Lessons from the Covid War: An Investigative Report

by Covid Crisis Group

The world war against this invader, COVID-19, has not gone well. No country’s performance is more disappointing than that of the United States. America went into this war with unsurpassed scientific knowledge. Once at war, its politicians were willing to spend whatever it took. Thousands of people and organizations made heartrending, life-saving efforts. Yet our institutions did not meet the moment. They did not have adequate practical strategies or capabilities to prevent, to warn, to defend their communities, or fight back in a coordinated way, in the United States and globally.

In 2020 and 2021, using common methods for the estimates and adjusting for age, the U.S. excess mortality rate was about 40 percent higher than the rate monitored among the Europeans.

the Congressional Budget Office estimates that, between the first quarter of 2020 and the third quarter of 2021, the federal government deployed more than $5 trillion in fiscal policy responses to deal with the pandemic, including tax cuts or rebates. That amount was more than a trillion dollars larger than the entire budget of the federal government, mandatory and discretionary, in fiscal year 2019.10

In the United States, it is sobering to compare the Covid pandemic of 2020–21 with the great influenza pandemic of 1918–19. In the world of 1918, knowledge of viruses and vaccines was in its infancy. Health and medical institutions were rudimentary. The doctors and nurses struggled, often valiantly, and were usually overwhelmed. More than a hundred years later, in the world of 2020, the danger of a coming pandemic was predicted and publicized. Scientific knowledge was vastly more advanced. Health and medical institutions were vastly more extensive. The money available was also vast; the U.S. Congress appropriated more than any country on earth. Millions of skilled Americans pitched in to help.16 Yet, for all their giant edifices, the net effect of the U.S. governance, public health, and medical institutions in 2020–21 seems all too comparable to the outcomes in 1918–19.

What the Covid war exposed, what every recent crisis has exposed—even in Iraq and Afghanistan—is the erosion of operational capabilities in much of American civilian governance. The giveaway is how often governments and agencies had to hire management consultancies—McKinsey, the Boston Consulting Group, Bain & Co., and a number of others—to perform basic operational tasks. These firms used to be thought of as outsiders that would occasionally be called in to assess the usual operators. What was telling in the Covid war, as in other wars, was how often such firms were asked to do the work itself, to staff leading officials and organize the management of the crisis.

American policymaking has become less about deliberate engineering and more about improvised guesswork and bureaucratized habits.

We have spoken with leading scientists associated with both of the major theories for how the virus got to Wuhan—either due to animal-to-human spillover or via the research process. Both theories remain plausible. As we said at the beginning of the chapter, more evidence about the origins of COVID-19 might emerge from investigations into sources outside of China. At present, we just do not think there is enough evidence available, yet, to come down hard either way.

In 2005, after the first SARS, the countries of the world agreed on a revised set of International Health Regulations. These regulations required states to do more to detect and respond to outbreaks and warn the WHO about emerging health threats that might spread internationally. In the Covid war, this system failed. It failed because countries, including China, ignored these regulations and continued to ignore them throughout the pandemic response.

Long before the pandemic outbreak in Wuhan, the global scientific community had been debating the pros and cons of research programs that collect and experiment with potentially dangerous viruses, or experiment with them to explore their possible danger. Those debates have not been resolved. There are still no agreed upon international standards for what sorts of research would pass a risk-benefit test. Any such standards would be technically complex and difficult to monitor across national borders.

The United States has twenty-eight hundred local public health departments, but these authorities are not organized into any coherent system. Half report to a centralized board of health; half do not. Some have carve-outs and carve-ins, where animal health is excluded but environmental health is included, and vice versa. No two are the same. Add to that antiquated information technology systems and it is no wonder that these departments cannot collect complete, reliable data on public health threats.

