On January 20, 2020, the first known case of covid-19 in the U.S. was reported—a man in his 30s who had traveled back to Washington State from Wuhan, China, where the first cases of the novel viral disease had been discovered in December 2019. Nearly everyone failed to predict the full scale of the devastation that would follow, largely fueled by those in power who did little to prepare us for the worst.
Of course, the coronavirus was likely circulating in the U.S. well before the official first case on January 20. Twelve months later, covid-19 has claimed at least 2 million lives worldwide, including more than 400,000 Americans. And though we now have several effective vaccines available against the virus, it may still take months to turn the tide.
We asked several public health experts and scientists to reflect on the past pandemic year. If they had the chance, what would they tell the public—and themselves—in late January 2020 about what was coming?
For Joshua Sharfstein, a physician and researcher at the Johns Hopkins Bloomberg School of Public Health, his message would focus first on the threat that was already established in the country before January 20. The virus was circulating locally in the U.S. by then, and it’s possible that a proactive effort to track and contain those early outbreaks could have at least blunted the impact of the first wave, much as other countries like Germany were able to do. New Zealand and South Korea, with their strict contact tracing and strong testing capability, have been able to keep the pandemic largely at bay this entire time.
“If I could go back in time, I would warn everyone that on January 20, the virus was already spreading in the United States and that a full-scale mobilization was urgently needed,” Sharfstein said. Instead, President Trump and others continued to dismiss covid-19 as nothing more than a bad flu, while the country endured months of shortages of important resources like masks and covid-19 tests.
This threat, Sharfstein added, didn’t hit everyone the same.
“I would emphasize the coming inequity of the pandemic, with rates of death, for example, nearly three times higher among African-Americans and Latino persons,” he said, referencing a large base of evidence. “Had the nation considered the disparate social impact at each stage of the response, many lives could have been saved.”
One glaring reason why the U.S. spectacularly failed to contain the pandemic at any point has been people’s reluctance to admit the severity of the crisis. No one has played a larger role in spreading this denial than President Trump and his administration, said Saskia Popescu, an infectious disease epidemiologist affiliated with George Mason University and the University of Arizona.
“In all honesty, most of us working in infectious disease and health security knew that a biological event under the current administration would be challenging, but I don’t think any of us anticipated how horribly negligent, divisive, and anti-science it would be,” she said. “I wish we could’ve planned more for that, instead of having to run uphill against a novel pathogen and an administration that almost appeared to be working against us.”
From the very start, Trump and others in his administration tried to minimize any blame that could be shifted on them, while shutting down anyone trying to tell the public about how bad things could get, such as CDC scientist Nancy Messonnier. In February 2020, Messonnier correctly warned that the pandemic would cause severe disruption to our lives, and for her trouble, she and other CDC officials were effectively silenced for the rest of the year.
Beyond Trump, many ordinary people in the U.S. and elsewhere have bought into misleading or false claims about the pandemic. This willingness to grasp onto covid-related conspiracy is something that Tim Caulfield, a Canadian bioethicist and author who has studied the spread of pseudoscience belief in the public, wishes that we had been more prepared for.
“While we all realized that misinformation was going to be a big issue, we should have taken it even more seriously from the very start—even the stuff that seemed absurd,” Caulfield said, referencing research showing that up to a quarter of Americans could accept the idea that the pandemic was created intentionally for some nefarious reason (a common bogeyman is Bill Gates and his “goal” to put microchips in people through vaccination). Some denialists dismiss the idea there even is a virus causing covid-19, instead blaming things like 5G.
Conspiracy theories and misinformation have existed long before covid-19 and will endure long after the pandemic has ended. But Beth Linas, an epidemiologist and researcher at Johns Hopkins, pointed out that some authorities didn’t help their case early on in how they communicated with the public, providing conflicting messages on the best ways to stay safe during the pandemic. Covid-19 is far from the only global health crisis we’ll face in our lifetimes, so it’s important to acknowledge and hopefully improve on public health messaging next time.
