Nov 04 2022

Consensus on Dealing with COVID-19

A panel of 386 experts from various disciplines and 122 countries have put together a consensus statement on how the world can best deal with the continued challenge of COVID-19. The statement contains 57 specific recommendations that had >95% consensus from the panel, with most having >99% consensus. This is like an M&M rounds for the world’s COVID response. In medicine we have morbidity and mortality rounds where we review both statistics and individual cases with bad outcomes. The point is to explore those cases and determine what went wrong, if anything, and how individually and systemically we can prevent or minimize future similar negative outcomes. This panel did the same thing for our COVID response.

Such endeavors are not about placing blame. We can leave that up to the politicians looking to score points. The purpose is to map out a future course, to take specific actions that will minimize future death and negative health outcomes from the COVID pandemic, which is (despite what you may want to believe) not over. The SARS-CoV-2 virus continues to spread throughout the population, and continues to mutate with variants and subvariants increasingly able to evade prior immunity (from infection or vaccination). As predicted the pandemic is slowly morphing into an endemic infection, like the flu, that will simply be with us indefinitely. But infections are still at pandemic levels.

The focus of the recommendations is on how governments can enact policy and allocate resources to better tamp down infections and reduce negative outcomes. This is needed, because government responses were mostly a failure. This doesn’t mean that the US and other governments didn’t do anything useful. They did. But from the perspective of what a fully prepared optimal response would have been, the actual response, in my opinion, was basically a failure. It’s not like we didn’t see it coming. Even now, after everything the world has been through, our preparedness and response is less than ideal.

The other aspects of the response we can consider is the scientific community and and the public. The response of scientists and researchers, while not uniformly good, was generally effective. The biggest success in our response was the rapid development of multiple effective vaccines. The research community jumped all over COVID, with rapidly developing medical data and experience, the development of effective practices and eventually medical treatments in addition to the vaccines.

The public response was mixed, partly due to the lack luster political response. COVID became a political issue, rather than a public health issue. Large segments of the population essentially failed the test of civic responsibility, and allowed tribalism to supersede even common sense. This is not to say there weren’t legitimate criticisms of the official response and recommendations. We were feeling our way through a novel pandemic, learning as we went. There were also trade-offs, and the full consequences of those trade-offs would not be known until after the choices were made. We paid a higher price for trying to shift instantly to online classes than we expected. But of course, we don’t know what the alternative reality would have been if we tried to keep live classrooms going through the height of the pandemic. You have to look at the risk vs benefit of all options, and we only truly know the outcomes of the paths we actually chose.

But this is all part of the M&M review. What worked, what didn’t, what were the actual outcomes, what could we do better going forward. The panel made three top recommendations:

i) adopt a whole-of-society strategy that involves multiple disciplines, sectors and actors to avoid fragmented efforts; ii) whole-of-government approaches (e.g. coordination between ministries) to identify, review, and address resilience in health systems and make them more responsive to people’s needs; and iii) maintain a vaccines-plus approach, which includes a combination of COVID-19 vaccination, other structural and behavioural prevention measures, treatment, and financial support measures.

Sounds good, but the devil is in the details. Definitely a coordinated approach among government, industry, academia, and scientific institutions is needed. This means having institutions and systems in place, ready to go, for when the next pandemic hits, with evidence-based protocols and resources that will snap into place. Chances are it won’t be another century before another COVID-19 like pandemic hits. We are already facing challenges, such as the latest Ebola outbreak, which we are also not handling optimally.

Other recommendations included:

Other recommendations with at least 99% agreement were: communicating effectively with the public, rebuilding public trust, and engaging communities in managing the pandemic response.

While I completely agree with this – this may be the most challenging recommendation, and the one where big-picture goals are not enough. How, exactly, do we rebuild public trust given the current political environment? In order to achieve this goal I think nothing short of a radical overhaul of modern society is necessary. That society now includes weaponized misinformation, social media, political systems that exploit division and ignorance, conspiracy theories that have wormed their way deep into the political mainstream, and unacceptable levels of scientific illiteracy. We can make small changes to communicate more effectively, for example, but these efforts may be wasted given the current environment. At best we can hope to not make things worse.

The problems with the public and political response to COVID go way deeper than just our pandemic preparedness and response. There are core problems eating away at the center of our society, even to the point of threatening democracy. A poor pandemic response was just one symptom of these deep structural challenges. To really address these issues we need to improve our educational system to promote much higher levels of scientific literacy, critical thinking, and media savvy. We need to make fighting dangerous misinformation on social media a high priority, and figure out the most effective ways of preventing the worst abuses while not stifling legitimate freedom of speech.

We also need to take a serious look at our political infrastructure. In a world where politicians pay no political price for blatant lying, stoking conspiracies, and essentially being horrible human beings, then our leaders will be horrible human beings. If the system rewards sociopathic behavior, we will be ultimately lead by a bunch of sociopaths. Being honest, decent, ethical, and minimally competent has to mean more than simply being a member of our own team. Right now it doesn’t. Until we fix this problem, talking about how to better communicate about a pandemic is not going to amount to much.

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