Defeat Covid 19 Quotes

COVID-19 is not just a medical challenge, but a spiritual challenge too. To defeat covid humanity need to follow the path of self-purification, compassion, nonviolence, God and the Nature.

Better to dare mighty things and fail, than to live in a grey twilight where there is neither victory nor defeat. (Covid19 the enemy 2020)

If we are at war with Covid 19 (Corona Virus) . In war there must be casualties and collateral damages. Drink, smoke, loot, visit friends, go outside , go to parties, events, funerals, church and clubs at your own risk. Be ignorant, don't wash your hands and gather in groups at your own risk. You might become the percentage of casualty or just be safe , stay home and practice social distance. We can defeat the virus, but as for how long will it take.It is up to you.

The point here isn’t that the federal health officials were wrong. The point is that they were working with faulty tools, and from faulty data sets. Because health officials couldn’t test widely for the presence of the virus, they overrelied on information that they had access to, which was based on a model for flu. This is the central failing that needs to be fixed for our future preparedness.

Later analysis found that of the 675,000 travelers who were subjected to enhanced health screening at airports, fewer than 15 cases of COVID were identified.34 In the end, the number of federal personnel charged with implementing the screening who caught COVID exceeded the number of infected travelers that the efforts would intercept.

Even though some of his public statements over that time period would have suggested he didn’t see the looming calamity, or the need for strong action, his private demeanor that day left me with the clear impression that he recognized the grave risks, he was more solemn than previous meetings, and when it came to the question of mitigation, he was mostly sold on the ideas before I had arrived.

The measures that we’d be forced to embrace would be far more sweeping, more indiscriminate, and more burdensome, because we had no idea where SARS-CoV-2 was already spreading widely, and where we could still try to use testing and tracing to contain it. We had no way of detecting the virus.

However, there’s always a risk that a vaccine can be too potent, or too indiscriminate, and activate too many parts of our immune system.

The dominant narrative over this time period remained that the White House pressured the CDC to subdue certain reporting. The record shows political actions certainly played a role in the suppression of some critical information. But there was another problem afoot. The CDC didn’t have all the pertinent information in the first place, or the ability to collect it in a reliable fashion that would enable timely reporting.

In other words, the number of hospitalizations that the CDC was reporting each day weren’t people who were actually being admitted to the hospital but were hypothetical patients being modeled off a small sample that the CDC was collecting.16 The CDC reported on the number of hospitalizations each day as if it were tabulating these totals, but it wasn’t. Making matters more uncertain, the data that underpinned that modeling exercise was being lifted from a system that had been built years earlier as a way to monitor the prevalence of hospital-acquired infections like urinary tract infections and hospital-acquired pneumonias, not for tracking hospital admissions.

Deborah Birx convinced the Coronavirus Task Force to direct money to the CDC to modernize its reporting of the COVID hospital data, but the CDC said no. Birx had previously worked at the CDC for nearly a decade, running the agency’s global HIV/AIDS division. After that, she had continued to collaborate with the CDC in her role as the US global AIDS coordinator, an ambassador-level job inside the State Department. Now, prodding the CDC to reform the way it collected hospital data, she found it was hard to get the agency to change approaches.

The public is willing to follow sensible, evidence-based directions. But experts can only ask people to sacrifice so much before resistance starts to form, given the potential social and economic hardship. If the CDC expects Americans to follow its guidance, it will have to be more transparent and get the public invested in how these decisions are made.

The federal government had bought the entire available supply, and HHS needed to know where to ship its limited doses, to make sure that the scarce medicine would get to those hospitalized patients who might benefit most from the treatments. However, the CDC didn’t have actual data on who was currently hospitalized for COVID, just estimates built off a model. They couldn’t tell HHS where real patients were, only hypothetical patients that were being extrapolated from an algorithm.

The simulation, dubbed Crimson Contagion, was a joint exercise conducted from January to August 2019 that aimed to test the capacity of the federal government and twelve states to respond to a severe pandemic flu originating in China. In the scenario they drilled, tourists returning from China spread a respiratory virus in the US, beginning in Chicago. In less than two months, the virus had infected 110 million Americans, killing more than half a million. The report issued at the conclusion of the exercise was ominous.56 Federal agencies fought over who was in charge. There were shortages of protective gear like N95 respirators and ventilators. States went their own way on mitigation, with some states refusing a CDC directive to close schools as a way to limit spread.

