Next time, will we be better prepared.....?
The true failure to prepare surely lies with our leaders!
We are humble folk, minding our own business; their business should be safeguarding our welfare, advised by expert specialists. You or I could hardly be expected to read Gro Harlem Brundtland’s October Global Preparedness Monitoring Board Report, and if we did, it is not clear what action we could really take. Surely every government should have someone who is paying attention to such things?
Margaret Heffernan, the author of Uncharted, warns that the same mental failings that blind us to certain risks can do the same to our leaders.
“We hang around with people like ourselves and if they’re not fussed, we’re not fussed,” she says. “Gro Harlem Brundtland lives inside a global health institution, so she cares. Most politicians don’t.”
While politicians have access to the best advice, they may not feel obliged to take experts seriously. Powerful people, after all, feel sheltered from many everyday concerns.
Heffernan argues that this sense of distance between the powerful and the problem shaped the awful response to Hurricane Katrina.
Leaked emails show the response of Michael Brown, then the director of Fema. One subordinate wrote: “Sir, I know that you know the situation is past critical. Here are some things you might not know. Hotels are kicking people out, thousands are gathering in the streets with no food or water… dying patients at the DMAT tent being medivac. Estimates are many will die within hours..…”
Brown’s response, in its entirety, was: “Thanks for update. Anything specific I need to do or tweak?”
That’s a sense of distance and personal impunity distilled to its purest form.
Sometimes, of course, the feeling of invulnerability is an illusion: in early March, the British Prime Minister Boris Johnson jovially declared that people would be “pleased to know” that he was shaking hands with everybody at a hospital tending to patients with coronavirus, and inviting people to make their own decisions about such matters.
It was a shamefully irresponsible thing to say – but it also spoke volumes about his misplaced intuition that he could come to no harm. Within weeks, the story of Johnson had become a classical tragedy, the hero laid low by his own larger-than-life qualities.
We should acknowledge that even foreseeable problems can be inherently hard to prepare for. A pandemic, for example, is predictable only in broad outline. The specifics are unknowable.
“What disease? When? Where?” says Heffernan. “It’s inherently unpredictable.”
The UK, for example, ran a pandemic planning exercise in October 2016, dubbed ‘Exercise Cygnus’. That forethought is admirable, but also highlights the problem: Cygnus postulated a flu pandemic, perhaps a strain of the H1N1 virus that killed tens of thousands in 2009, and many millions in 1918. Covid-19 is caused by a coronavirus instead, a relative of the Sars-Cov strain from the 2003 outbreak. Some of the implications are the same: we should stockpile personal protective equipment. Some, such as the danger of flu to young children, are different.
In any case, those implications seem broadly to have been ignored.
“We learnt what would help, but did not necessarily implement those lessons,” wrote Professor Ian Boyd in Nature in March. Boyd had been a senior scientific adviser to the UK government at the time. “The assessment, in many sectors of government, was that the resulting medicine [in terms of policy] was so strong that it would be spat out.”
Being fully prepared would have required diverting enormous sums from the everyday requirements of a medical system that was already struggling to cope with the nation’s needs. The UK’s National Health Service was short of staff before the crisis began, seems to have had woefully inadequate stores of protective equipment for doctors and nurses, and has long pursued a strategy of minimising the use of hospital beds.
It’s this quest for efficiency above all else – in the NHS, and modern organisations in general – that leaves us vulnerable. The financial crisis taught us that banks needed much bigger buffers, but few carried the lesson over to other institutions, such as hospitals.
“On a good day, having 100 per cent of your intensive care beds in use looks efficient. The day a pandemic strikes is the day you realise the folly of efficiency. You’ve got to have a margin,” says Heffernan.
These margins are hard to maintain, though. In 2006, Arnold Schwarzenegger – then Governor of California – announced an investment of hundreds of millions of dollars in medical supplies and mobile hospitals to deal with earthquakes, fires and particularly pandemics. According to the Los Angeles Times, emergency response teams would have access to a stockpile including “50 million N95 respirators, 2,400 portable ventilators and kits to set up 21,000 additional patient beds wherever they were needed”.
