The Wall Street Journal - 04.04.2020 - 05.04.2020

C2| Saturday/Sunday, April 4 - 5, 2020 **** THE WALL STREET JOURNAL.

It would

have

been

devilishly

difficult

to lock

down the

U.S.

earlier.

typical, Italy was seen at the

time: its demographics, the

high proportion of Chinese visi-

tors, the spotty availability of

health care.

What’smore,wouldithave

been feasible—politically, ad-

ministratively—to lock down

the U.S. sooner? How could we

have expected people to keep

children home from school,

stop working and suffer the

enormous economic losses we

are now seeing when the

threat was still seen by most

(including experts) as a low-

probability outcome?

All the time, we have to

make almost impossibly diffi-

cult estimates around the risk-

reward calculus of our actions.

Even now, as the virus threat is

unmistakable, some argue that

it does not justify the economic

devastation of the lockdown.

History suggests that we

rarely get these decisions right.

In the 1930s, Britain and France

failed to head off the threat

posed by Nazi Germany. In the

summer before Sept. 11, 2001,

the White House was warned of

an impending al Qaeda attack

and failed to head it off. These

were not failures of leadership.

They were almost inevitable

failures of human nature.

We never act until it’s too

late, mainly because most of

us don’t believe the threat is

real until it is. WILLIAM CAMPBELL-CORBIS/GETTY IMAGES

EDITOR

AT LARGE

GERARD

BAKER

thority—who have

decided to con-

tinue functioning

moreorlessas

normal.

I write this not

to join the orgy of

finger-pointing

that is now rou-

tine. Quite the op-

posite. For all the

name-calling and

blame-apportion-

ing we are now

doing, the evi-

dence of much of

history is that the

failure to respond adequately to

a looming threat is embedded

in our nature. Expecting us to

respond to an impending chal-

lenge by taking the most ex-

treme measures to prevent it is

expecting something we have

rarely done—something ahis-

toric and virtually unhuman.

Much of the media’s cover-

age of the past couple of weeks

has been built around validat-

ing the claim that the U.S.

failed to protect its people from

this extraordinary scourge and

is, as a result, headed for a far

more devastating outcome than

just about anywhere else on the

planet. The focus is, of course,

very much on the president.

Warnings were missed, it’s said,

and scientists ignored—all be-

cause of President Trump’s de-

termination to keep public con-

city’s hospitals.

Many in the same

media organiza-

tions now con-

demning the pres-

ident’s dilatory

response were

themselves dis-

missing Covid-19

as nothing worse

than a seasonal

flu. Neither will

we forget how

many of them denounced as xe-

nophobic one early measure

that the president did take to

protect the U.S.: the decision to

block flights from China in late

January.

The point is not that individ-

uals failed to respond ade-

quately. It’s that it is devilishly

difficult, especially in a com-

plex democracy, to mobilize a

community to preempt a chal-

lenge of this sort.

In hindsight, it was probably

epidemiologically optimal to

lock down the entire country a

month earlier than we did—in

mid- to late February, let’s say.

We should have known, some

say, because we had the experi-

ence of Italy. But look back at

the commentary on Italy a

month or so ago, and you will

see how particular, rather than

fidence high and the economy

strong ahead of the election.

It’s surely true that Mr.

Trump’s repeated dismissals of

the seriousness of the threat

contributed to a sense of secu-

rity in the early stages of the

epidemic that we now know

was misplaced. More could

have been done, especially to

ramp up testing capacity. But to

move from that proposition to

the argument that Mr. Trump’s

assurances were responsible for

blocking preventive action is a

leap at odds with all we know

about human behavior.

For one thing, the president

wasn’t alone. Those of us in

New York City will long re-

member Mayor Bill de Blasio

exhorting us to go out to bars

when there was already evi-

dence of extreme stress in the

Main Street in

Livingston, Mont.,

March 20.

THERE ARE SOME PLACESin

the U.S. where, as I write, you

can still go into a bar, order a

drink and have a meal within a

few feet of fellow diners. “Take

me there!” we may be tempted

to say, especially those of us

who are already weeks into a

mandatory lockdown diet of

home-cooked food, experimen-

tal cocktails and takeout.

These last, fading glimpses

of normality are still visible as,

everywhere, the scale of the

threat from Covid-19 has be-

come abundantly clear: thou-

sands of deaths already and

multiples more to come.

We have known for some

time now how much of a men-

ace this epidemic is and that

proximity among humans is the

primary means by which people

will get sick and die. Still, in

places there seem to be some—

citizens as well as those in au-

We Only

Ever Fight

Threats

When

They’re

Upon Us

REVIEW

tant model for the future.