South Korea showed the importance of having in place the infrastructure that was required to respond to a pandemic. This was true especially when it came to the equipment needed to deploy an enormous amount of testing. However, having enough test kits and test supplies was just one half of the equation. We also needed an installed base of labs and equipment that could run the tests and the ability to deploy testing sites that could quickly screen a massive population.

And yet the CDC wasn’t the right agency to take ownership of anticipating and developing strategies to counter national security threats, because it possesses a retrospective mind-set.

Given the intense isolation that nations are now likely to experience when they disclose that they’re host to a menacing outbreak of a novel disease, and the economic repercussions they’ll incur, we can expect countries to adjust their behaviors. They’ll be even more reluctant to reveal the existence of a new pathogen or to share strains and sequence information

but the concerns that a lab leak could have been the origin of COVID persist largely because the Chinese government has withheld information that could help put such theorizing to rest.

It was once thought that a terrorist or nation-state would be unlikely to weaponize a pathogen that could easily blow back on them. COVID may have changed some of that calculus. Western democracies proved uniquely incapable of implementing respiratory precautions and defending from this threat. The US was one of the worst hit among nations. Terrorists along with more traditional nation-state adversaries may now see that respiratory pathogens are a poor man’s nuclear weapon.

Across Canada, China, and Singapore, thermal scanners had been used to screen more than 35 million travelers in 2003, detecting nearly 11,000 fevers but uncovering not a single case of SARS-1.31 Still, Canada would record 250 cases of SARS-1, and Singapore 206 cases. During past pandemics, it was reported that people took fever-reducing drugs to defeat the scanners.

These failures caused the perceived risk of fomites to be overestimated, and the perceived value of better respiratory precautions, like the use of masks, to be underestimated. We put far too much emphasis on cleaning surfaces, when we should have been taking more steps to improve airflow and filtration in confined indoor spaces and to get N95 respirators to individuals at high risk of bad outcomes. Asymptomatic spread played an especially large role in transmission from, and among, younger people.

the executive director of the WHO emergencies program, Dr. Michael Ryan, put his own spin on this observation. “Perfection is the enemy of the good when it comes to emergency management,” he said. “Speed trumps perfection, and the problem in society we have at the moment is everyone is afraid of making a mistake, everyone is afraid of the consequence of error. But the greatest error is not to move. The greatest error is to be paralyzed by the fear of failure.

Black New Yorkers were twice as likely as white New Yorkers to die from COVID and more than twice as likely to suffer a nonfatal hospitalization.

This is also the approach used by the two leading COVID vaccines that were made in China and marketed by the Chinese drug makers Sinovac and Sinopharm.

The mRNA approach could also provide a more reliable way to manufacture the vaccine in large quantities without relying on millions of chicken eggs.

What we needed instead was sustained investment in broad capabilities that could counter a range of similar dangers—not specific countermeasures, but general approaches to designing and developing drugs and vaccines that could be employed against an array of adjacent risks.

Birx said that the government couldn’t ship scarce doses of the valuable medicine to treat estimated patients that were hypothetically hospitalized according to a mathematical formula. So she gave hospitals an ultimatum. If they wanted to get access to remdesivir, they would need to start reporting real data on the total number of COVID patients that they admitted each day. Hospitals quickly started to comply, reporting actual data on their total daily hospitalizations to a new portal that Birx had helped set up inside HHS. Rather than try to cajole the CDC into fixing its reporting system, Ambassador Birx and Secretary Azar decided to re-create that structure outside the agency. They had concluded that getting the CDC to change its own scheme, and abandon its historical approach to modeling these data, would have been too hard.

Later, in 2006, Congress appropriated funds to improve the CDC’s system for detecting and reporting on novel threats, directing the agency to “establish a near real-time electronic nationwide public health situational awareness capability” to “share data and information to enhance early detection of rapid response to, and management of, potentially catastrophic infectious disease outbreaks”; but the CDC never implemented the called-for changes.

Until Hatchett and Mecher undertook their efforts, the received wisdom was that nonpharmaceutical interventions didn’t work and that the Spanish flu was “unstoppable.” Hatchett and Mecher didn’t see it that way and thought the tactics were underestimated.

