Opinion: The unnecessary price of Covid-19

Editor’s Note: Peter Bergen is CNN’s national security analyst, a vice president at New America, and a professor of practice at Arizona State University. He is the author of “The Cost of Chaos: The Trump Administration and the World ”  and was the founding editor of the Coronavirus Daily Brief. The opinions expressed in this commentary are his own. View more opinion at CNN.

According to a new report, half a million Americans may have died unnecessarily of Covid-19. At the same time, the US government spent trillions to deal with the pandemic when better preparedness could have saved many lives and much money. American schools were also closed for many months unnecessarily, with students paying the price.

The report, “Lessons from the Covid War,” by the Covid Crisis Group, is being published as a 347-page book Tuesday. It will likely stand as the most authoritative account of American policy failures and successes during the war against Covid-19.

The report makes for sobering reading, concluding that “no country’s performance was more disappointing than the United States.” The group came to that conclusion because, despite the great depth of scientific knowledge in the United States, American “excess deaths” during the pandemic were about 40% higher than the European death rate.

If the US had had a similar rate to Europe by the end of 2022, “probably” at least half a million Americans wouldn’t have died, according to the report. That’s a big number. The federal government also deployed $5 trillion to deal with the consequences of the pandemic. That is also a big number.

So how did the US get into this mess?

Given America’s hyper-partisanship, just about everything about the Covid-19 pandemic was deeply politicized – from the precise origins of the coronavirus in China, to lockdowns, mask-wearing, school closures, vaccines, and the best drugs for treatment.

As a result, there has been scant official reckoning over how the government fared during the pandemic and what lessons might be learned for the inevitable next pandemic.

A 2022 bipartisan bill seeking to establish a National Covid Commission never made it to the floor for a vote in the US Congress. This is astonishing when you consider that more Americans have died of Covid – around 1.1 million so far – than all the Americans who died in every US war going back to the American Revolution.

So, without a congressionally mandated inquiry like the 9/11 Commission, 34 American public health experts, physicians, and other policy experts decided to investigate what went right and wrong during the pandemic.

Starting their work in early 2021, the non-partisan Covid Crisis Group conducted “listening sessions” with 274 people who had played some role in responding to the pandemic or had been affected by it.

The group was directed by Philp Zelikow, a leading historian and former senior State Department official in the George W. Bush administration who had also served as the Executive Director of the 9/11 Commission, which had set the gold standard for how to conduct a comprehensive examination of a major catastrophe and the lessons that could be learned from it.

Other members of the Covid Crisis Group included Michael Osterholm of the University of Minnesota who had been publicly warning of the emergence of a global pandemic for a decade and a half before Covid-19 first emerged; Dr. Margaret “Peggy” Hamburg, the former Commissioner of the US Food and Drug Administration and Dr. Ezekiel J. Emanuel, former chair of the Department of Bioethics at the National Institutes of Health.

Origins

The report examines both the “lab leak” theory that the coronavirus accidentally escaped from a research lab in Wuhan, China, and the natural transmission theory that the virus moved from a wild animal into humans. But the report doesn’t come down on the side of either theory, which seems fair enough given the inadequate evidence.

The Chinese government’s penchant for secrecy was on full display in the early days of the outbreak. As a result, the origin issue may never be fully settled as it would have required considerable transparency by the government about what was happening in Wuhan at the beginning of the pandemic.

Yet, as the report points out, “both theories drive toward common urgent insights for action.” If the virus occurred because of animal transmission, that calls for improved surveillance for new viruses, using tools such as monitoring both work absenteeism and Internet searches that might indicate new viruses may be making the rounds, as well as increased biomedical surveillance.

And if it was a lab leak, better safeguards must be put in place for research on viruses worldwide given that “synthetic biology” will likely be one of the defining technologies of the 21st century.

The botched US response

The American health system is a patchwork of 2,800 state and local systems, according to the report. This would have made a coordinated national response to Covid-19 challenging to pull off in any administration, but the Trump administration’s response at the federal level “failed quickly.”

Some Trump officials did understand the likely dimensions of the Covid pandemic early on. Matthew Pottinger, a former Wall Street Journal reporter who spoke Mandarin and had covered the SARS outbreak in China, served as senior director for Asia at the National Security Council. Pottinger warned then-President Donald Trump in late January 2020 that the virus spread quickly from human to human, often without apparent symptoms.

The Trump administration soon banned non-American travelers from China from arriving in the US. While that may have slowed the spread of the virus in the U.S. a bit right at the beginning of the pandemic, travel bans were not especially effective given that the coronavirus is so transmissible, often spreading without symptoms in an age of mass global travel.

A problem in the US government’s early response was the lack of effective tests for the virus during the first months of the pandemic. By contrast, South Korea, better prepared for the emergency, had tens of thousands of tests running daily by mid-February 2020, according to the report.

The report found that the Centers for Disease Control and Prevention (CDC) – despite its name suggesting that it is at the forefront of preventing the spread of disease – didn’t do operational pandemic preparedness, but instead acts as a quasi-academic institution that collects and analyzes data after an incident has happened. In a chilling finding, the report says when it came to tracking Covid-19 cases in the United States, researchers at The Atlantic magazine’s Covid Tracking Project did a better job in real-time than the CDC did.

Compounding the problem at the federal level was President Trump, who, as is well known, continuously played down the threat posed by the virus and refused to wear a mask when masking was one of the few tools that prevented the spread of the virus before vaccines. By April 2020, Trump had decided that Covid wasn’t much worse than the flu, and he wanted to “reopen” the economy as he was “deep into his reelection campaign,” according to the report.

