False Confidence and Our Covid-19 Failings

In 2009, President Obama declared a national emergency eleven days after the first case of swine flu was reported. Because recovery from the devastating Great Recession was the priority of the day, President Obama never shut down cities or business or schools. Republican governors and Congress fell in line quickly behind the Obama administration’s health decisions, perhaps because the most vulnerable to infection were children and those under 30 years old.  Funding decisions faced little opposition. Biologically, we got lucky. Swine flu turned out to be far less lethal than Covid-19. Although vaccines arrived late, after most infections had happened, fewer than 15,000 Americans died even as at least 60 million Americans were infected.

We had been lucky before. While in 2003 SARS resulted in the quarantine of thousands in Toronto, its effect was barely felt in the US. Other outbreaks like Ebola have barely touched our shores.

This good fortune perhaps left us with a false sense of confidence about our ability to weather pandemics. That false sense of confidence may have been disastrous in the context of Covid-19.

The Trump administration waited 53 days after the first case of Covid-19 was detected in the US to declare a national emergency. During those weeks, the president himself declared the virus “is going to disappear” like “a miracle.” The administration’s public health arm at the CDC was scared and silenced. The threat was dismissed.

Soon we were essentially in 1918 again: faced with a highly contagious, lethal virus, with no medical tools at our disposal.  We had only the tools of public health. And this time our infection surveillance, the first tool of public health, was particularly poor after decades of underinvestment in public health. This set the stage for a catastrophically bad national response, until we were saved by astonishingly effective vaccines.

This all makes us wonder: how much of our failure was due to our overconfidence, informed by recent pandemics that were not that consequential? And how much of that could have been averted by a more honest reckoning with our vulnerabilities?

Because while Covid-19 was much worse than swine flu biologically, we still got lucky with Covid-19. Mortality from Covid-19 will likely end up being around 2%, mortality from SARS is 10%, MERS 34%, and H7N9 Bird Flu more than 39%. Why do we think that these will not become pandemics in the US?


Michael Stein & Sandro Galea

As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.

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