However, Hatchett and Mecher’s modeling, and the deep dive into the history of the Spanish flu, started to change minds inside the public health establishment, and especially the CDC. The findings on the NPIs from 1918 were so striking that they surprised the team. The nonpharmaceutical interventions had a profound effect on slowing spread, but they needed to be adopted early in the course of a pandemic. The best way to contain a pandemic would remain through vaccination. But it might be months, or longer, before a vaccine could be made available.

The plan that we had drilled for always envisioned the CDC taking the central role in developing a test and following a very staged process in deploying it across the nation. This system could work with a slow-moving outbreak. It was no match for a fast-moving pandemic.

Two of the biggest failures was the CDC’s overestimation of the risk of spread from contaminated surfaces, and its underestimation of the risk from asymptomatic transmission. The two errors were mutually dependent.

Antibodies can continue to circulate in our blood for many months, but not all antibodies are equally effective in neutralizing a virus.

The law required the CDC to “establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems to share data and information to enhance early detection of rapid response to, and management of, potentially catastrophic infectious disease outbreaks and other public health emergencies that originate domestically or abroad.”30 As Levin observed, “the simplest way to describe the CDC’s response to this binding legal mandate was that it just ignored it. It did nothing.

The US government would pay Pfizer only if the vaccine worked, and only for the doses they were buying.37 Bourla wanted it that way. He was concerned that the strings attached with federal grant money could slow the process. He wanted his scientists unencumbered. He knew that speed to market would save lives.

A decade earlier, we might have struggled for a year to get SARS-CoV-2 to grow in cell cultures. Messenger RNA proved to be an agile approach, allowing us to develop highly effective vaccines directly from the virus’s genetic composition.

The schools didn’t have enough information to guide safe decisions to reopen. At best, these political efforts were a misreading of the value that information could play in supporting action in the setting of uncertainty. Did masks lower the likelihood of spread in classrooms? Did distancing help? Was keeping students in distinct social pods effective? These were critical questions that needed to be answered. If we had data to guide these actions, more schools would have had a framework to know how to both stay open and reduce the risk of outbreaks. Secretary of Education Betsy DeVos said it wasn’t the responsibility of her department to collect and report this information.

During a fast-moving crisis, in the absence of good information, people tend to be more conservative, and less willing to try something perceived as risky.

hospitalization data away from the CDC and set up the new system, many in the media would almost reflexively cite the incident as support for a dominant narrative that the CDC was seeing its role obstructed and reduced by the political leadership at HHS and the White House.25 US senator Patty Murray sent HHS an oversight letter in which she argued that the new system was wasteful and “duplicates existing CDC work.”26 It was alleged that the Trump administration had taken the hospital reporting away from the CDC and given it to TeleTracking with a political not a public health goal in mind—political officials wanted to fudge the data to give a false rosy picture of the pandemic. Or so the narrative went. While the CDC was certainly subject to some deeply unfortunate and ultimately damaging political intrusions into its work, this wasn’t one of those instances. Some of the frustrations with the CDC’s execution had merit, and the CDC’s method for reporting COVID hospitalizations was one of those moments.

In the traditional approach to making a vaccine, the antigens are cleaved off the virus that you’re targeting, a tactic that requires scientists to isolate proteins on the surface of the virus.

In fact, Moderna never had the actual coronavirus on its premises. It never needed a sample, just the computational sequence of the virus’s RNA. Once Moderna got the sequence, the entire process to construct a candidate vaccine took just two days.

As part of our national preparedness, it will be important to stockpile countermeasures to some of the known risks, but it’s equally important to support the development of novel technology platforms that have broad applicability over a range of potential threats. We can’t always see the future. We can’t focus solely on the dangers that we can see today. And we can’t guess which approaches to developing drugs and vaccines will yield the most effective solutions.

Studies showed that about 70 percent of patients infected with SARS-CoV-2 wouldn’t spread the virus any further, but about 5 percent of infected individuals without masks could account for as many as 80 percent of all subsequent cases, mostly the result of superspreading events.

One senior airline executive told me that their internal data showed that after their flight personnel started to wear masks, the incidence of coronavirus infections among staff fell sharply.

As the industry/government cartel ramped up its campaign to keep HCQ from the masses, many doctors fought back. On July 23, Yale virologist Dr. Harvey Risch persisted, this time with a Newsweek article titled “The key to defeating COVID-19 already exists. We need to start using it.”136 Dr. Risch beseeched the authorities: HCQ saves lives and its use could quickly end the pandemic.

