The COVID-19 Pandemic is repeating history as in 1918 and other catastrophes. Maybe this will be a wake-up call to governments to listen to their health departments, to prepare for the future. Obviously, no one had prepared properly, even the largest most wealthy governments. This was all totally predictable, as I have been describing repeatedly in my comments, based upon history with previous pandemics, and notably the 1918 flu pandemic. The scenario is following the same format as has been done many times, it has been totally predictable, as I have been documenting for the past 6 months, and is predictable for the future. Human society needs to prepared better for the next time we have a pandemic, because it will happen again. Also, I think we are lucky in a way this time, as the mortality rate is only about 5%, but think about the next time, perhaps it will hit young people harder, or think about what happens if Ebola virus becomes airborne at 95% mortality. Obviously, this time no one was prepared, but the species will survive until the next hit. Everyone needs to wake up, and get better prepared. Thank you and stay safe. Gary Ordog, MD July 15, 2020.
July 15, 2020: Okay we are now at the point between Stage Two and Three "Reopening" from quarantines and isolations, with the use of PPE and social distancing in place, and Phase Two beginning as per the 1918 daily death rate curve. I note at this time that the above measures did work in New York and elsewhere to lower the death curve on Phase One. This prevented natural herd-immunity being achieved in Phase One, but only to flatten and prolong the curve out over time, there is yet to be a "cure" or a good vaccine distributed. Thus, we are following the scenario of the death curve of the 1918 flu Pandemic repeated here in 2020 COVID-19 Pandemic. See attached mark-up graph with my labels to show the various points mentioned above. Thank you and stay safe, Gary Ordog, MD.
Yes obviously we need to be better prepared for such disastrous vitiations. We are evolving and so do microorganisms. Like we have disaster management task forces in many countries, in the same way we should have health calamity task forces for better tackling of the health disasters. In most of the countries they spend a trivial part of their GDP on health services and that too are managed by the bureaucrats who have no experience of the health field. It needs to be stalled and better preventive modes needs to be installed for future. Till than enjoy the slumber of ignorance and apathy of ........
Yes; we need to be prepared for such disastrous situations, well before the situation arises.
I agree with you Gary Joseph Ordog We now have more resources and knowledge than in January-February 2020.
In Germay about 8 years ago a study was done and published about the next SARS-pandemic that would most likely emerge in Asia.
What all stakeholders and hospitals and homes of the elderly must do (in theory and practice). It was published and still is available online...
The problem is: precautionary measures were not followed or done (e.g. nobody thought of buying N95 masks or equip the homes of the eldery)...
What must be learned: disaster preparedness is for real and not for papers only. Do not only research but in reality be prepared... Thank you.
Germany's risk analysis study was called:
„Pandemie durch Virus Modi-SARS“
Germany's federal Parliament (Deutscher Bundestag) Is reporting here about the 2012 risk analyis which must be bought, see
https://dipbt.bundestag.de/dip21/btd/17/120/1712051.pdf
Absolutely, I hope governments and health departments the world over are listening.
September 26, 2020: Ordog's Summary and Comments on: September 22/29, 2020
The COVID-19 Pandemic and the JAMA Network
by: Michael Berkwits, MD, MSCE; Annette Flanagin, RN, MA; Howard Bauchner, MD1; Phil B. Fontanarosa, MD, MBA
in: JAMA. 2020;324(12):1159-1160. doi:10.1001/jama.2020.18298
The following are some of the concerns noted in todays edition of JAMA Covid-19 edition. These include multiple organ injury and debility that result from COVID-19 infections. As I have noted before, up to 97% of patients who have recovered and survived a COVID-19 infection have been left with at least some of the following sequelae, and this is of major concern. As the conclusion of the editors' written article, "No single event since the end of the Cold War has so affected the lives of virtually every person living in every country of the world." (Comments by Gary Ordog, MD)
These are the most prominent of the currently recognized COVID-19 concerns:
1. Benefits and harms of treatments and identifying mortality risk markers beyond age and comorbidities
2. Cardiovascular consequences of COVID-19 infection, including risks to those with comorbid hypertension and risks for myocardial injury
3. Risk for direct central nervous system invasion and COVID-19 encephalitis and for long-term neuropsychiatric manifestations in a post–COVID-19 syndrome
4. Risks related to SARS-CoV-2 infection for patients with compromised immunity, such as those receiving treatment for cancer
5. Challenges unique to patients with acute kidney injury and chronic kidney disease
6. Risks of viral transmission from aerosol-generating procedures, including most minimally invasive surgeries, and the need for eye protection as well as personal protective equipment as part of universal precautions
7. The prevalence and pathophysiology of skin findings in patients with COVID-19, determining if they are primary or secondary cutaneous manifestations of infection, and how best to manage them
8. The prevalence and significance of eye findings in patients with COVID-19 and the risk of transmission and infection through ocular surfaces
9. The role of anticoagulation for managing the endotheliopathy and coagulopathy characteristic of the infection in some patients
10. Developmental effects on children of the loss of family routines, finances, older loved ones, school and education, and social-based activities and milestone events
11. Effects of the pandemic, mitigation efforts, and economic downturn on the mental health of patients and frontline clinicians
12. Seasonality of transmission as the pandemic enters its third season
13. How to implement reliable seroprevalence surveys to document progression of the pandemic and effects of public health measures
14. Effects of the pandemic on access to care and the rise of telehealth
15. Consequences of COVID-19 for clinical capabilities, such as workforce availability in several specialties, delays in performing procedures and operations, and implications for medical education and resident recruitment.