In all of these efforts, an essential

balance must be struck between the

wish to quickly get remedies to se-

verely ill patients and the potential for

intolerable side effects. In addition,

media hype can lead to treating pa-

tients with ineffective medication in

the face of better choices. The experi-

ence with Covid-19 is a powerful re-

minder of the importance of conduct-

ing excellent clinical trials that

generate the proof needed to assure

caretakers and patients.

Anyone who studies the Covid-19

pandemic knows that we need a vac-

cine, and we need one

quickly. Yet, even more

than diagnostics and thera-

peutics, a safe and effective

vaccine will take time. Both

the pace and the breadth of

the efforts to produce a

vaccine are impressive. The

biotech company Moderna

wasthefirsttotreatapa-

tient with an experimental

vaccine only 66 days after

the viral sequence was

available. Today, WHO lists

dozens of vaccine ap-

proaches under study.

It is exciting to see how

advances in genomics,

structural biology and im-

munology have contributed

to more innovative ap-

proaches to vaccines. And

it is not only small compa-

nies who are participating.

Johnson & Johnson an-

nounced a collaboration

with the federal Biomedical

Advanced Research and De-

velopment Authority and a

commitment of $1 billion as well as

their manufacturing capacity. Global

collaborations for rapidly developing

and producing vaccines for Covid-19

include Biogen and VIR Biotechnology,

Pfizer and BioNTech, GlaxoSmithKline

and Clover Health, and many others.

Perhaps the key organization fo-

cusing on long-term preparedness is

the Coalition for Epidemic Prepared-

ness Innovations, funded jointly by

the Bill & Melinda Gates Foundation,

Wellcome Trust, the European Com-

mission and seven nations. Since 2017,

CEPI has been working to produce a

“plug and play” platform approach for

dealing with “Disease X,” a newly

emerging epidemic disease such as

Covid-19. The concept of a platform

technology would enable rapid vac-

cine development, elicit rapid onset of

immunity, and enable production to

be scaled up quickly to respond to

outbreaks.

This is the way forward—to focus

not only on the pathogens we know

but on preparing ourselves for the

pathogens we don’t expect. Today’s

epidemic is a powerful reminder that

infectious agents do not respect bor-

ders and that global cooperation is

essential for dealing with them. Clas-

sic public health tools are a must: We

cannot control what we cannot un-

derstand. And we need to maintain

the collaborative and generous spirit

that has emerged in response to

Covid-19. It may feel like a once in a

lifetime experience, but that, alas, is

unlikely to be the case. FROM TOP: DAVID L. RYAN/THE BOSTON GLOBE/GETTY IMAGES; MIKE SEGAR/REUTERS

anti-viral compounds, such as remde-

sivir, a compound developed by Gilead

Sciences, which failed in treatments

for Ebola but have shown promise

with some Covid-19 patients; antimi-

crobials, such as the antimalarial

drugs hydroxychloroquine and chloro-

quine, used together with the antibi-

otic azithromycin, which have shown

mixed results in small trials; and rem-

edies for severe Covid-19, such as the

compounds sarilumab from Regen-

eron Pharmaceuticals and Sanofi, and

toclizumab from Roche Holding. This

is just a small subset of medications

furthest along in their development.

The pursuit of therapies will be

further advanced by funding from the

newly launched Covid-19 Therapeutics

Accelerator (funded by the Bill & Me-

linda Gates Foundation, the Chan

Zuckerberg Initiative, Wellcome Trust

and Mastercard), specifically intended

to speed up R&D. There is also the

FDA’s Coronavirus Treatment Acceler-

ation Program, designed to fully staff

and support an accelerated regulatory

path for novel therapeutics. Many new

approaches to product development

are under way, using tactics ranging

from artificial intelligence to CRISPR

gene-editing.

An example of unprecedented col-

laboration is the QBI Coronavirus Re-

search Group, involving hundreds of

scientists at the University of Califor-

nia, San Francisco. These investiga-

tors have found 50 drug candidates

that shield proteins that the corona-

virus needs to thrive. It is an impor-

Scientific

innovation is

one of the

success

stories of the

response to

the Covid-19

crisis.