Researchers from the University of Southampton in England, using mobile-phone location data from Chinese internet firm Baidu, estimated that if China had implemented its strict measures in early January, it would have reduced the epidemic’s victims to just 5 percent of the eventual total.76 That’s a small enough outbreak that Chinese officials might have been able to fully contain the spread inside China.

One illuminating fact: the Chinese authorities sent the head of their biowarfare program to Wuhan to oversee the response. In the US, we were misled by a belief that China’s effort would conform to the type of response that many US public health officials would have envisioned, with public health institutions taking the lead. China’s CDC was largely sidelined.

Pottinger had covered the 2003 SARS-1 epidemic for The Wall Street Journal and had seen firsthand the Chinese government’s effort to conceal its spread.

Early on, Pottinger also raised concerns about potential shortages of medical supplies like masks. But not everyone was similarly convinced of the dangers. As the pandemic later took its grip on the nation, he was one of the rare White House officials who routinely wore a mask to work, despite persistent scorn by colleagues, who labeled him an alarmist. Pottinger had two older relatives living with him at home and was so worried about the lax precautions being observed inside the White House that he had his office moved from the West Wing to the Eisenhower Executive Office Building, an historic and ornate office building located next to the White House that housed many of the staff who supported the president. It was Pottinger’s own act of social distancing. He was worried that he would catch the virus in the White House and bring it home with him.

All the work that Hatchett and Mecher had done in 2005 and 2006 would be put to the test for the first time, and on a wide scale, against a pathogen for which it wasn’t fashioned. But more critically, the historic failure to deploy a simple screening test, and thus our inability to identify the virus and slow its advance through testing and tracing, meant that mitigation would be used far more strictly, and indiscriminately

To get the manufacturers and commercial labs into the market early, senior officials needed to guarantee the purchase and payment for their tests. We needed to anticipate the threat, and the officials at HHS needed to create a market where one didn’t yet exist.

South Korea reformed its CDC after MERS and gave it responsibility for creating a testing market in a crisis. In the US, HHS turned to the CDC, and the CDC didn’t have the policy orientation, operational experience, or industrial expertise to pull off an effort on this scale. As a consequence, we never had enough testing to keep up with the initial spread, and we lost control of the pandemic at its very outset.

labs that enrolled in the FluNet Global Influenza Surveillance System—a network of reference labs that sample for flu as a way to track its global spread—recorded 4,623 cases of flu in 2019 but just 53 in 2020. In Chile, there were 5,000 cases in 2019 and 12 in 2020; and in South Africa, the network’s labs detected 1,094 cases in 2019 and just 6 in 2020.53 In New Zealand there was a “near extinction” of influenza.54 With so little flu virus migrating, a similar scenario played out in the US during our fall and winter. By the end of January 2021, the CDC had recorded only 1,316 positive flu cases in its surveillance network, compared to 129,997 they had recorded over the same time frame in 2019.55 The mitigation we put into place was designed to deal with a pandemic flu, not COVID, and it worked much better against its intended viral target.

In the next two days, as cases grew (reaching one hundred civilian cases and another nine hundred at a local barracks), Starkloff asked the city’s mayor and other leaders for legal authority to issue public health edicts. His request was granted. Starkloff’s actions were swift and forceful. Starting on October 8, theaters, pool halls, and other public amusement venues were ordered shut. All public gatherings were banned. Churches were also shut. Schools were ordered closed the next day.25 The difference in the response times between Philadelphia and St. Louis amounted to fourteen days when measured from the first reported cases—but those two weeks represented about three to five doubling times for a flu epidemic.

They found that cities like St. Louis, where multiple mitigation steps were taken early, had peak death rates that were about 50 percent lower than cities that acted more slowly and sparingly. They also had lower cumulative deaths. Early action mattered.27

In Israel, a teacher strike began in the last week of December 1999, causing elementary schools to close nationwide. The strike came right in the middle of a furious flu epidemic. Flu cases fell sharply when the strike forced the schools to close. And when the strike ended and kids returned to classes, flu cases rebounded sharply.

Modeling suggested that timing matters: the interventions had their greatest impact if schools were closed before 1 percent of a local population was infected.41 More systematic studies had found that in the setting of flu epidemics, closing schools for long stretches of time reduced the total number of community cases.42 These steps could also reduce peak attack rates by up to 45 percent among a community, according to the research (and by as much as about 50 percent among children).43 Real-world studies, including surveys done after the 2009 pandemic that analyzed the influence of school closure on transmission, supported these conclusions.