It was impressive. But after a brutal recession, Schwarzenegger’s successor, Jerry Brown, cut the funding for the scheme, and the stockpile is nowhere to be found.
Brown isn’t the only one to look for something to cut when funds are tight. Managers everywhere have long been promoted on their ability to save money in the short term.
I spoke to a friend of mine, a senior NHS consultant who had contracted Covid-19 as he tended his patients. Recovering in self-isolation, he reminisced about the days that he was told to find cuts of five to 10 per cent – and the fact that his hospital was no longer providing coffee for staff meetings as a cost-saving exercise. That seems like a memo from another era – but it was just a few weeks ago. As the cost-saving measures were being introduced in the UK, Italians had started to die.
The pandemic has offered us few easy choices so far. Nor are there many easy answers to the general problem of preparing for predictable catastrophes. It is too tempting to look at a near miss like Hurricane Ivan or Sars and conclude that since the worst did not happen then, the worst will not happen in the future. It is tempting, too, to fight the last war: we built up reserves in banking after the financial crisis, but we did not pay attention to reserve capacity in health, vaccine production and social care.
Preparedness is possible. Margaret Heffernan points to Singapore, a tiny country with front-line experience of Sars, acutely aware of its geographical vulnerability.
“The foresight unit in Singapore is the best I’ve ever encountered,” she says. “There are serious people working through very serious scenarios, and there’s a diversity of thinking styles and disciplines.”
Serious scenarios are useful, but as the UK’s Exercise Cygnus demonstrated, serious scenarios are no use if they are not taken seriously. That means spending money on research that may never pay off, or on emergency capacity that may never be used. It is not easy to justify such investments with the day-to-day logic of efficiency.
Singapore isn’t the only place to have prepared. Almost four years ago, philanthropists, governments and foundations created the Coalition for Epidemic Preparedness Innovations. Cepi’s mission is to support and develop technologies and systems that could create vaccines more quickly.
While the world chafes at the idea that a vaccine for the new coronavirus might take more than a year to deploy, such a timeline would have been unthinkably fast in the face of earlier epidemics.
Still, we are left wondering what might have been if Cepi had existed just a few years earlier. In October 2019, for example, it started funding vaccine ‘platform’ technologies to enable a more agile, rapid response to what it called “Disease X… a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 [million] to 80 million people and wiping out nearly 5 per cent of the world’s economy”. That’s preparedness; alas Disease X may have arrived just a little too soon for the preparedness to bear fruit.
And what of New Orleans? In the summer of 2017, it was underwater again. A vast and expensive system of pumps had been installed, but the system was patchy, under-supplied with power and unable to cope with several weeks of persistent rain. It does not inspire confidence for what will happen if a big hurricane does strike.
Robert Meyer says that while the city has learnt a lot about preparation, “Katrina was not close to the worst-case scenario for New Orleans, which is a full category-five storm hitting just east of the city”.
The same may be true of the pandemic. Because Covid-19 has spread much faster than HIV and is more dangerous than the flu, it is easy to imagine that this is as bad as it is possible to get. It isn’t. Perhaps this pandemic, like the financial crisis, is a challenge that should make us think laterally, applying the lessons we learn to other dangers, from bioterrorism to climate change.
Or perhaps the threat really is a perfectly predictable surprise: another virus, just like this one, but worse. Imagine an illness as contagious as measles and as virulent as Ebola, a disease that disproportionately kills children rather than the elderly.
What if we’re thinking about this the wrong way? What if instead of seeing Sars as the warning for Covid-19, we should see Covid-19 itself as the warning?
Next time, will we be better prepared?
Tim Harford is a senior FT columnist, and the presenter of the “Cautionary Tales” podcast.
This an excerpt of an article in the Financial Times, weekend edition, April 18-19, 2020. https://digital.olivesoftware.com/Olive/ODN/FTUK/Default.aspx