“When I came here [to] the premier public health agency of the world… I thought I was coming down here to use data to make an impact on public health. And you’re telling me what I really am is, I’m a medical historian.” To Redfield, “The culture of the agency is not a response agency. It’s a ‘we collect data, and tell you what happened.’… And most of the people at CDC, which I respect, but they’ve [been] lull[ed] into feeling like they’re in academic medical science, an Emory [University] II.” And still, in 2022, Redfield believed that “we don’t have an integrated system [for public health data] in this country.”

“The CDC,” he went on, “has become like an independent academic institution in their ivory tower. They have almost no urgency and almost zero operational capability. And that was shown in the pandemic.” He was bewildered to see CDC trying “to improve maternal health… and have a thousand people working on that, which is really HRSA’s role [the Health Resources and Services Administration of HHS],” at which HRSA was the best, “bar none.” The CDC had to focus on its core mission. It needed “to understand how to control infectious disease.”

In September 2019, just before the Covid outbreak, the White House Council of Economic Advisers issued its own little-noticed report. It estimated that a pandemic (influenza, for example) would cause economic damage that could range from nearly half a trillion to nearly four trillion dollars. It thought, if the pandemic was really bad, it could kill more than half a million people.22 That 2019 report may have seemed alarmist. It actually greatly underestimated the impact of what was about to hit.

Trump explained to Woodward that “I wanted to always play it down. I still like playing it down, because I don’t want to create a panic.” The panic was there without any presidential help. What was missing was the mobilization and readiness that would reassure the American people with action.

Innumerable speeches, books, and articles have stated that the Obama administration gave the incoming Trump administration a “playbook” on how to confront a pandemic and that this playbook was ignored. The Obama administration did indeed prepare and leave behind the “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents.”15 But the playbook did not actually diagram any plays. There was no “how.” It did not explain what to do.

Subsequent evidence has confirmed that, after the first week of February, travel bans would probably have been useless. The virus was already in the country and cases were being generated locally much faster than they could be imported into the United States.21

a $2.3 trillion economic stimulus package, the Coronavirus Aid, Relief, and Economic Security (CARES) Act. There was little planning behind it. Rather than start figuring out how to adapt businesses and employment to the pandemic, the plan simply gave out stunning sums of money to the American people. Economists sometimes refer to such blanket stimulus as “helicopter money,” since the theory is not far from the idea of just throwing money out of a helicopter flying over a city. This was the largest helicopter money experiment in the history of the United States. In his memoir, Kushner simply wrote: “We were shooting bullets into a cloud of smoke and hoping that enough of them would hit their targets to save an economy veering toward collapse.”11

on March 21, Jared Kushner, President Trump’s son-in-law and senior adviser, had told a gathering of private sector officials: “The federal government is not going to lead this response. It’s up to the states to figure out what they want to do.” At the same time, President Trump was privately telling Bob Woodward: “You know, it’s a local problem. You can’t solve that federally.”1 One of our members, a former public health official out in the field, said it reminded her of The Hunger Games. “It was like there was an invasion on U.S. soil by a foreign adversary and the White House was telling all fifty governors, ‘Good luck. You’re on your own, and now you’re also fighting each other for weapons and supplies.’”

While Republicans and Democrats differed somewhat in their approaches, the entire country began to emerge from lockdown in May 2020. Most Democratic governors began relaxing restrictions around the same time that Republican governors began to do so. Democratic governors were more cautious than their Republican counterparts. They tended to relax restrictions more gradually. They did not commit to dates for reopening. They preferred, instead, to wait and see how the pandemic evolved. Like Democrats, most Republican governors began to lift restrictions gradually, in phases, but their timetables were aggressive.

A common fallacy among critics of lockdowns is to assume that, if the rules on reopening changed, everything would go back to normal. The people were not sheep. Studies indicate that, regardless of how the rules were changing, a lot of citizens were doing their own version of the hammer and the dance. When the virus worsened, people were more fearful and were more careful. When the virus seemed to ease, they eased up, too.6

To be clear: there is a common view that politics, a “Red response” and a “Blue response,” were the main obstacle to protecting citizens, not competence and policy failures. We found, instead, that it was more the other way around. Incompetence and policy failures, including the failure of federal executive leadership, produced bad outcomes, flying blind, and resorting to blunt instruments. Those failures and tensions fed toxic politics that further divided the country in a crisis rather than bringing it together.