It was always likely that, in the event that a new virus emerged, the first therapeutics that could be made available would be antibody drugs fashioned to attack proteins on the virus’s surface. Yet we didn’t have a plan on the shelf for how we would maximize their use.

Data released later by the president’s physician, Dr. Sean Conley, showed that Trump didn’t have detectable antibodies of his own when he was first diagnosed with COVID.13 That could have been because his antibodies were measured early in the course of his infection, before his body had had enough time to mount a response. Or, as seemed possible, it could have been because the president was among the subset of patients, usually older individuals, who don’t mount a robust initial immune response to the virus, putting them at more risk. It’s for these patients that the antibody drugs seem to work the best. What happens in these situations is that the virus replicates largely unchecked because patients don’t develop antibodies to interrupt its progress. By the time their immune systems kick in, a lot of virus has accumulated. Faced with a high load of virus, their bodies will then overreact to the infection and dump a whole lot of immune cells into the bloodstream.14 This is the immune system becoming overcharged all at once, the “cytokine storm” that can damage organs.

Antibody drugs like the products that Trump and Christie received could have been a bridge to a vaccine. They could be used as effective treatments in high-risk patients, especially when the drugs were administered early in the course of the disease. Moreover, these drugs could also be used as a prophylaxis to prevent infection in those at greater risk of contracting COVID and suffering a bad outcome.

When policymakers lost interest in Regeneron’s drug for MERS, the company advanced an idea for a pan-coronavirus antibody that could be used if another coronavirus should emerge and threaten a pandemic.27 Regeneron believed it was possible to develop a cocktail of antibodies that would be effective against any coronavirus. But the project couldn’t attract investment from federal agencies like BARDA that would have had to fund these sorts of countermeasures.

From start to finish, it took Lilly eight months to go from concept to a commercially available medicine.30 The company’s previous record for discovering, developing, and commercializing an antibody drug—soup to nuts—was four and a half years. Lilly received FDA authorization for its COVID antibody drug on November 9, and Regeneron soon followed suit on November 21.31

However, neither Lilly nor Regeneron would be able to produce enough supply in 2020 to meet the expected demand in the epidemic that was surging in the winter of 2020–21.

And yet the CDC wasn’t the right agency to take ownership of anticipating and developing strategies to counter national security threats, because it possesses a retrospective mind-set. The CDC doesn’t generally focus on actionable assessments of future risks; it produces academically oriented after-action reports in an effort to define new scientific principles.

Most of the notable features on the virus could be found in coronaviruses already identified in nature, including the furin cleavage site. So, in theory, all of its genetic diversity could have evolved through natural selection. The features didn’t necessarily need to arise from a lab, or from any special circumstance.

RNA viruses mutate relatively quickly, and many, like influenza, are able to undergo a process known as antigenic drift, by which the virus is able to alter the surface antigens that are the targets of our antibodies—thus evading our existing immunity. Some viruses, like measles, cannot change their genomic sequence in ways that substantially alter enough of their surface proteins, so measles remains susceptible to our vaccines or the immunity that we get from prior infection. However, for viruses like influenza, as their surface proteins undergo change, the virus is able to dodge the protective antibodies that we’ve developed from past infection or vaccination

In a crisis like COVID, information is not foresight. It takes exceptionally brave leadership to act decisively, before the full scale of a threat becomes obvious. By the time the situation is evident, it can be too late to avoid a catastrophic outcome.

federal health officials were repeating a now-common refrain in their public appearances: “There is no need to panic.” In reality, they didn’t have the tools to know for sure. You have to admit what you do not know. Government officials often make the mistake of trying to answer every question.

When I met with senior White House staff that morning, they wanted something different: my help in trying to convince the president that we needed to adopt some form of mitigation to slow the spread.

But a good vaccine maximizes its ability to kindle all of our immune system’s machinery, not only stimulating the production of antibodies but also spurring the activity of T cells and B cells that have memory, and are able to churn out new antibodies and other mediators of our immune response after they come into contact with a virus months or years later.

An analysis conducted by the office of Scott M. Stringer, the New York City comptroller, found that 75 percent of front-line workers in the city are minorities.

The vaccine by Sinovac, called Coronavac, followed this strategy and was eventually shown to be about 50 percent effective, or less.