As a result, the Covid Crisis Group concluded that “Trump was a co-morbidity” with Covid. Comorbidity is a medical term meaning that a patient suffers from two or more chronic diseases simultaneously.

With little in the way of federal executive leadership, the war against Covid-19 was left up to the governors of the 50 states and to local authorities. The conventional narrative that red states favored opening up for the economy’s sake and blue states favored shutting down to save lives is overly simplistic, according to the report.

Most states adopted more of a purple approach whether they were run by Republican or Democratic governors – they chose to begin to open up when the virus seemed to be abating, as it was in May 2020, and close back down again whenever the virus came roaring back, as it did in the winter of 2020-2021.

Given the understandable angst that many Americans had over school closures, the report points to some fascinating data from UNESCO showing that in countries like France and Spain, schools closed or partly closed for only two weeks and 15 weeks, respectively. While in the US the average school closures lasted 77 weeks, which particularly affected children from disadvantaged communities and kids with disabilities. “Closed schools, even with remote education, failed many students, particularly those already most at risk for disrupted learning,” the report noted.

The UNESCO school data suggests that there must have been a more thoughtful way to manage American school closures. The report points to research about safe and smart ways to keep schools open that was undertaken by Covid Crisis Group member Danielle Allen of Harvard, Brown University, and the research institution, New America (where I work), as emblematic of an approach that could have been followed but wasn’t. It included developing infection prevention and control programs at each school.

Operation Warp Speed

The operation to develop workable vaccines was a true American success story. The report credits a framework outlined by Richard Danzig, a former US Secretary of the Navy with expertise in biowarfare, who wrote to an informal network of colleagues in late March 2020, advocating for “previously unthinkable government support” for vaccines financially and for expediting their laborious approval process.

Danzig also recommended invoking the Defense Production Act so that the manufacturing of the vaccines could be scaled up quickly. Danzig said that if the right resources were directed at developing a vaccine, it could be available as quickly as only six months, which would be an extraordinarily fast turnaround as typically effective vaccines take five to ten years to develop.

Danzig’s ideas helped germinate Operation Warp Speed, led on the Pentagon side by General Gustave Perna, an expert on logistics, and on the civilian side by a former Big Pharma executive, Dr. Moncef Slaoui. With political top cover provided by the president’s son-in-law, Jared Kushner, who supported Operation Warp Speed, General Perna secured $26 billion to fund the operation, according to the report.

The vaccines that succeeded in Operation Warp Speed were based on messenger RNA (mRNA) rather than on a weakened or inactive form of the virus typical of many vaccines. Using mRNA, researchers made cells produce a protein that instigated the immune response against the coronavirus. The basic science of mRNA had been around for decades, but it had never been used in a workable vaccine.

Companies such as Pfizer and Moderna produced effective vaccines in just months. The government invested $1 billion in Moderna and placed another $1.5 billion order for 100 million vaccine doses. Pfizer didn’t take US government money during the research phase for its vaccine, but the government initially guaranteed to buy more than 100 million doses from Pfizer for $1.95 billion.

As Danzig had suggested, the Defense Production Act ensured that the materials needed to make the vaccines were quickly secured. At the same time, the government partnered with major American pharmacy chains to ensure that jabs got into arms quickly once they became available.  

The report underlines how a perfect constellation of factors made Operation Warp Speed succeed, including the right leaders at the Pentagon and in the private sector harnessing existing, long-term basic research into mRNA. Operation Warp Speed was arguably the most significant achievement of President Trump and his administration.

Vaccine hesitancy

You might have the best vaccines in the world, but that doesn’t do you much good if there are substantial percentages of your own population who are hesitant to be vaccinated.

A National Academies of Sciences, Engineering and Medicine panel co-chaired by Dr. Helene Gayle – who had led efforts to combat AIDS at the CDC – warned in October 2020 that the CDC needed to develop a campaign using behavioral science and social marketing techniques while partnering with hospitals, faith-based organizations, and community centers to help increase vaccination uptake. But as the report notes, “That didn’t happen.”

Vaccinations also became politicized; by July 2022, 90% of Democrats reported being vaccinated to some level, compared to only 69% of Republicans. It turns out that your politics, in this case, could literally kill you.

During the Delta wave of Covid-19 in 2021 and the Omicron wave of 2022, “the vast majority of hospitalized patients were unvaccinated,” according to the report. By early 2022, one study found that there were somewhere between 120,000 and more than 350,000 excess deaths in the US because of vaccine hesitancy.

What should be done?

The key to preparing for the next pandemic is, of course, preparedness. The Covid Crisis Group underlines how “time is everything” when managing a possible pandemic, as just one week can mean the difference between a mere outbreak and the emergence of a full-blown pandemic. That means creating “early warning radars” worldwide that can detect emerging threats and ensuring the most stringent controls at labs around the world doing “gain of function” research so manipulated viruses don’t escape into the outside world.

The Covid Crisis Group has performed a major public service with its comprehensive investigation of the pandemic, an investigation that the US political system proved largely incapable of doing. This itself points to a general failure of American governance that the report underlines on many of its pages.

Still, the publication of this report by a group of concerned experts is also a testament to the enduring strengths of American civil society, which Alexis de Tocqueville had noted in his travels around the United States almost two centuries ago.