# COVID-19/Lessons from COVID-19

We are now living at a unique time in history as an unprecedented pandemic of COVID-19 sweeps across the world. Without discounting the immense tragedy this is causing, we have a unique opportunity to observe this pandemic, record events, and importantly to seek lessons we can learn.
This on-going crowd-sourced research project is best understood as contemporaneous working papers under development. Certainly, each of us must rely on the most reliable sources of information for making decisions related to the COVID-19 pandemic. These reliable sources include:
* The Center for Disease Control (CDC) COVID-19 website.
* The John Hopkins University of Medicine Coronavirus Resource Center.
* The World Health Organization COVID-19 Website
Information from the sites listed above supersedes anything provided here and must be relied on for decision making.
None of us can change the past, and it is not useful to lament decisions made or actions taken in the past. Casting blame is not constructive, however, carefully analyzing cause and effect, identifying contributing causes, and identifying preventive measures that may help prevent or mitigate similar events in the future is useful.
Each lesson learned begins with a reliable account of what happened, a careful analysis of the many factors that contributed to each event, and suggestions for preventive measures that can be taken in the future to mitigate a similar event.
It will be instructive to compare the course of this pandemic to other pandemics, outbreaks, epidemics, zoonotic diseases, and novel viruses along the various characteristics described below.

## Outbreaks Happen

While the extent, intensity, and duration of the COVID-19 pandemic is extraordinary, it is important to recognize that outbreaks of emerging and re-emerging infectious diseases happen often. Research conducted in 2007 identified a list of 87 human pathogens first reported in the period between 1980 and 2005. This is an average of more than three new human pathogens each year. A tabulation of major outbreaks since 1998 caused by emerging or re-emerging infection diseases includes more than 50 occurrences.
These data demonstrate that outbreaks of new infectious diseases are ordinary, not extraordinary, and it is helpful to anticipate their occurrence.

## Intellectual Honesty

After the initial outbreak of coronavirus disease 2019 (COVID-19), conspiracy theories, misinformation, and disinformation emerged online regarding the origin, scale, prevention, treatment, and various other aspects of the disease. Officials are making harmful false public statements, and some are acting selfishly. Misinformation is rampant.
Facts are our friends, especially during the emergence of a pandemic. Reality is our common ground. Disinformation, false rumors, reports of ineffective cures, fear mongering, scapegoating, false hope, cover-ups, censorship, and other suppression or distortion of the facts, as best they are known, are harmful.
We all need to insist on intellectual honesty—good faith combined with a primary motivation toward true beliefs—from ourselves and others who are gathering information, forming hypothesis, reporting results, or communication to the public.
Authority must yield to expertise. Let the doctors, scientists, health-care workers, and others with first-hand knowledge and specific relevant knowledge, experience, or skills speak—without censorship, spin, or fear of retribution—especially if they are speaking difficult truths and courageously calling for difficult policies.
Similarly, aspirations must yield to ground truth. It may be interesting to hear that "Millions of masks have been ordered", but it is vital to know that needed masks are not available in the hospitals where sick patients are being treated.
Messaging based on factual information is consistent messaging. This builds trust.

## Origins

The origins of COVID-19 are not yet known for certain. Research needs to continue to identify the specific origins of novel disease. However it is likely this is a zoonotic disease. Precautions for preventing intimate human contact with potential sources of zoonotic diseases need to be put in place, worldwide.

## Early Detection

The timeline of the 2019–20 coronavirus pandemic is documented and useful for on-going study and learning.
Early detection of a novel disease is essential to preventing its spread.
Based upon the low variability exhibited among known SARS-CoV-2 genomic sequences, the strain is thought to have been detected by health authorities within weeks of its emergence among the human population in late 2019. The earliest case of infection currently known is thought to have been found on 17 November 2019. The virus subsequently spread to all provinces of China and to more than one hundred other countries in Asia, Europe, North America, South America, Africa, and Oceania.
It will be important to record and study the methods used to detect this strain, propose approaches that may be used to detect new strains even sooner, and share techniques that were successful in this case.