As Murray wrote, “This information can provide insights into how combinations of public health mandates—masks, social distancing and school closures, for instance—can keep the virus spread in check. But the government, inexplicably, is not sharing all of its data. Researchers have asked federal officials many times for the missing information but have been told it won’t be shared outside the government.

The three groups would reach identical conclusions: there was a tight correlation between the number of interventions that cities would adopt, the speed by which these measures were implemented, and the outcomes that different cities experienced.

But even against the backdrop of rising death and disease, and an especially cruel impact that the virus was having on Philadelphia’s poorest residents, the steps stirred anger and opposition. On one side of the debate, the Philadelphia Inquirer said the orders went too far, calling them a product of, and a currency for, the unfounded panic that accompanied the flu.

Cases continued to surge. And yet many civic leaders would argue that the Spanish flu was driven by misguided fears and wasn’t that dangerous. In 1918, one of the most prominent of these individuals was Krusen, who would declare that the end of the pandemic was near and that the cases had reached a “crest.” Dr. John W. Croskey, president of the West Philadelphia Medical Association, similarly said that “the public should be educated to the fact that the disease is not as deadly as many believe it to be.” However, Croskey had grossly underestimated the severity of the flu, putting the case fatality rate—the percentage of people who developed symptoms of flu and would die from the disease—at about 0.5 percent, which was far less than its real fatality rate.

In the setting of a fast-moving public health emergency, there’s no time to waste. We squandered far too much time running studies on dubious therapies, often with trial designs that were inadequate to answer the question of whether a therapy worked. We needed more practical studies like RECOVERY and more central organization around the conduct of research in a public health crisis.

Yet while all these studies were under way, many of which wouldn’t yield useful answers, the trials with the antibody drugs, the most promising medicines in development, were delayed because of difficulty enrolling patients. A lot of eligible patients were being siphoned away by competing studies that were evaluating inferior drugs.

At the peak of the winter surge, we were losing as many as seven thousand patients a week in nursing homes to COVID. About thirty thousand long-term care facilities were impacted by COVID with outbreaks. Less than 1 percent of America’s population lives in long-term care facilities, but by the end of 2020, this population accounted for about 40 percent of all COVID deaths—nearly 175,000 in total.55 During the worst week of infections, the week of December 17, there were 72,586 COVID cases diagnosed in nursing homes.

Dialysis facilities were another site where vulnerable patients congregated and where the impact of COVID was especially brutal. Dialysis patients suffered a higher rate of hospitalization for COVID disease than any other group in the Medicare program.

The political pressure by the White House to hasten vaccine approval may have had the opposite effect on its commissioner, instigating a series of actions that ultimately might have delayed those products from reaching patients sooner.

I always felt the FDA was at its best when it was in firm control of its own process and decision making, when it could make independent decisions based on the close evaluation of data.

The White House thought the FDA would take more risk if they were put under pressure. The reality was quite the opposite: the agency would be more able to do a careful weighing of risks and benefits, and perhaps embrace some additional uncertainty, if it had the independence to evaluate the available evidence. I can’t help but think how the process might have played out if the FDA had felt more firmly in control of these events, and if Hahn’s unfortunate entanglements with hydroxychloroquine and plasma had never occurred.

America’s dismal experience with COVID leaves us little choice but to expand the tools we use to inform us of new risks. In bolstering our pandemic preparedness, our purpose shouldn’t be merely to blunt the impact of the next pathogen that emerges, but to make sure that a calamity on the scale of COVID can never happen again, and the US can never be threatened in this way again.

A highly respected pair of researchers put the odds that such an effort (in this case involving a hypothetical strain of a novel influenza) could create a dangerous pathogen that would accidentally escape from a lab and trigger a pandemic at 1 in 10,000 to 1 in 100,000 per lab year.64 This was a meaningful risk. The US government imposed a moratorium on gain-of-function studies in 2014. No such restrictions were imposed in China. The US moratorium was later lifted by the NIH in 2017 and gain of function experiments continued including one widely cited study that was done by US researchers in collaboration with the WIV.65

In all, SARS-1 had been the subject of six outbreaks since its last-known natural occurrence, each one the consequence of its escape from a laboratory: one time each in Singapore and Taiwan, and then four separate escapes from the same lab in Beijing.69 Another instance where an experiment in China had gone awry, and triggered the global spread of a novel virus, had occurred in 1977 and involved a strain of H1N1 influenza.

