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Coronavirus: Gaps in Preparedness, Coordination Costing Lives

“You have to have uniform guidance across the country and, ideally, across the globe where you have to have coordination of supply chain, so you don’t have every state over-ordering for the worst-case scenario …”

Emergencies are local — most of them. State and local governments should take ownership of most emergencies. One prominent former emergency manager was on national television recently to make that point about the response to the coronavirus. The feds should provide resources, then get out of the way and let the governors lead.

But experts who have been warning of a pandemic for years are perplexed by the response and the chaos that has been created by the federal government’s mixed messaging and its unwillingness to direct traffic when it comes to providing personal protective equipment (PPE) and to lead in issuing orders that might protect citizens, health professionals and first responders.

But this pandemic is different.

What’s needed in this case is a czar or point person who doesn’t necessarily make the decisions or act as spokesperson, but who coordinates the strategy from the federal government, working with state and local governments.

“Pandemics are not run-of-the-mill disasters,” said Jeff Schlegelmilch, deputy director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute. In general, Schlegelmilch said, he agrees with the mantra of FEMA that disasters are federally supported but state managed, but he said it doesn’t work that way in a pandemic.

“You have to have uniform guidance across the country and, ideally, across the globe where you have to have coordination of supply chain so you don’t have every state over-ordering for the worst-case scenario, but you can actually move things around within the resources of the supply chain,” Schlegelmilch said.

What’s needed in a pandemic like the one we’re in is national-level guidance and national-level resource coordination and then implementation of that to be directed by the governors and local officials. “What you don’t want,” Schlegelmilch said, “is like what we have right now where you have some governors implementing social distancing but others not.” The problem with that lack of national guidance or strategy is that eventually those states that fail to flatten the curve may become hot spots and affect the rest of the country.

Schlegelmilch saw that former emergency managers on television “going off the rails” about states hoarding equipment. “Well, no, if you’re telling them to fend for themselves, they’re going to take their worst-case scenario and order for themselves,” he said.

That problem of states “hoarding” should have been addressed early on by the federal government with some supply chain management, said Dr. John Hick, deputy chief medical director for Emergency Preparedness at Hennepin Healthcare in Minneapolis.

“There are some pretty key things you need to do early, and one of those is recognize the supply chain shortages and try to get those rectified, but also take control of some of the manufacturing and distribution processes. Otherwise it turns into a war between states for resources that everybody needs,” Hick said.

That’s where the czar would have come into play early on.

Schlegelmilch pointed to Ron Klain taking that role during the 2014 Ebola crisis and how he helped to coordinate with the various “overlapping authorities” like FEMA, the Department of Homeland Security, Health and Human Services, and the Department of Defense. “We wondered why they had a bureaucrat and not a doctor, but it turned out well because what you need is someone to run air traffic control with all the other experts,” he said. “You need a bureaucrat in the center of it all making sure that everything is synchronized.

“At the federal level, unlike on a local disaster scene, there isn’t clear command and control. There are no national health officers. That’s why President Obama had the pandemics team. “The Trump administration didn’t really get rid of it, they just moved it under another directorate to the point where it wasn’t functional,” Schlegelmilch said.

What we’re seeing now are public health recommendations being altered by non-public-health people, and drugs being recommended by non-public-health people. “Ideally there would be a clearer command and control structure instead of this kind of loose coordination structure that may look good in a national response framework, but in practice, you have blind spots and things that you have to have someone in charge of to sort out,” Schlegelmilch said.

He said you need consistent messaging that’s driven by the public health experts. You really do want consistent messaging coming and you want that messaging being driven by the public health experts.

Hick said the United States probably dodged a bullet during the 2009 swine flu crisis, and we may be paying the price now. “We got off easy, but this pandemic has revealed gaps in manufacturing, gaps in PPE, gaps in vaccine development, gaps in coordination,” he said. “We absolutely must close those gaps.”

But, he said, the lessons from disasters tend to fade and priorities shift and the public loses interest until it’s too late. “Now we’re trying to spend a ton of money to catch up,” Hick said. “It’s like trying to buy a fire truck when your house is on fire.”

He said the planning for a pandemic had been there and we should have been more prepared for the coronavirus. “Shame on us. It’s not as if we haven‘t table-topped and beat pandemic planning to death from a planning standpoint for years, including from 2009. Priorities have shifted. Our funding has been reduced and we’re probably in a worse position now than we were in 2009.”

“A lot of people are dying because we don’t have the tools to do surveillance and prevalence testing to know where the disease is in the community and what’s happening with it,” Hick said. “We don’t have the right PPE, there are a lot of pieces missing here that are going to cost lives. Shame on us if we don’t do something about it this time.”