HOW THE UNITED STATES, THE MOST ADVANCED COUNTRY IN THE MEDICAL SCIENCE, MADE A MESS OF THE PANDEMIC

Masood N. Khan M.D.

After passing through three years of the pandemic with more than a million dead and finally having achieved some relieving flat line in the rate of new cases and new fatalities, it is possible to evaluate how we fared in this deadly journey.

A DEADLY HEALTH TSUNAMI IN THE MAKING

1. Coronavirus first detected in Wuhan, China in early December 2019

2. Within a month, hospitals in Wuhan started quarantining sick patients and found that members of medical staff taking care of
these patients were falling sick thus giving a strong indication of human to human transmission.

3. By December 31, 2019, as news about the disease spread widely, the Wuhan health officials acknowledged the 27 cases of an “unexplained pneumonia” caused by a virus. However, they claimed there was no evidence of human-to-human transmission.

4. Finally on January 20, 2020, Chinese authorities publicly admitted and reversed their earlier conclusion by declaring that the virus was showing human-to-human transmission. Three days later city of Wuhan was shut down.

5. By the time this admission was made, it was too late. The virus had spread far beyond Chinese borders and was beginning to cause outbreaks globally – a pandemic was on its way.

6. On January 11, 2020, a Chinese scientist bravely allowed an Austrian colleague to upload the virus’ genome to a gene bank, without official authorization. The whole world could now see this was a novel Coronavirus closely related to SARS.

7. It was not until China shut down Wuhan on January 23, 2020, that the rest of the world could see how serious the threat was. But in spite of mounting evidence of human to human transmission, WHO waited for Chinese offical confirmation and did not make a proactive conclusion of its own that the virus was spreading human to human.

TAIWAN TAKES A HEAD START:

Measures were taken immediately by Taiwan by the end of December 2019. On December 31, 2019 Taiwan officials gave an urgent head start to preventive measures that included the following.

1.They entered every flight coming from Wuhan and screened patients who showed symptoms for a viral infection. Taiwan alerted WHO with an email, of a viral illness in Wuhan that showed human-to-human transmission.

2. Masks were manufactured and distributed in quantities enough for the entire country and especially to schools.

3. The country quickly allocated money to businesses that lost customers and revenue.

4. Once the tests were available, Taiwan put in place a program of extensive testing and tracing the contacts, thus squashing two major outbreaks – one that started in March 2020 and the second more impressively, of the more transmissible Alpha variant in summer of 2021. Taiwan suffered a total of 853 deaths. At the same death rate, United States if had implemented similar measures would have suffered only 12000 deaths during the entire two outbreaks.

SOUTH KOREA TAKES A HEAD START

South Korea experienced major spreading events in February 2020, including one in a secretive church that accounted for more than 5000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.

South Korean health officials sprang into action rolling out a mass testing program with drive-through options and vigorous contact tracing and quarantining. Thus, South Korea beat back a potentially catastrophic outbreak in 2020. They had fewer than 1000 deaths in all of 2020 that would translate to fewer than 7000 deaths in the U.S. Instead estimates placed the number of deaths in the U.S. at more than 375,000.

JAPAN TAKES A HEADSTART:

On February 3, 2020, the cruise ship ‘Diamond Princess’ was ordered to stay in Yokohama harbor, in Japan, two days after a passenger who had disembarked at Hong Kong was tested positive for Covid. Later, when 10 other people on the ship were found infected, the ship was quarantined.

Eventually 19% of those on the ship including 9 public health workers, a total of 712 cases were detected and 14 of them died. Following this news, a Japanese Virology professor began suspecting that the virus was probably spread human to human by airborne transmission of tiny particles which could spread more widely and float around longer than thought before and would concentrate especially indoors.

In the same month Oshitani and his colleagues concluded also that a vast majority of infected people did not transmit the virus at all while a small number of the individuals were super- spreaders especially in closed door settings like night clubs, restaurants, Karaoki bars and gyms etc. Based upon Oshitani’s conclusions Japan immediately imposed mask wearing, massive early testing and shutting down of places with indoor crowding.

The public was advised with serious emphasis to avoid the three Cs. 1. Closed spaces, 2. Crowded places 3. Close contact settings. Japan had throughout the pandemic of about 25000 deaths which would be the equivalent of just under 66000 deaths in a country the size of the U.S.

UNITED STATES TAKES A HEAD DROP: (MISHANDLING AND MIS-STEPS)

It was perhaps a divinely imposed misfortune on the United States that Donald Trump was the President of the country who had no clue what the pandemic was and what it meant for the country. His affluence-induced pathologically puffed-up egoistic personality, which psychiatrists have defined to be a kind of personality disorder, refused to admit that the Pandemic possessed deadly power.

