The 4 Mistakes Made by the US in COVID-19 Response

August 7, 2020

A famed virologist weighs in on the country's earliest shortcomings—and how they can still be resolved today.

David Ho, MD, does not mince words on the coronavirus 2019 (COVID-19) pandemic.

In fact, the world-leading virologist begun a discussion with HCPLive on the matter with as frank an assessment as there could be: the US is in a disastrous situation right now.

“The country is doing very poorly,” Ho, an HIV/AIDS pioneer researcher and founding director of the Columbia University Aaron Diamond AIDS Research Center, said. “What we’re confronting here in the US is what we would have expected in a developing country, not a rich and strong nation.”

These are among the opening statements Ho had on Lungcast, the new monthly respiratory health podcast from HCPLive and the American Lung Association (ALA). As the show’s very first guest, Ho set a stage for addressing COVID-19 in both public health and scientific parameters—by first stressing its burden and reach thus far.

As he stressed, despite the US making up about 4% of the world’s population, approximately one-quarter of all COVID-19 cases and mortality apiece are from US citizens.

Though Ho—along with Lungcast host and ALA chief medical officer Al Rizzo, MD—spent the majority of the episode discussing strategies to resolve COVID-19, he also presented a quartet of reasons that explain just how the US failed in its initial response, leading to this current “disastrous situation.”

1. Testing Slip-Ups

When asked for perspective on the regulatory and advisory infrastructures in place for COVID-19 response—from the World Health Organization (WHO) to the US Food and Drug Administration (FDA)—Ho offered lesser criticism than the agencies have heard in recent months.

That said, he did point to early failures in facilitating, regulating, and distributing effective SARS-Cov-2 assays at the very initial US spread. He estimated the US lost about 1-2 months in progress from use of inaccurate testing kits alone.

The issue continues today—in both inadequate testing use, and limited supply of reliable assays. As such, the country is still reactive to what its true burden of infection is.

This also hinders the US’ capability in establishing proactive measures of data collection, including contact tracing, a practice Ho praised regions of western Europe in executing early on.

Contact tracing is indeed a very necessary practice to work ahead of the virus—to actually set strategies that will definitely reduce its spread and isolate strains from the public. But the country is nowhere near position where it could be done feasibly.

“At 70,000 cases per day, it’s pointless,” Ho said.

2. Poor priorities

A portion of the US population, as well some key legislators, emphasized the vitality of the economy as a key issue when stay-at-home orders and business closures were enforced at the beginning of the pandemic.

This issue was mostly unique to the US—at least in its severity of rhetoric. What was lost in these mixed priorities, or was potentially harmed due to their presence, was the matter of comprehensive public health response.

Ho stressed the need for a politically-based message and commitment toward bringing the virus under control.

He understood the significance of a reopened and mostly returned society for the sake of the country’s economic health, but, “there is not going to be economic health without public health.”

3. Losing Position

Unlike most countries with better control of new daily COVID-19 cases, the US has been susceptible to great, regional spikes which have continually and sharply raised the national wave.

Already, there’s been 2 different peaks in the first US COVID-19 wave—and descents from both waves have not been substantial enough to warrant progress toward reduced social distancing responses.

As Ho explained, it’s like pushing a rock up a hill—mistakes could mean restarting the entire process.

“For every week we slip, it would take 4-6 weeks to regain position,” he explained.

4. Prevention shortcomings

“Overall, I don’t think we’re very good at prevention,” Ho said.

From influenza (flu) vaccination dissent, to public health response among non-viral crises—skyrocketing obesity and diabetes rates, among other metrics of overall health—the US has continually failed at reducing disease threats.

The issue is one that expands beyond having effective prophylaxes and access to preventive care; it reaches community health and clinical outreach to at-risk populations. Failed healthcare prevention is an indictment of resourcing, education, research, pharmacological development, and prioritization.

Overcoming that failure is not simple, but very necessary. The earliest opportunity the US will get will be in vaccine candidates—will they seek preventive care?

“It requires a lot of persistence and tenacity,” Ho said. “For the entire public to buy into that is going to be a struggle, but one we must take on.”