## Candor

Candor—clearly communicating the facts as they are best known—is essential to speed learning and informed decision making. While hope and optimism may provide short-term comfort, candor will provide the best solutions. This especially includes communications of what is known, and not known, what is fact and what is speculation, best case, worst case, and mostly likely scenarios for the future.
Reliable fact checking must become an expected prerequisite to each communication. Errors must be candidly disclosed as soon as they are identified. Misinformation must be immediately identified, corrected, and dismissed.
Sharing what was learned about the emergence of this novel disease as rapidly, completely, transparently, widely, and candidly is essential to responding effectively to the threat.

## Isolation

Isolating contagious people from others is the best immediate approach to limiting the spread of an infectious disease. Where no known cure or vaccine is available, as in this case, isolation is the only action that can be taken to prevent the spread.
While It is important to maintain and strengthen social connections even as we maintain physical distancing, physical distancing is effective and essential in slowing the spread of disease.
Isolation must be rapid and complete to be effective. This requires accurate detection of contagious people. If this is impossible, or identification is not accurate, then isolation of anyone who may be contagious is required.
Comprehensive contact tracing can help to identify people who are likely to be contagious.
Accurate, early, and wide-spread testing can also identify contagious people.

## Testing

Accurate, early, and wide-spread testing can identify contagious people.
Reliability, access, speed, and safety of patients, health-care workers and others are all important.
The overall testing capacity, locally and globally, must rapidly become sufficient.
Rapid and reliable self-testing can help quickly identify people who are contagious and need care. This is not yet available for COVID-19.

## Vaccine

When a safe vaccine becomes available it can be used provide active acquired immunity and prevent spread of the disease.
Vaccines must be safe and effective.
It will be helpful to follow vaccine development and extract valuable lessons.

## Wastewater Surveillance

As of August 5th 2020, the WHO recognizes wastewater surveillance of SARS-CoV-2 as a potentially useful source of information on the prevalence and temporal trends of COVID-19 in communities, while highlighting that gaps in research such as viral shedding characteristics should be addressed.
Systemic use of wastewater surveillance may provide early warning and systematic monitoring of virus levels and prevalence.

## Global Perspective

National boundaries are invisible to pathogens. Because pandemics are a global phenomenon, we must adopt a global perspective to respond effectively. Planning, communication, mitigation, and research must be coordinated and executed globally. Officials must transcend local, regional, county, state, political, and national boundaries to prevent outbreaks and create effective responses.
As COVID-19 spreads geographically and affects various regions, governing officials, agencies, institutions, organizations, and individuals are responding in a variety of different ways. It will be instructive to study this variety of responses to determine what efforts were most effective and why. Why did some regions encounter more cases and suffer more deaths (per capita) than others? What best practices can we learn? Countries and regions are affect at different times and how can countries and regions use the additional preparation time to mitigate the risk for health, logistic support of good and service, tranformation of economy, ...

## Resilience

The pandemic is resulting in many Socio-economic impacts.
Shortages of test kits, personal-protective equipment, ventilators, hospital beds, test capacity, and other medical supplies and resources became critical as the pandemic emerged.
In addition, sporadic shortages of food, cleaning supplies, and other essentials occurred.
Efficiency is often obtained at the cost of robustness. Reliance on just-in-time inventory strategies that minimize stored inventories contributed to these shortages.
Stockpiles of supplies useful during a pandemic, to the extent that forecasts or risk assessments can be made, can help to avoid short-term supply shortages. This can be done at several levels of aggregation. Households can keep a supply of shelf-stable foods in the pantry. Institutions can keep emergency food supplies. Hospitals, regional centers, national centers, and even world-wide stockpiles of medical supplies and other strategic assess can be planned, managed, and maintained.

## Limiting Factors

Limiting factors constrain the rate at which processes proceed. During the spread of this pandemic, key processes include: 1) the rate of spread of the virus, 2) the ability to test for the virus, 3) the ability to treat patients, 4) vaccine development and deployment, and 5) others.
It is helpful to quickly identify the limiting factor in each case, and work to remove (or impose) that constraint.
The limiting factors are likely to change as the pandemic proceeds, and as organizations work to cope with the pandemic.
To promote learning, it can be useful to track these limiting factors over time, along with the effective and ineffective measures taken to eliminate each limiting factor.

