

Eisenhower: Wow.

COVID policy, when did that develop?

When would you say we had a COVID policy, and how would you evaluate it?

I'm going to go around the room, but-- I think you have to, David, look back 20 years, really, to understand fully our response and where our response fell short to COVID.

I look at pandemic and public health preparedness funding as a tale of two decades, really.

It was after 9/11 and the anthrax attacks which, you remember, came right on the heels of 9/11 that Congress got serious about bio defense, public health preparedness.

I was fortunate to work in the Senate during that era and was involved in several laws that passed that put together-- basically created the policies, the programs, and the structure that we're currently operating under today.

Congress also increased funding tremendously.

Tens of billions of dollars went into-- above and beyond the spending at that current time-- went into bio defense, went into pandemic preparedness, when into hospital preparedness, state and local public health departments.

Dr. Fauci's institute at the NIH got a sixfold increase in funding in one year, and then-- As a result of anthrax.

Yeah.

Well, as a result of, you know, our focus on preparing for a bioterror attack and/or a pandemic.

Eisenhower: So you're saying 9/11 essentially alerts us to the vulnerabilities of-- Yeah, and if you look at how we responded to H1N1, bird flu, in 2009, we responded, I think, generally pretty well as a country, as a health care system to bird flu, so then what happened in the next decade, the 2010s, I think couple of things happen.

We got complacent, and then we got distracted.

We had the economic crisis, the Great Recession, and that ended up doing a number on spending on public health.

Spending decreased for hospital preparedness, for state and local public health departments, so we got complacent, and we got distracted.

We stopped investing.

COVID's new, so what do you prepare for?

Much of the preparations you put into place are going to be the same regardless of the particular pathogen.

You have to have a surveillance system.

You have to have data systems that are that are interoperable, that are collecting the right data-- genomic data, clinical data, epidemiological data, so our systems were designed to be a pathogen agnostic, if you will, and we should have been prepared for a coronavirus because we'd had, you know, a couple of scares previously with other-- with SARS, with-- MERS.

MERS, yeah.

Yeah.

We just-- Yeah.

Our systems are designed to be pathogen agnostic, again, so it was really not anything specific about COVID that I would say.

It was just a general sort of failure to anticipate, failure to fund properly the programs and policies and structures that we had in place that do make sense.

Was there a way that this might have become treated as a public health matter, could have avoided politicization of it?

Is there a way... that could happen?

Personally, I think we need to elevate public health.

You know, I talked about this surveillance system.

You wouldn't let air traffic controllers be run by whoever feels like it.

Right.

I mean, it has to be coordinated.

We need a coordinated, national approach to public health, and we leave it up to-- This county voted out their public health department.

This city-- I mean, the virus doesn't know county lines, so I think we can if we elevate public health to the its right place, and what do we lose, a million people?

If a foreign enemy killed a million Americans, we'd be going to war with them.

Northrup: Also, though, our public health leaders really need to be trained on scientific communication, communicating with clarity, with empathy, and with honesty, and honesty means leveling with the American people.

I look back to the early days of the pandemic with masks.

At the beginning for several weeks, it was communicated to the American people that, "Well, we probably don't need masks.

"Masks are not necessary.

Don't run out and get masks."

I think I understand why that decision was made.

It was to avoid there being a run on masks because of a public policy failure previously and not replenishing the strategic national stockpile with masks.

Again, that was a policy that was put into place 15 years ago, and after the pandemic of 2009 with bird flu, we didn't replenish the masks in the stockpile, so we were concerned about preserving the supply of masks for those who really needed them-- health care workers.

I think if we'd communicated that directly and said to the American people, "Please don't run out and get masks.

We need to preserve what we've got," some people would have still gone out to get masks, but I think most people-- and I still have some faith in the American people-- I think most people would have respected that clear communication, but instead, we tried to say, "Well, we're not sure if masks are necessary.

Masks probably aren't necessary right now."

I think it was a combination of communications missteps like that that undercut-- that's undercut every communication going forward.

Looking at Manhattan Project, A-bomb, there's an international atomic disarmament agency that comes out.