It is the role of the federal govern-
ment to adequately stockpile and plan
for a pandemic. Clear accountability
on the National Security Council,
matching the authority that already
exists for the military procurement
and supply chain, would allow asset
allocation to the states and regions in
greatest need. It would avoid what we
see today, with states competing
against each other for vital supplies.
Second, the concept of “surge ca-
pacity” does not appear to have been
part of the planning for ventilators,
and current needs massively exceed
normal demand. There is not only a
lack of supply but also a lack of readi-
ness—parts, established partnerships,
training—for quickly manufacturing
more machines. No single ventilator
company has significant excess capac-
ity, and none can produce large vol-
umes, so federal leadership is needed
to maximize the use of available ca-
pacity. There is also a clear need for
simpler ventilator designs, with stan-
dard parts to allow production to
scale up quickly.
The U.S. established the Strategic
National Stockpile in 2003 as an
emergency repository for antibiotics,
vaccines and other critical medical
supplies, but it has not adequately
served its role in this crisis. Covid-19
will focus attention on funding and
supplying it properly and planning for
distribution. For their part, the gover-
nors and mayors making
requests for aid today need
to be making “just in case”
plans for tomorrow, using
their experience with
Covid-19 to encourage the
reform and expansion of
the Strategic National
Stockpile.
Public Health.It is a
common complaint that
health systems and insur-
ers are too focused on ur-
gent and acute health
problems, treating disease
rather than investing in
prevention. We treat lung
cancer but underfund tobacco con-
trol, treat opioid addiction without
enough work on pain management,
and treat babies in intensive care
rather than give their mothers ade-
quate prenatal care.
This tendency to address what’s
right in front of us rather than pre-
venting what might happen in the fu-
ture is clear from the numbers. Ac-
cording to the Trust for America’s
Health, in 2017, public health repre-
sented just 2.5% of all U.S. health
spending ($274 per person). That
small portion covers prevention, pre-
paredness, wellness and community
recovery for all Americans. A pan-
demic takes full advantage of such un-
derinvestment, especially our failure
to make primary medical care widely
and easily available.
Good public health means that in-
dividuals are far less likely to be
struggling with hypertension, obesity
or diabetes. People who start out

Continued from the prior page healthier will experience lower rates
of morbidity and mortality when in-
fectious disease is spreading. Higher
vaccination rates are essential too,
since they mean that fewer people
will be sick with flu and other pre-
ventable infections and occupying
precious hospital beds.
Even more important, we must
have functional public health depart-
ments for essential disease-control
efforts like contact tracing
and quarantine. While our
global governance for
public health derives from
WHO, the national entity
we count on is the CDC
and ultimately state and
local public health depart-
ments.
These agencies have
been front and center for
our safety in the face of
multiple prior infectious
threats, from HIV/AIDS to
Ebola and Zika. This safety
is grounded in public
health basics. The essential
tool in an epidemic is in-
formation: who has the
disease and who have they
been in contact with?
Surveillance and epide-
miology are key tactics in
this quest, but critical gaps
in our capacity have been
clear since Covid-19 hit the
U.S. Of greatest impact

were the now well-known mistakes in

novel coronavirus testing that left the

government blind to its spread. This

inability to trace the pandemic was

exacerbated by the clinical manifesta-

tions of Covid-19. Current estimates

suggest that 25% of those infected do

not have symptoms. Failures in test-

ing and high rates of asymptomatic

patients meant that leaders, health-

care providers and decision makers

did not know the incidence or preva-

lence of Covid-19, which is the basic

information necessary to effectively

contain an epidemic.

Finally, public health must provide

expertise in an aspect so far lacking

in this pandemic: serologic surveil-

lance. This allows us to ask a second

key question: not whether individuals

currently have Covid-19 but whether

they were ever infected and are now

immune. The ability to do such test-

ing would allow us not just to under-

stand the biology and course of

The Steps Needed to

Avoid the Next Crisis

Covid-19 but also, potentially, to cer-

tify health caregivers and other

workers who will not risk acquiring

or transmitting the infection.

For future epidemics to be man-

aged more effectively, we must have

better information, and that means

having well-funded, well-trained and

well-prepared public health experts—

trained in statistics, epidemiology, and

laboratory and clinical medicine—at

the CDC and in the states

Innovation.Our ability to tap into

scientific innovation may turn out to

be one of the success stories in our

fight against the pandemic. Since

China released the SARS-

CoV-2 genetic sequence in

early January, countless

labs around the world have

been working to develop

new ways to test, treat and

prevent Covid-19.

On diagnostics and testing, scien-

tific innovation is not yet making a

difference. Serologic tests for antibod-

ies have lagged behind testing for the

disease itself, and despite multiple ac-

ademic and laboratory successes in vi-

ral detection, these advances have yet

to improve access to testing, accuracy

of results or speed of turnaround. Is-

sues have included inadequately

trained staff as well as the availability

of testing swabs and testing reagents.

Dealing with what might be consid-

ered the more mundane aspects of di-

agnostics is just as important as tech-

nical breakthroughs.

A true bright spot in innovation

has been the work happening on

treatment. Since the novel coronavi-

rus was reported in Wuhan, health-

care providers have been working to

repurpose existing medications. Bio-

tech and pharmaceutical companies

have fully participated in the early

tests. These have included work with

Lab work at Moderna,

which is testing

a Covid-19 vaccine

(above); N-95 masks at

a New York State

operations center (left).