In Brief:

• America lost more lives to COVID-19 than any other country in the world, despite spending the biggest share of its GDP on health.
• A group of nonprofit foundations funded a COVID Crisis Group to study the pandemic response. The intent was to build the foundation for a national commission that could look objectively at state and federal efforts, to improve outcomes in future public health events.
• To date, there has not been official government support or sanction for such a commission. The group has published its findings, and one of its members spoke to Governing.

Will we learn from a traumatic public health event that has taken more than a million American lives and counting? For many in government and politics, the desire to move past lockdowns, masks and school closures could be strong enough to stifle curiosity.

In 2021, four foundations—The Rockefeller Foundation, the Skoll Foundation, Schmidt and Stand Together—funded work to set the stage for a national commission that could look objectively at what worked and what didn’t in pandemic response. An international group of experts, the COVID Crisis Group, was led by Philip Zelikow, who directed the 9/11 Commission. Their research included listening sessions with almost 300 people.

Bills introduced in the House and Senate in 2021 to establish a COVID-19 task force went nowhere. (A new bill was put forward in the Senate in May of this year.)

Rather than waiting for the federal government, in April the COVID Crisis group published an “investigative report” summarizing its work, Lessons from the COVID War.

In almost 300 pages, it recounts a complex public health event in plain language. It compares the COVID-19 response to a multisection orchestra playing without a shared score or a conductor. (This was never more true than in spring 2020 when the president and his key advisers decided that it was not the job of the federal government to lead.)

“In June 2020, the FEMA-HHS ‘realigned’ from ‘take charge’ into working groups that would just support the state, tribal and territorial crisis management efforts,” the report notes. Cases were trending downward at the time, but would increase almost sixfold by winter, the darkest period of the pandemic.

While these estimates can’t account for every variable related to the COVID-19 experience in various countries or differences in data collection or cause of death determinations, they raise difficult questions about U.S. pandemic response.

Lessons from the COVID War sheds light on mistakes, data gaps and dysfunctional organizational cultures that contributed to America suffering more loss of life than any other country in the world. The U.S. death toll might have been reduced by as much as half a million if its response had been as effective as that of the EU, the authors say.

The report also documents heroic efforts by those in public health and government who rose to the occasion despite all obstacles. It points to ways to revive the problem solving and engineering prowess that made the U.S. the envy of the world in the 20th century.

Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania, chair of its department of medical ethics and health policy and brother of former White House Chief of Staff and Chicago Mayor Rahm Emanuel, was a member of the COVID Crisis Group. He spoke with Governing about the uphill climb that lies ahead.

Governing: Who do you hope will make it a priority to read this report?

Ezekiel Emanuel: Government officials who have control over public health matters. That includes the staff of governors as well as the officials in state health and local health agencies; they’re very important. We hope that people at the [Centers for Disease Control and Prevention] CDC read it.

Nongovernmental agencies that are engaged in various aspects of health. One of the things we’ve noted is the withdrawal of a lot of foundations from doing pandemic-related things, shifting their attention. That’s unfortunate. It’s like the federal government clawing back its COVID-19 money.

Unless we take this report seriously and make some substantive changes, we’re going to be in the same pandemic panic mode when we confront another one of these.

That’s a real bad mistake.

Governing: The idea was that you would lay the groundwork for a national commission, like the 9/11 Commission. Were you surprised that didn’t happen?

Ezekiel Emanuel: Yes. This is an orphan and it’s an orphan for a lot of reasons.

The fundamental reason is the Republicans don’t want fingers pointed at the mistakes under Trump. He had one huge victory, which is Warp Speed, getting a vaccine. But the flip side is lots of mistakes. They would prefer those mistakes and problems not be revealed. They want to claw back the money and not spend it on additional preparedness.

Similarly, the Democrats have their interests. We’re going into an election and the American public is largely beyond COVID-19. They don’t want to remind the public by having this national commission turn up things.

Each side has its own reasons to not push for a national commission—even one that will cost nothing, that foundations that supported development of this report would be willing to support.

Governing: If there isn’t going to be a commission with the authority of the federal government behind it, is there a similar way to create a national push for the changes you’d hope to see?

Ezekiel Emanuel: You could have a private commission, but you’d have to have a very senior, highly respected person who’s not controversial involved.

It’s hard to know who that might be at this point in the political cycle.

Governing: Where does that leave us?

Ezekiel Emanuel: We’re into the “let’s forget and move on” mode of American responses. That is going to hamper our ability to respond in the next pandemic or next health emergency, because we won’t have in place the right infrastructure. We won’t have learned the lessons, and we’ll be improvising again and making mistakes.

I think it’s pretty tragic. People are going to die, and there’s no reason for that.

The problem is that we actually know what to do to fix things. This is not one of those problems where it’s not clear what the solutions are. It’s a matter of money, but we’re not talking about tens of billions of dollars.

Think of it as insurance. Three billion dollars is 10 bucks a person in America. Is that a worthwhile expenditure?

Governing: Are there any ways to move in the right direction?

Ezekiel Emanuel: There’s one concrete change that would have a profound impact. It’s happening in fits and starts and bits and pieces. That’s indoor air quality.

We have tons of data about the importance of indoor air quality for cognitive function, for learning, for respiratory illnesses, but no initiative nationally to improve it.

I feel really proud that an initiative I began in January 2022 to create a national strategic plan focused heavily on indoor air quality. It was one of our chief conclusions.

In plain language, Lessons from the COVID War offers findings from a deep dive into the highs and lows of America’s response to COVID-19.(Public Affairs)

It wasn’t on the agenda to improve indoor air quality, but the Office of Science and Technology Policy has [since] had a number of meetings on it. We’ve just recently had CDC release some standards on it.

J.B. Pritzker has said that he’s going to have HEPA filters or improved air quality in every classroom—except in Cook County, because they get different money.

That’s progress. That’s good. But it’s not national, so that’s unfortunate.

Governing: What could push this to the next level?

Ezekiel Emanuel: If Illinois studies this and shows that it’s actually beneficial, that would be a big home run that would lead to a major shift in thinking by states.

The main benefits will probably be better student test scores, lower asthma absences and maybe even lower Medicaid costs from students who have Medicaid having to go to the emergency room or be hospitalized.

Governing: Are there other ways to move in the right direction? It’s a bit grim to think we won’t learn enough to keep the next wave from crashing over us.

Ezekiel Emanuel: There are things that can be done. Some of them don’t require legislation, like having a pandemic group at the White House doing tabletop exercises to be better prepared on the public health side.

We are getting lots of interest in doing additional research on mRNA vaccines. We’re going to learn a lot for the next pandemic by additional research in that area.

I think there are going to be a few lights here and there, but the wholesale change that would be important—here are a hundred recommendations, and we’re going to try to systematically institute them—I’m pessimistic on that.

This is a case where politics is trumping good policy. [In a future event] no one will be able to say we did everything to prevent it. No, we didn’t.

Republished with permission from Governing Magazine, by Carl Smith