16. Additional important questions that require careful observation and research include
17. Randomized evaluations of treatment: what is effective and safe, and what timing of which drug will reduce morbidity and mortality? Will a combination of therapies be more effective than any single drug?
18. Randomized evaluations of preventive interventions, including convalescent plasma, monoclonal antibodies, and vaccines. Which are effective and safe enough to prevent COVID-19 at a population level?
19. How can COVID-19 vaccines and therapeutics be distributed and paid for in ways that are fair and equitable?
20. Is immunity complete or partial, permanent or temporary, what is its mechanism, and how best is it measured? Can the virus mutate around host defenses?
21. How important are preadolescent children to the spread of infection to older family members and adult communities, and what are the implications for parent, caregiver, and teacher personal risk and disease transmission?
22. Is SARS-CoV-2 like influenza (continually circulating without or with seasonality), measles (transmissible but containable beneath threshold limits), or smallpox and polio (eradicable, or nearly so)?
23. Has the pandemic fundamentally altered the way health care is financed and delivered? By shining a spotlight on health inequities, can the pandemic motivate changes in health care finance, organization, and delivery to reduce those inequities?
24. The public’s health is threatened by sophisticated campaigns churning disinformation into social media and other platforms as part of what the World Health Organization is calling an infodemic.15 Careful, deliberative science is at a disadvantage in today’s instantly networked information economy, validating the classic saying (misattributed to Mark Twain) that “lies travel halfway around the world while the truth is still putting on its shoes.” As a matter of health and potentially national security, health agencies, public health authorities, elected leaders, news organizations, and editors and publishers all need to find strategies to counter the disinformation.15-17 The health of the global population depends on this effort.
25. The pandemic has exposed vulnerabilities in public and private health systems, with the costs to health and lives borne by the least fortunate.
26. The national US pandemic response has been halting and fragmented. Just as airport security has not and would never be ceded to individual states, health security for the country cannot come from states acting alone without coordination to manage regional infectious disease outbreaks. A restored and strengthened US Centers for Disease Control and Prevention—better funded and structurally protected from political influence—could provide the public health leadership necessary to manage future similar outbreaks and protect the US population.23
References:
1. Paules CI, Marston HD, Fauci AS. Coronavirus infections: more than just the common cold. JAMA. 2020;323(8):707-708. doi:10.1001/jama.2020.0757
2. Bonow RO, O’Gara PT, Yancy CW. Cardiology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15088
3. Shinkai K, Bruckner AL. Dermatology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15276
4. Redberg RF, Katz M, Steinbrook R. Internal medicine and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15145
5. Winkelmayer WC, Khairallah P, Charytan DM. Nephrology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.16779
6. Josephson SA, Kamel H. Neurology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.14254
7. Disis ML. Oncology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.16945
8. Bressler NM. Ophthalmology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.17595
9. Piccirillo JF. Otolaryngology–head and neck surgery and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15779
10. Christakis DA. Pediatrics and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.14297
11. Öngür D, Perlis R, Goff D. Psychiatry and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.14294
12. Kibbe MR. Surgery and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15191
13. Rivara FP, Fihn SD, Perencevich EN. JAMA Network Open and COVID-19. JAMA. Published online September 22, 2020 doi:10.1001/jama.2020.15194
14. Ayanian JZ. JAMA Health Forum and COVID-19. JAMA. Published September 22, 2020. doi:10.1001/jama.2020.18432
15. World Health Organization. WHO ad-hoc online consultation on managing the COVID-19 infodemic. Accessed August 27, 2020. https://www.who.int/teams/risk-communication/infodemic-management/who-ad-hoc-online-consultation-on-managing-the-covid-19-infodemic
