In 2005, Republican President George W. Bush read a book on the 1918 flu pandemic. The potential devastation from a recurrence of that world-shaking catastrophe struck the president powerfully; he immediately insisted that his cabinet begin work on a pandemic response plan. The 9/11 trade towers attack sensitized Bush and his cabinet to the potential disruption of improbable but highly impactful events. Eventually, this would lead to a CDC triumph.
The CDC pandemic play book
Bush’s cabinet produced a nearly 400-page playbook detailing evaluation of dangers, limiting disease spread with travel bans and closures, marshaling critical supplies, managing adequate health care facilities, implementing social controls and practices, tracing contacts, the discovery, production and distribution of treatments and vaccines, best practices for avoiding panic and promoting compliance to healthcare measures. The playbook was tested and refined on Ebola, SARS, H1N1 and other infectious outbursts. The 2017 revision of this playbook still exists on a Center for Disease Control website.
Pandemic preparedness
The 2019 Global Health Security Index, a report produced by an international group of institutions, including Johns Hopkins Center for Health Security and The Economist magazine, ranked the U.S. number one among 195 nations in pandemic preparedness, largely on the basis of the playbook.
The week before the November 2020 general election, ten months later, the U.S. has almost 230,000 dead, roughly 70,000 more deaths than Brazil, the next hardest hit country. Brazil ranked 22 on the Global Health Security List. The United Kingdom, ranked 2 on the Global Health list has almost 50,000 dead. Columbia, ranked 65, has only 30,000 dead.
Preparedness results
The U.S. was the most prepared and it has had the worst results. The U.K. was second most prepared and their results are not good. Columbia gets a low B on preparedness and protects their people better. Angola is in the bottom segment of the list and has only 275 dead, far fewer than our own Washington State.
Looks like preparedness is overrated.
Think twice, grasshopper. That hop to a conclusion sailed clear off the dock. Preparation without execution is a wandering ghost: free floating intent with no consequence.
What in blazes is that supposed to mean?
Preparation without execution is null
Preparation does not matter if it is ignored. Read the CDC playbook. The plans were ignored and neglected. Protective gear was supposed to be stockpiled. Congress refused to allocate funds and the stockpiles were under supplied. The play book calls for extensive testing and includes guidelines on developing and deploying tests. The U.S. flubbed this badly at the beginning. The official test didn’t work, which was an unfortunate but recoverable misstep. But the U.S. did not follow its own plans to correct and recover. Over and over, the playbook was ignored. Testing is still below the plans in the playbook. I could go on. You can check it for yourself. The official 2019 playbook is here. The full implementation is here.
The playbook was ignored. Would the plans would have worked if they were followed?
The CDC playbook is not dead
Astoundingly, the plans developed by the CDC under Presidents Bush and Obama were followed and used. Just not by the U.S. I looked at two countries that have dodged the covid-19 bullet: Taiwan and New Zealand. Both have documents with nearly the same name as the U.S. playbook. Taiwan has its Pandemic Influenza Strategic Plan. New Zealand has its New Zealand Pandemic Influenza Plan.
The plans of the three countries are long detailed documents and I confess that I have not read them in their entirety, but I have read enough to convince myself that all three are the same plan, close enough that I would be surprised if there was not a lot of cribbing. I’ll be a U.S. chauvinist: I think New Zealand and Taiwan did most of the copying, but I don’t know that. The difference is that both Taiwan and New Zealand followed their plans, the U.S. did not.
The day after I wrote the above paragraph, I stumbled on this, a video report from the New York Times that makes the same point far better than I.
The CDC playbook test
Two countries that executed the playbook and one that wrote the book but did not execute the plan is as close to a gold standard test of a strategy as you can get.
Results
Now let’s see the results. Taiwan, population 23 million, 554 cases, 7 deaths, no new covid-19 cases in the last 200 days. New Zealand, population 5 million, 1950 cases, 25 deaths. U.S., population 328 million, 8,990,196 cases, 229,141 deaths on the Johns Hopkins COVID-19 Dashboard.
Compare apples to apples
That comes out to 24 cases/million for Taiwan, 390 cases/million for New Zealand, and 27,400 cases/million for the U.S.
If the U.S. had kept covid-19 in check like Taiwan, we would have under 8,000 cases. At New Zealand’s rate, 125,000, instead of close to 9 million. If we compare deaths, 100 at Taiwan’s death rate, 1600 at New Zealand’s death rate, instead of 230, 000 deaths in the U.S.
Covid-19 hoax
If we had followed our own playbook for a pandemic, we could have expected a few thousand deaths. Less than the estimated 22,000 flu deaths we had in 2019. Like Y2K, covid-19 would have been declared a hoax, not as bad as the flu.
The CDC triumph
There is a silver lining to this: the U.S. CDC playbook won. We didn’t use it, but it won. The scientists who wrote the playbook are still here. They have the same abilities they had under Presidents Bush and Obama. They are here for us to call on.
All we have to do is elect a government that will use our treasures to save us.