That is, there's sort of a higher authority where these things can be brokered.

Does that institution exist?

Is that NIH or CDC or-- There's no coordinated institution to do that right now, and I think that not only do we need to have that central organization for future pandemics, but I think we also need to learn from this for many other diseases in the health care system.

I mean, COVID is not the only thing killing people, and so I think what's happened with COVID is somewhat a symptom of the problems that we have, and I think we do need leadership to drive forward things like, you know, figuring out PPE and, you know, stockpiling, but we also-- I think as a society, we think that there are these systems set up to figure out what drugs are working, what drugs aren't working, you know, pulling together data, but actually a lot of this is quite random.

It's, you know, one doctor here, one researcher here is doing this analysis or that analysis, and I think that needs to change because we have access to data.

We just aren't using it.

Well, there's a documentary series that I enjoy watching with my kids called "How the World Ends," and there's a segment on pandemics, and it's remarkable how much foresight there was in the production of this thing.

Somebody gets on an airplane, and, you know, the oxygen is circulated through the cabin, and so forth.

They step off, and they've infected 25 people before they reach their hotel on the other end.

The thing that haunts me is the randomness, the origin of this.

This is a wet market, supposedly, in Wuhan, or maybe it's an escape from a lab-- we're still debating that-- but this could have been something as simple as one of several trillion bats in China is infected and sold in a wet market in Wuhan.

We've been there, by the way, my wife and I, Wuhan.

When were you there?

We were there in 2013, and I can remember thinking, this is a place that's stretched environmentally about as far as you can stretch anything.

This had been a rural community which had been Mao's favorite retreat, and suddenly, it's a city of 15 million people, 12 to 15 million people, and it felt like one-- it was an amazing complex-- but so we're surprised by this, and I guess what I would go around the table again would be to ask, first of all, are you, "A," satisfied, "B," dissatisfied with our response from your perspective as health care professionals, and, two, what kind of lessons that we can derive from this.

I am 100% satisfied with every nurse, doctor, public health worker, housekeeper, EMT across this country that really stepped up, and to say anything negative about that response would just be... unconscionable to me.

I mean, it's just incredible, the humanity that I saw expressed by people who didn't know, "If I go into that room and I go home, am I going to infect my family?"

so they were staying in hotel rooms and sleeping in garages, so I am very satisfied with the American spirit of every health care worker that's stepped up.

I'm very dissatisfied that we're not learning from this, so you talked about Wuhan and the wet market.

There's a lot being published right now on transmission between deer and humans, and we shouldn't treat it like, "Let's wait and see if anybody gets infected."

Like, we should, again, have a surveillance system...

I'm recovering from an infection.

Guilty.

but have a surveillance system where we're collecting data on a regular basis from every point of the country and the globe so that we know what's going on before it gets here, and we live in a world of big data, and we need to apply it to public health.

Eisenhower: Where those barriers?

In other words, we're not learning from one another.

Where are the barriers?

Are they national governments or-- I think it's national governments.

I think it's, you know, frankly, social media.

You know, Steve and I were talking earlier today.

If social media had been as embedded as it is right now around 9/11, would our response had been the same, or would there have been all kinds of conspiracy theories?

There were, but would they have been more rooted and run so quickly around-- Eisenhower: Which raises a whole new subject, which is essentially disinformation Yeah.

and the Internet.

This is something that is a very touchy, sort of First Amendment political question because you don't know where to-- how to define disinformation or where to draw boundaries there, but you're saying that is a real problem.

I think it was, and I think it still is, so I'm I don't want to be negative, but I am dissatisfied that we haven't-- particularly as a nation, because I still think we lead the world-- come up with a way to make public health a number-one priority in the country.

Yes.

I totally agree with Kevin.

It's incredible what people have done, I think, while at the same time, I don't think the systems were in place or are in place right now for future pandemics to track drugs being used, to track new cases.

We have to build those things.

I think the other thing that I'm not satisfied with is, in an attempt to combat disinformation, there was, I think, maybe more confidence than we actually should have had in the way that we gave good information.

We made it seem like it was perfect information.