## Foresight

It will be instructive to study what was first known, early warning signs, responsible forecasts and predictions, and preparation work performed.
This section seeks to provide insight and "teachable moments" while avoiding unhelpful "I told you so" accusations.
Here are some early indicators:
* In March 2015 Bill Gates gave a TED talk called “The Next Outbreak? We’re not ready.” With the benefits of hindsight, he described what we should have done better to have coped with the 2014 outbreak of Ebola. His message was “There’s no need to panic…but we need to get going.” What did we learn from this warning? Could we have learned more?
* A tabletop role-playing exercise was held on January 13, 2017 to prepare the incoming Trump administration for the possibility of an emerging pandemic. The exercise included a simulation of an emerging pandemic — a strain of novel influenza known as H9N2 — and news that health systems were crashing in Asia, overwhelmed by the demand. During the simulation Trump’s aides were told “Health officials warn that this could become the worst influenza pandemic since 1918,”. Soon, they heard cases were popping up in California and Texas. Was this effective in preparing the incoming administration to lead during such a possible crisis?
* Crimson Contagion was a simulation administered by the Department of Health and Human Services from January to August 2019 that tested the capacity of the U.S. federal government and twelve U.S. states to respond to a severe influenza pandemic originating in China. The exercise involves a scenario in which tourists returning from China spread a respiratory virus in the United States, beginning in Chicago. In less than two months the virus had infected 110 million Americans, killing more than half a million. What preventive actions resulted?
* On December 31, 2019 BlueDot's computer reported an alert: a Chinese business paper had just reported 27 cases of a mysterious flu-like disease in Wuhan, a city of 11 million.
* In early February 2020, Senator Richard Burr sold between $628,000 and $1.72 million of stock in 33 transactions during a period when, as head of the Senate Intelligence Committee, he was being briefed daily regarding potential health threats from COVID-19. The stocks sold included several that are considered vulnerable to economic downturns, such as hotel chains. Similarly On March 19, 2020, the public release of federal financial-disclosure documents revealed that Senator Kelly Loeffler and her husband, Jeffrey Sprecher, had sold stock in companies vulnerable to the COVID-19 pandemic with an aggregate value of several million dollars. Did these senators overlook opportunities to better prepare the nation for the pandemic?
As we study these early warnings, how can we learn:
* Were these warning signs effective? What, if anything, could have made them more effective?
* What actions resulted from this early information? Could more have been done? Were the actions taken and not taken appropriate in the context of global priorities and the available risk assessments?
* Were the risks adequately assessed, and communicated?
* What should we do differently as a result of what we learn?
* What preventive actions are indicated?

## Compassion

Hoarding causes shortages. A scarcity mindset, fear, suspicion, and hatred bring out the worst in humans. However, compassion, generosity, tolerance, helpfulness, and positive intent elicits the best in each of us and is especially valuable during the difficult times caused by a pandemic.
Focus on what matters. Practice and maintain emotional competency. Contribute to the community.
Think about how you can help and what you can contribute rather than what you can grab.
Many creative people contributed and provided positive change throughout the pandemic.

## Patience

Each pandemic will last until vaccines are created, isolation is effective, or cures are found. The pathogen proceeds at its own pace, we can only mitigate its effects. Be patient with yourself, your family members, your colleagues, healthcare workers, first responders, and officials as the pandemic runs its course.

## Recommended Reading

I have not yet read the following books, but they seem interesting and relevant. They are listed here to invite further research.
* Quammen, David (October 1, 2012). Spillover: Animal Infections and the Next Human Pandemic. W. W. Norton & Company. pp. 592. ISBN 978-0393066807.
* Cuomo, Andrew (October 13, 2020). American Crisis: Leadership Lessons from the COVID-19 Pandemic. Crown. pp. 320. ISBN 978-0593239261.
* Christakis, Nicholas A. (October 27, 2020). Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Little, Brown Spark. pp. 384. ISBN 978-0316628211.
* Zakaria, Fareed (October 6, 2020). Ten Lessons for a Post-Pandemic World. W. W. Norton & Company. pp. 320. ISBN 978-0393542134.
* Barry, John M.. The Great Influenza: The Story of the Deadliest Pandemic in History.
* Randall, David K. (May 7, 2019). Black Death at the Golden Gate: The Race to Save America from the Bubonic Plague. W. W. Norton & Company. pp. 304. ISBN 978-0393609455.
* Talwar, Rohit (May 27, 2020). Aftershocks And Opportunities: Scenarios for a Post-Pandemic Future. Fast Future Publishing Ltd. pp. 192. ISBN 978-1999931162.