He thought Covid 19 was a mere passing illness that temporarily affected people like influenza. He believed it could not withstand the might of a superpower whose President had to be in possession of omnipotent control over any crisis. This was further supported by his anti-science mindset like many people of his base and like many of the religio-fascist illiterate members of the clergy who unfortunately had big influence on the ordinary people. Such clerical groups are present in every religion. For some
reason religious preachers (and mullas in Muslim countries) are threatened by the revolutionizing adventures of science.

Hence a kind of arrogant callousness resulting in every possible effort to minimize and ridicule the seriousness of the impending devastation, prevailed not only in the executive corridors around the President and his staff but also in the so called spiritual corridors of church and clergy exercising direct influence on general population. To be specific, following points need to be paid attention to as the examples of gross negligence on the part of the U.S.

1. Even though China could have notified the WHO sometime in early to mid-December 2019 that it had an outbreak of a previously unknown Coronavirus similar to the dreaded SARS virus and could have immediately sequenced the virus and shared the genome with the world allowing tests to be developed, yet the delayed refractory time in reacting to the impending danger on the part of the U.S was unforgivable. Precious time was lost since the early Corona virus cases were reported from Wuhan China in December 2019. United States failed to react as quickly and aggressively as Taiwan, South Korea or Japan did. It also failed to put appropriate protective measures in place as South Korea did. Not only the governmental officials but the renowned national health institute the CDC was in a mood to underestimate the impending danger thinking it was over exaggerated. Even though reporters working for Western media were kicked out, a trait common to the communist countries, the writing was on the wall only if United States had cared to read. Western scientists had known of the outbreak in China by middle of December 2019 and the whistleblower doctors had complained they were being silenced by authorities in China. All such signs were underestimated and neglected.

2. Alarming evidence of human-to-human transmission was completely ignored by WHO & CDC. Any doubts over such transmission of the virus should have been swept away in mid-January 2020 by reports that a woman in Thailand and a man in Japan had tested positive without having been to the Wuhan Seafood Market that Chinese authorities had said was the center of the spread.

3. CDC came up around February 2020 with the “large droplet theory” causing surface- to-human transmission. It was assumed that the virus was spread by large droplets from the nose and mouth of an infected symptomatic patient that quickly fell to the ground or the surfaces of things, because of their size. People were only advised to keep enough distance from others to stay out of range of these droplets and to wash their hands after touching surfaces that could potentially contain the virus. This was in spite of mounting evidence that the virus was transmitted airborne, through small particles that floated around in the air for long time
and even reached beyond 6 feet, the distance marked for social distancing. 61 people attended a Choir practice in a church at Skagit, Washington on March 10, 2020. The church followed the droplet-based guidance by propping the door open so nobody would touch the doorknob and avoiding handshakes and hugs. No one was within six feet of the other person. Nevertheless 52 people, 85% of those present became infected. This proved “large droplet theory” wrong, yet Americans were disinfecting their
groceries, mail and other potential surfaces while WHO and CDC kept emphasizing hand washing and social distancing and only in Decemeber 2021, two years into the pandemic WHO finally admitted airborne transmission and recommended highly protective special masks for health workers.

4. It was also assumed that only people with symptoms – like fever – would be infectious even though evidence for the spread of virus by asymptomatic Covid positive cases had emerged early on. For example, on January 26, 2020 the Chinese Health minister
gave a news conference warning that people without symptoms could transmit the virus and the same week an article in ‘The Lancet’ had documented a case in which infection was visible in the lungs of a patient who had shown no symptoms. However many health authorities in the U.S., ignored, denied and even belittled the evidence of spread by patients without symptoms. Such callous ignorance meant that the urgency for mass testing wasn’t realized and the virus was allowed to spread silently without critical precautions being taken, until explosive outbreaks occurred in places like New York and other major cities.

In addition to the blunders committed by health officials, scientists and health organizations, in understanding the science behind Covid infection, American public had to pay a price for their misplaced yearning for individual rights and freedom. For long time people in the U.S. showed resistance to mask-wearing, observing of social distancing, getting tested early and getting readily vaccinated, all in the name of not giving up their individual freedom. The governmental officials particularly, and guidelines from the CDC and WHO, failed to impress upon general public the seriousness of the life-threatening danger much less mandatorily imposing on them the recommended preventive measures.