“In fact, lockdowns were not an active policy themselves but mostly an unavoidable and largely organic response to failed policy.”

The most important and fundamental misjudgment about the viral enemy was about how it spread. Early on, the U.S. government and the WHO mistakenly assessed that the virus was transmitted on surfaces, or large respiratory droplets, and that aerosol transmission was rare. The truth was just the opposite.14 Experts, including the Wolverines network, were already calling out this misjudgment and pressing the case for aerosol transmission.

This misjudgment was disproportionately American. Public health authorities from other nations picked up the clues on the aerosol threat much more quickly. They then implemented policies that dramatically curtailed community transmission.

During the fall of 2020, good studies were conducted to assess the danger of schools becoming hot spots for contagion. By January 2021, the results started coming in. On average, schools were not hot spots. Opening them did not affect community spread. People at schools were probably as safe, or safer, than they would be elsewhere.29

In the first year of the pandemic one in five healthcare workers resigned, retired, or were fired. In 2022, 44 percent of infectious disease fellowship slots for young physicians went unfilled.

Policymakers could have gathered the information that people most need, tested messages to ensure that they would be understood as intended, disseminated them through popular channels, partnered with trusted intermediaries, monitored how things were going, and changed course as needed. Instead, they improvised. Often they sent untested, incoherent, uncoordinated messages, and then deplored the public confusion that this caused.7

During the second wave of the virus, from the last quarter of 2020 through the first half of 2021, the European excess mortality rate was 51.5 percent lower than in the United States. During the second half of 2021 this difference widened to 83 percent. Yet in 2021 the Americans had access to more vaccine doses, sooner, than the Europeans did.18 At this stage, a fundamental difference was vaccine uptake.

During the Biden administration, there were renewed arguments over the proper usage of booster vaccines. In August 2021, Woodcock, now the acting director of the FDA, agreed that Americans should start receiving boosters. Resenting yet another bout of political interference in their scientific decisions, the two leading officials in the vaccines office of the center headed by Marks resigned. They were not against boosters in principle, but they felt such shots were not yet needed for most vaccinated people and should, at that time, be reserved for high-risk populations or those, including people around the world, who were still unvaccinated.7

the business model for making vaccines is different and harder than the business model for making drugs. Sick people are eager to buy drugs they think will help. Vaccines are preventive. The consumers aren’t sick yet. Because they aren’t sick, healthy people worry more about adverse effects from vaccines than sick people do about the side effects of drugs that make them well.

Before the Covid war, only a small number of large pharmaceutical companies had assembled the needed production capabilities and supply networks. Big pharmaceutical companies were cautious about making huge investments in medicines or vaccines for emerging diseases. They knew that government interest in such threats cycles between panic and neglect. Yes, there would be panicked interest during the crisis. Then the panic would subside. The money would dry up. Companies risk losing their investments. It had happened before, with Ebola and other diseases.

The Covid war has been immensely profitable for Moderna and Pfizer. For example, Pfizer’s revenue in 2021 was more than $80 billion, doubling its 2020 revenue. Its mRNA vaccine formulations have majority market share in the United States and Europe, and Paxlovid is the best early stage Covid drug. In 2022 the Covid vaccines and drugs alone are expected to bring in more than $50 billion in revenue, worldwide. Pfizer has gained growing influence over the nature and timing of future Covid vaccines.15

One reason the American response to the pandemic was discouraging was because, at least at times and to many, our governance was seemingly revealed to have been so incompetent. If citizens do not believe their government can handle the largest emergencies, the republic is in trouble.1