“Unified messaging could have provided the public with clear factual information and also set expectations that the situation was fluid; i.e., that updates to our scientific understanding of covid would be expected due to the evolving nature of a pandemic and that the global scientific community was working collaboratively to understand the novel disease,” Linas said.
“Mask wearing becoming an indicator of political affiliation was never something I could have imagined,” Linas added, reflecting on one area where public health communication was confusing at times.
Many scientists and public health agencies, including the World Health Organization, were reluctant to endorse universal mask-wearing early on. They did so because they felt the evidence at the time for their benefits outside of medical settings wasn’t very strong (some experts also wanted to deliberately discourage mask hoarding by the public to prolong the available supply for health care workers). More recent research has since found that even cloth masks could help lower the risk of transmission and that people can spread covid-19 without feeling sick. Scientists changing their mind with more evidence isn’t anything new and has happened plenty during the pandemic. Early on, for instance, the so-called six-foot rule of maintaining distance from other people indoors was strongly endorsed by the CDC and others. But evidence has shown that transmission through aerosols and droplets can happen even at that distance, especially in poorly ventilated rooms, leading to calls for more nuanced messaging on lowering our risk of catching and spreading covid-19.
Linas said that the process of reevaluating our approach to the pandemic based on new evidence should have been made clearer to people. At the time, she didn’t foresee that mask-wearing and other complex issues would become so polarizing.
“I would have thought most people would want to do everything they could to protect themselves and their families,” Linas said.
Caulfield noted that this polarization was aided by social media. While Twitter in particular has allowed scientists across the world to communicate directly with the public during the pandemic, it’s also helped create a parallel network of denialists and armchair experts who have spent the last year claiming that the pandemic isn’t really killing anyone, that hospitals actually aren’t flooded with covid-19 patients, and that the pandemic is less dangerous to young people than smoking pot.
“What was needed was more meaningful action by regulators, the scientific community, and the social media platforms,” Caulfield said. “We needed and still need meaningful public engagement and creative communication strategies to counter the flood of misinformation.”
On a more personal note, Elizabeth Stuart, a biostatistician focused on mental health at Johns Hopkins, wondered if it would have been worse to know from the start just how awful 2020 was really going to be. “I’m not sure it would have been good to know last March that we’d still be in this situation today,” she said. “I guess the question is whether it’s good to know in advance that something is going to be a marathon, not a sprint, and in this case I’m not sure!”
At the same time, she added, hindsight would have been preferable for some complicated issues like school re-openings. With the rise of more transmissible virus variants and still-high levels of community spread, schools have increasingly switched to virtual learning. But it is possible that in-person schooling could have been made more available to people last fall, provided the resources were there to mitigate risk, Stuart said. Whatever your opinion on the matter, many families have had to make difficult choices this past year.
“I never could have imagined last March that my kids wouldn’t be back in a school building until at least a year later (from what it looks like now), although I feel very thankful that we have been able to adjust relatively well,” Stuart said.
The sheer scale of the pandemic’s toll would be hard for anyone to foresee last year—not just in the millions dead but in the countless survivors who are now struggling with long-term complications. But it’s not as if no one knew what could happen.
“So many of these things we’ve known for years—novel coronaviruses pose a significant risk, zoonotic diseases and spillover are increasing, hospitals and public health are exceedingly vulnerable and underfunded for preparedness, and that a national vaccination program is a massive task,” Popescu said. “I guess… I wish that people would’ve listened to infectious disease, epidemiology, and public health people earlier on, because we’ve been highlighting these vulnerabilities for a long time.”
Many scientists have warned about a viral pandemic and the chaos it could cause, even as recently as October 2019. They warned—correctly—that the most effective countermeasures against a pandemic have to be created before it shows up. And while the incoming Biden administration does look to have a much firmer commitment to public health than the Trump admin ever did, time will tell whether we can build up our defenses enough to better face the next inevitable pandemic threat that comes our way.