It is true that the great scientific achievement of the pandemic has been the speedy development of safe and effective vaccines. for which the U.S. deserves credit But here also miscalculations and mishandling marred the desired beneficial effects of the vaccination, and did not, on a mass scale, control the spread as it should have.

On May 15, 2020 the United States began ‘Operation Warp Speed’ which financed the development of vaccine. Out of five vaccine- candidates only Pfizer, BioNtech and Moderna, succeeded in bringing the vaccines into the market time-effectively. Yet supply was an immediate problem as production could not match the demand. Even though Pfizer could immediately make as many as 1.35 billion doses in 2021- enough only for about 8.5% of the world’s population to get two doses. Modern a much smaller company and AstraZenica another small company would not cover the gap quickly enough. Vaccine production grew but too slowly. In addition to production and demand mismatch, a global plan and vision to save the world from the pandemic was nowhere to be found. There was no consortium or sharing of resources to ramp up supply. Technology was not transferred to lower and middle-income countries. The WHO initiative to get vaccine to poorer countires known as COVAX failed because WHO did not have enough money to buy the vaccines. Then there was too little commitment to how vaccines could be distributed fairly around the world. Instead wealthy countries who preordered or financed research got not only most of the initial doses but also
started hoarding the doses. Lack of concern to consider that humanity around the world was at the threshold of fatal destruction, the hoarding of vaccine, once again brought to light the ugly, selfish, inhuman and immoral behavior on the part of so called civilized countries controlled by profit- making capitalism. The United States was a leader in demonstrating such behavior.

*WHAT SHOULD HAVE BEEN DONE:

1. Early recognition of danger and its seriousness: Neglect of the scientific facts as given below, in a country that is a leader in medical research and therapeutics, was astonishingly shameful. This led to loss of precious time in recognizing the danger and taking steps to prevent it.

A. No realization for long time that human- to-human spread of the infection was taking place and causing the impending pandemic to cross international borders and effect people globally.

B. No realization that the virus was spreading air-born packaged in small particles that could float in the air for longer time and reach distances sometimes even more than 6 feet.

C. No realization that asymptomatic patients infected with COVID could also cause the virus to spread.

2. Immediate formulation of scientifically backed and evidence-based strategic plan of action: The above mentioned ignorance of the scientific facts naturally resulted in poor planning to ward off the danger. Additionally, an ignorant President who had an anti-science mentality and suffered from a personality disorder that was pathologically egoistic and self-centered, further aided in poor planning. A misplaced understanding of freedom and human rights among the public especially those who were the supporters of the President and those in clergial sector, resulted in unreasonable resistance and refusal to cooperate with the implementation of vaccination programs in the various parts of the country. Now having learned costly lessons, it becomes very clear that the plan of action to fight the pandemic and save hundreds of thousands of lives could actually have been very simple. The essential features of this plan could have been organized in the following three levels.

Level 1: After an early recognition of the danger by understanding the nature and mode of spread of the pandemic, the U.S. should have immediately mandated by law, mask-wearing by every individual at public places and encouraged social distancing to individual’s own safety.

Level 2: Without losing precious time, an effective test to detect the virus should have been immediately brought in the market as soon as the genome of the virus was made known as early as January of 2020, to be followed by implementation of a widespread mass testing program with quarantining of the positive cases and rigorous tracing of the contacts. All contacts should have been divided into positive cases to undergo regular quarantining and negative cases to undergo limited quarantining to cover the incubation period only.

Level 3: More money should have been rolled in for even faster and larger production of vaccines and a mandatory vaccination program by law, should have been implemented, discarding in the interest of larger good, any argument of protection of human freedom.

With the above three-leveled plan there was no need to shut down businesses and public services, and the money in trillions of dollars spent to support the economy by giving stimulation stipends and unemployment checks could have been saved and used instead in production and easy availability of testing capabilities and vaccines. Exposing the darker side of the so called civilized country, New York Times on August 17, 2022 has reported that in the midst of pandemic billions of dollars of relief money into programs aimed at helping the newly unemployed and at bolstering the economy, were stolen by thousands of people making it one of the largest frauds in American history.

References:
1. COVID 19: The Pandemic That Never Should Have Happened And How to Stop the Next One : Deborah Mackenzie
2. Reflections from the COVID 19 pandemic: Pursuits and panaceas : Neha B. Jampala
3. COVID 19 Pandemic Didn’t Have to be This Way’ New York Times: opinion, March 12, 2022
4. Pandemic Fraud Claimed Billions Meant for Relief : New York Times August 17, 2022