Books will be written detailing the series of decisions made that preceded the current Covid-19 crisis. Lessons will be learned. And our government being what it is where leaders regularly turnover–they will be forgotten as well. But a key question will be, “Why was everyone so surprised?” Why is it that we can prepare extensively for war and even for the potential threat of computer and telecommunications disasters predicted to result when the calendar clicked over from 1999 to 2000–dubbed Year 2000 or Y2K. There was extensive White House directed preparation and then nothing happened.

Why is our response to Covid-19 so haphazard?

Given all the exercises and contingency planning that has been done with respect to pandemics in the last two decades, it is astonishing why key steps were not taken in preparation. One reason is the bureaucracy is not structured for this type of threat.

For nuclear and conventional war, the Department of Defense spends billions in acquisition and training. Defense contractors and congress have an interest in this process. Every congressional district gets money from the defense department and jobs are created building weapons systems. Not so for pandemics.

Still, the equivalent of war games are done for pandemics and contingency operations plans are developed and on the shelf, but the identified capability shortages are not addressed. I had a minor role in an early one called Dark Winter in 2001 (a smallpox outbreak was modeled). As recently as this past fall a government exercise called Crimson Contagion (a flu-like scenario) reminded again that a lack of personal protection equipment would be a key problem among other things. The George Mason University’s esteemed Bio-defense Program created a synopsis copied below. Things could definitely have been done better. Political science and physical science intersect in government crisis management–as does psychology both individual and mass It’s not pretty but many issues are predictable.

There will be many reasons advanced for why the US response was not better. But one key factor is simply experience in running a crisis by the White House. Simple decision criteria like recognizing that acting early and big given the potential consequences is better than not. If you waste time and resources preventing something with potential horrible consequences that doesn’t happen (as in Y2K) so what? Better that than having to play catch up as thousands die and the economy tanks for an in-determinant period. All administrations come down a learning curve. The early Obama administration learned a lot from the oil well blowout in the gulf (BP’s Deepwater Horizon platform) that poured seemingly endless torrents of oil into the Gulf of Mexico. Better to learn on that than a crisis where learning may cost hundreds of thousands of American (and worldwide) lives.

French General Ferdinand Foch, if I remember correctly said something like, “It takes 1500 casualties to make a general”.

From George Mason Pandora Report Blog of 6 December 2019 put out by GMU Biodefense program weekly)

“Synopsis of the Crimson Contagion 2019 Functional Exercise After-Action Review
This week, the National Biodefense Science Board convened a meeting focusing on the after-action review of the Crimson Contagion 2019 Functional Exercise, a national level exercise series conducted to detect gaps in mechanisms, capabilities, plans, policies, and procedures in the event of a pandemic influenza. Current strategies include the Biological Incident Annex to the Response and Recovery Federal Interagency Operational Plans (2018), Pandemic Influenza Plan (2017 Update), Pandemic Crisis Action Plan Version 2.0, and CDC’s Pandemic Influenza Appendix to the Biological Incident Annex of the CDC All-Hazard Plan (December 2017). These plans, updated over the last few years, were tested by the functional exercise with emphasis on the examination of strategic priorities set by the NSC. Specifically, examined priorities include operational coordination and communications, stabilization and restoration of critical lifelines, national security emergencies, public health emergencies, and continuity. The Crimson Contagion 2019 Functional Exercise included participation of almost 300 entities – 19 federal departments and agencies, 12 states, 15 tribal nations and pueblos, 74 local health departments and coalition regions, 87 hospitals, 40 private sector organizations, and 35 active operations centers. The scenario was a large-scale outbreak of H7N9 avian influenza, originating in China but swiftly spreading to the contiguous US with the first case detected in Chicago, Illinois. Continuous human-to-human transmission of the H7N9 virus encourages its spread across the country and, unfortunately, the stockpiles of H7N9 vaccines are not a match for the outbreak’s strain; however, those vaccines are serviceable as a priming dose. Also, the strain of virus is susceptible to Relenza and Tamiflu antiviral medications. The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response. To do so, the exercise began 47 days after the identification of the first US case of H7N9 in Chicago, otherwise known as STARTEX conditions. Then, the HHS declared the outbreak as a Public Health Emergency (PHE), the World Health Organization (WHO) declared a pandemic, and the President of the United States declared a National Emergency under the National Emergencies Act. As was the case in the 1918 Great Influenza, transmissibility is high and cases are severe. At STARTEX, there are 2.1 million illnesses and 100 million forecasted illnesses as well as over half a million forecasted deaths. As the pandemic progresses along the epidemiological curve, the overarching foci of the federal-level response adjusts across four phases:

Operational coordination with public messaging and risk communication
Situational awareness, information sharing, and reporting
Financing
Continuity of operations

The outcome of the Crimson Contagion is that vaccine development is the silver bullet to such an outbreak, but there are complications beyond its formulation. Namely, the minimization of outbreak impact prior to vaccine development and dispersal, strategy for efficient dissemination of the vaccine across the country, allocation of personal protective equipment (PPE), and high expense of vaccine development and PPE acquisitions. The exercise concluded that HHS requires about $10 billion in additional funding immediately following the identification of a novel strain of pandemic influenza. The low inventory levels of PPE and other countermeasures are a result of insufficient domestic manufacturing in the US and a lack of raw materials maintained within US borders. Additionally, the exercise revealed six key findings:

Existing statutory authorities, policies, and funding of HHS are insufficient for a federal response to an influenza pandemic
Current planning fails to outline the organizational structure of the federal government response when HHS is the designated lead agency; planning also varies across local, state, territorial, tribal, and federal entities
There is a lack of clarity in operational coordination regarding the roles and responsibility of agencies as well as in the coordination of information, guidance, and actions of federal agencies, state agencies, and the health sector
Situation assessment is inefficient and incomplete due to the lack of clear guidance on the information required and confusion in the distribution of recommended protocols and products
The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza
There is clear dissemination of public health and responder information from the CDC, but confusion about school closures remains

A final report with greater detail of the after-action review of the Crimson Contagion 2019 Functional Exercise is forthcoming. Stay tuned.”