It was a leaky protocol. The tests were not fit to the purpose for which they were being used. Without masks and other mitigation inside the compound, the White House needed an airtight testing system. They didn’t have one.

even as the US developed a surplus of COVID vaccine—stockpiling as many as 100 million vaccine doses by the beginning of the month—the Biden administration wouldn’t allow those doses to be shipped to Brazil, which was experiencing an uncontrolled epidemic. We were vaccinating healthy and low-risk sixteen-year-olds in the US while hospitals in India and Brazil were running out of oxygen for patients hospitalized with the disease.

For those who still cling to the gauzy hope that nations will join hands to better identify and coordinate around global risks, the gloomy truth was revealed by the collective international response to COVID—the application of trade and travel barriers as a way to isolate the virus and the nations that hosted it; the nationalization of production facilities that made critical medical products; the deliberate withholding of drugs and equipment needed for the global response.

There’s a reason why much of this manufacturing left the US in the first place. It was cheaper to produce overseas. But we can no longer afford the luxury of valuing low price for these goods above all else.

Life can only be understood backward; but it must be lived forwards,” said the Danish philosopher Søren Kierkegaard.

Without a way to reliably test patients who had symptoms suggestive of SARS-CoV-2 infection, US doctors had no way to diagnose the sick or take measures to contain the spread.

Pfizer filed with the FDA on Friday, November 20, seeking authorization for emergency use of the vaccine.35 It was the first company to seek permission to offer a COVID vaccine to US patients. It was just 248 days since the company had first set out with BioNTech to develop the vaccine. No vaccine had ever been developed that fast. The process involved 150 different clinical trial sites, 43,661 patient volunteers, the work of thousands of Pfizer colleagues, and the hopes of a weary nation: it was one of the largest, fastest, and most important scientific endeavors of its kind in modern history.

The president was right to focus his attention on trying to get schools opened for a host of reasons, and principally the important role that in-class instruction plays for children. But the White House had failed to hone in on a root cause for why many districts remained shut. The CDC’s guidelines were the single greatest obstacle. I was speaking to the White House over this time period, and some officials there didn’t fully appreciate how much impact the six-foot requirement was having on efforts to reopen schools in the fall. They didn’t connect the lines between their policy goals, the parts of the pandemic plan that impacted those objectives, and the actions of the CDC that frustrated these outcomes. It was a breakdown in policymaking, and the way the pandemic playbook was implemented, that would plague other aspects of our response.

All of our focus was on flu. The next pandemic, it was firmly believed, would be triggered by a novel influenza. It’s likely that the next pandemic will indeed be from a new strain of influenza, and it will be a lot worse than COVID. However, we need to be prepared for the unknowns. That starts with the analytical systems to identify and characterize a new pathogen. It could be a new strain of influenza with features that are irregular. Or another coronavirus that’s even deadlier and more contagious than SARS-CoV-2. Or, instead, something else that we never anticipated.

South Korea’s testing capacity reached 20,000 tests per day in the opening weeks of its outbreak. That was for a country of just 51 million people. It equates to about 130,000 tests a day in the US. It’s a level of testing that the US wouldn’t reach for about four months into our epidemic.

A key to the success of South Korea, and other Asian nations, identified by healthcare advocate Andy Slavitt, wasn’t just the surveillance tools that they used, but social cohesion that made people more willing to engage in collective actions to advance societal interests.

As the Wall Street Journal’s Holman Jenkins observed, the lab leak theory might appear, at first blush, less plausible than a natural origin, unless you were to assemble the world’s largest repository of dangerous coronaviruses in a lab that’s located in a densely populated city, experiment with them in a lower-security facility with weak biological controls, and start infecting transgenic mammals as a way to evaluate the pathogenicity of the viral collection in the human immune system, all of which the Chinese did.

The new speed turned largely on our ability to deploy novel approaches for developing vaccines, where the initial constructs were derived entirely from the virus’s genome. This enabled us to use pieces of synthetic genetic material that could be made quickly available as the vaccine starting point. The application of these tools transformed the way we develop vaccines against a novel viral target. After COVID, these approaches will be routine.

It took more than a month after the authorization of the first vaccine to begin vaccinating the 1.34 million residents of US nursing homes, where the most COVID deaths were occurring.