It wasn't disinformation.

It wasn't perfect information.

Other words, you didn't expect it to be processed as though it was.

Exactly.

I think we needed to communicate with some more humility that, you know, "This is the best information we have right now, but it could change."

You say-- Were there entities out there that you feel were communicating effectively, made a difference?

Because this communications question is real.

Oh, absolutely.

There certainly were great organizations that had done a great job of communicating.

I think the challenge is that it's been the message coming from a lot of different people, and I think that the American people think that we in the medical community are sort of, like, one monolith where we work together, we collaborate, and then we share when, in reality, there's just millions of us, and we're all, you know, sharing and doing our own things.

It's not one entity, and so I think that's meant that people have interpreted when you hear from one doctor, you've heard from all doctors when that's not the case.

So I think I agree that it's amazing what people who work in health care have done.

It truly is inspiring.

One of the clear evidences of that is, we have record applications to medical school and nursing school, so while we have people who are currently working in health care who are exhausted and questioning whether or not they want to keep going, young people saw this.

They were inspired by it, and they're coming in droves, so, you know, to me, that's a real hopeful point for the future, and I think in terms of just what I think the challenge is, the big challenge is having that convener, the nonpartisan convener, for the medical and scientific community that has an effective strategy for communications, as David said, about, you know, how do we express what we are clear about and what we are uncertain about and how we're translating that into policy and why what we're recommending makes sense right now, but leaving open the door to come back later and say, "We may learn more in the future and come back on this point," so having that nonpartisan convener for the scientific and medical community, I think, is really important.

Eisenhower: Well, you have a follow-up on that in a minute, but what would you say, Stephen?

I'd say the number-one thing that we can do-- the number-one lesson learned from this pandemic so that we're prepared for the next one, and there will be a next one-- I don't know when, don't know how, don't know what, but there will be a next one-- the best thing we could do is treat public health preparedness like an issue of national security because it is an issue of national security.

Viruses don't care about your borders, so we need to be prepared in a way that we've never prepared before, and I look at-- For instance, the Pentagon has what's called an overseas contingency operations fund.

That OCO fund is outside the annual spending bills.

It's outside the budget and spending caps that we have.

We need to do something very similar.

We need to create a pandemic contingency operations fund.

This is something that I think the pandemic has demonstrated really can't be done by political offices.

We need a public health system that's got sustained funding that isn't subject to the vagaries of recessions, booms.

It needs to be consistent, and it needs to be something that the federal and state, local governments can count on.

Eisenhower: And I think that's something that we've had faith in for a long time, probably, and we've lost it without recognizing that our governmental authorities are going to be simply listened to on a matter like this, and, as it turns out, we need something else, so that's one of the lessons that comes in, huh?

Yeah.

We've had a bump in funding after Ebola, a bump in funding after Zika, and then the funding goes away when the crisis goes away.

I think our response was thrilling in a lot of ways, the idea of bringing cures to market as fast as we did, and generally there was a lot of complaints, but I would say the cooperative spirit that most people had and the heroism of the health care workers was kind of an inspiring thing, I have to say.

Appreciate and thank you all for joining in this discussion about COVID-19, and I'm sure we're going to be having plenty more of these in the months to come.

Perhaps if the world is very lucky or very blessed, it will be another century before we have a once-in-a-century pandemic, but having lived through the last several years, it seems certainly unwise for the public policy to be based around an assumption that such good fortune is in the cards.

COVID-19 showed that the world was capable of rapid responses to a new threat, innovations in technology and the economic policy, and the delivery of medicine at the bedside and so on which truly bear praise, perhaps much more so than has been acknowledged, but it also showed numerous hurdles and weak links in the chains of policy response.

The question is whether we can learn the lessons-- the good, the bad, and the ugly-- of the experience through which we have all recently lived to be better prepared to do a better job the next time.

As always, I am David Eisenhower.

I thank you very much for watching "The Whole Truth."

Announcer: This episode of "The Whole Truth" was made possible by the Commonwealth of Pennsylvania Department of Education, William and Susan Doran, CNX Resources Corporation, and NJM Insurance.