December 18, 2020

Weekly line: The 3 biggest lessons from my year covering the coronavirus pandemic

Daily Briefing

    By Ashley Fuoco Antonelli, senior editor

    A little over a year ago, news of a "mysterious pneumonia" in Wuhan, China, started popping onto my radar as an editor for Daily Briefing. Little did I know then, but it was the start to one of the most difficult and important years in recent history—one that would expose some tough lessons for public health in America.

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    Here are the three biggest lessons I've learned from my year covering the coronavirus pandemic and its outsized impact on the United States.

    1. When it comes to pandemics, history repeats itself.

    Early in the pandemic, when the coronavirus was still mostly confined to China, I spoke with University of Michigan law professor Nicholas Bagley about the "recurring themes" of disease outbreaks.

    At the time, Bagley had just resurfaced a 2016 list of 10 "themes" that he and his wife, who is also a law professor, found recur when governments and the public respond to disease outbreaks. As time went on and America also found itself in the grips of a coronavirus epidemic, I consistently thought about the themes Bagley and his wife had identified.

    All 10 are worth revisiting (and all come across as astonishingly prophetic, given what the last year has brought us)—but five in particular stand out:

    Theme 1: "Local, state, federal, and global governing bodies are apt to point fingers at one another over who's responsible for taking action. Clear lines of authority are lacking."

    Under the Trump administration, the federal government has mounted only a limited centralized response to the epidemic, choosing—for better or for worse—to let states and local governments determine what constitutes an outbreak and what responses to implement.

    Theme 2: "Calibrating the right governmental response is devilishly hard. Do too much and you squander public trust (Swine flu), do too little and people die unnecessarily (AIDS)."

    The federal and state and local governments have struggled to find the right balance between strict measures intended to curb the novel coronavirus's spread and easing those measures, leading to multiple surges of the virus in the United States.

    Theme 3: "Public officials are reluctant to publicize infections for fear of devastating the economy."

    President Trump has said he intentionally downplayed the novel coronavirus's threat in the United States to avoid creating "panic."

    Theme 4: "In the absence of an effective treatment, the public will reach for unscientific remedies."

    While the pharmaceutical industry pulled off an incredible feat by creating an authorized vaccine against the novel coronavirus in about a year and identifying some experimental treatments for Covid-19, providers at the outset of the pandemic did not have proven treatments to prevent or treat Covid-19. And without proven treatments for much of this year, misinformation has spread rampantly.

    Theme 5: "Historical memory is short. When diseases fall from the headlines, the public forgets and preparation falters."

    While it's too early to tell whether this last theme will come to fruition, one thing we do know is this won't be the last pandemic we face. In fact, public health experts predict that deadly disease outbreaks will likely become more common in coming years—so it may not bode well if we forget the lessons learned from this crisis.

    2. It's hard to navigate America's health care system, even when you know what you're doing.

    The second biggest lesson I learned from covering the pandemic this year hit close to home, when I had my own run-in with navigating coronavirus testing.

    In late June, I came down with an illness that may or may not have been Covid-19. I still don't know for sure—my test came back negative, but my doctor suspects it may have been erroneous. In any event, I experienced many Covid-19 symptoms, and some (especially coughing and shortness of breath) persisted for months.

    I detailed my experience with coronavirus testing, as well as what the experience revealed about the shortfalls of America's response to the epidemic. Perhaps most of all, the experience taught me that navigating America's health care system can be really, really hard.

    Because of my profession, I'm uniquely positioned with access to a wealth of information not only on the coronavirus pandemic, but on the U.S. health care system overall. I knew how to access testing for the virus, how to ensure my test and subsequent care was covered by my health plan, and how to prevent potentially spreading the coronavirus to others.

    But even so, I certainly won't claim that I handled my situation perfectly. And I know others are in the same boat, as I've received many messages from Daily Briefing readers and friends asking for help navigating their own experiences with suspected cases of Covid-19.

    3. America needs clearer messaging around public health, especially during an epidemic. (But this is harder than it sounds.)

    That brings me to the last major lesson I've learned while covering the coronavirus pandemic this year: America needs to do better when it comes to educating people about public health.

    Throughout the year, we've seen Americans sharply divided over basic public health measures that could help to curb the country's coronavirus epidemic. We've witnessed the invasive spread of misinformation regarding the virus, Covid-19, and potential treatments and vaccines. And we've seen reports of people being confused about how the coronavirus spreads and how to protect themselves.

    There is no simple fix to these problems. Contributing factors probably include America's individualistic culture, our complex health care system, our fractured politics, and much more.

    But this year has also made clear that we need more coordinated, clearer messaging around public health. Stakeholders in leadership positions often said confusing, contradictory things—making it hard for even Americans who follow the news closely to know what to believe.

    Some of this confusion arose from the natural "fog of war" that occurs early in any emerging epidemic, when we're still struggling to understand a new disease and pathogen. For instance, CDC suggested early on that only people who were sick or working in health care settings needed to wear face masks, before later reversing itself and encouraging near-universal mask-wearing. This reversal was grounded in a shifting understanding of the science on how the novel coronavirus spreads, but even so, it led to public confusion and skepticism of future public health messages.

    Other messaging problems were more persistent, and perhaps more avoidable. For instance, the White House, federal public health leaders, governors, and local authorities often gave different advice on the right steps to protect public health—sometimes within a single day.

    As Georges Benjamin, executive director of the American Public Health Association, recently told STAT News' Nicholas Florko, this year has shown that public health officials are "going to have to do some serious soul-searching," because while they may not be at fault for the divides and misinformation that pervaded this year, they do "play a big role in making sure that we come up with ways to deal with this in the future."

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