16. Tangcharoensathien V, Calleja N, Nguyen T, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22(6):e19659. doi:10.2196/19659
17. Eysenbach G. How to fight an infodemic: the four pillars of infodemic management. J Med Internet Res. 2020;22(6):e21820. doi:10.2196/21820
18. Fuchs VR. Is single payer the answer for the US health care system? JAMA. 2018;319(1):15-16. doi:10.1001/jama.2017.18739
19. Naylor CD. Canada as single-payer exemplar for universal health care in the United States: a borderline option. JAMA. 2018;319(1):17-18. doi:10.1001/jama.2017.19668
20. Fuchs VR. How to make US health care more equitable and less costly: begin by replacing employment-based insurance. JAMA. 2018;320(20):2071-2072. doi:10.1001/jama.2018.16475
21. Fuchs VR. Health care policy after the COVID-19 pandemic. JAMA. 2020;324(3):233-234. doi:10.1001/jama.2020.10777
22. Bauchner H, Fontanarosa PB. Health care is a right and not a privilege. JAMA. 2020;323(11):1049. doi:10.1001/jama.2020.0891
23. Gostin LO, Cohen IG, Koplan JP. Universal masking in the United States: the role of mandates, health education, and the CDC. JAMA. Published online August 10, 2020. doi:10.1001/jama.2020.15271
The summary above are some of the concerns noted in todays edition of JAMA Covid-19 edition. These include multiple organ injury and debility that result from COVID-19 infections. As I have noted before, up to 97% of patients who have recovered and survived a COVID-19 infection have been left with at least some of the following sequelae, and this is of major concern. As the conclusion of the editors' written article, "No single event since the end of the Cold War has so affected the lives of virtually every person living in every country of the world." How true! (Comments and further editorializing by by Gary Ordog, MD; County of Los Angeles, Department of Health Services, Physician Specialist, with roles of Residency and Research Director, Interim Vice-Chairman, Department of Emergency Medicine, King/Drew/UCLA Medical Center(retired)). September 26, 2020: Please add your thoughts to the current list condensed from JAMA:
Thank you, Gary Ordog, MD
We need to not only prepare with regrads to health care but also prepare the next generation for better human values. human values will work at all levels, we will be more sensitive about our choices of treatment with other species and also towards our own. less interest in biological warfare and if unfortunately we fail level one then atleast if a pandemic does happen , people need to care about other humans by obeying social distancing , caring for prone population.
At least if we can solve the basic problems, lets not go through this again, see photo of the news.
It still is. The vaccine, now ready, cannot even be distributed efficiently! Phase 2 of the death curve is getting worse than ever. Rioting (the invasion of the US Capital Building last week, without masks) with another ?million? mostly unmasked protesters outside, will not help defeat this virus. I really thought that the big problem was producing the vaccine, not distributing it, that should be the easy part! Good grief!
pandemic is a wake up call for humans to introspect about the direction humanity is taking. we need to prepare for pandemics and simultaneously we need to look into the cause of such pandemics..over exploitation of resources, degrading human values, race for weapons and new territories , misusing science are some of the things that need to be explored. we need to prepare next generation for more humane inclusive society that respects all living beings.
"As of January 2021, more than 400 000 people in the US will have died from COVID-19, with no definite end in sight to the tragic number of new cases and deaths. It is a national disgrace that with only 4% of the world’s population, the US accounts for nearly 20% of all COVID-19 deaths. There is a disturbing disconnect between the heroic efforts of physicians, nurses, and other health care professionals to save lives, and the practical difficulties of mobilizing widespread political and public support for common-sense actions to prevent new cases and deaths. The pandemic has made glaringly clear the risks to the nation of an inadequate public health infrastructure that would be incapable of mounting a speedy and well-coordinated national response to the next pandemic."
Moving Patient Care Forward in the Biden Era
Robert Steinbrook, MD; Mitchell H. Katz, MD; Rita F. Redberg, MD, MSc
JAMA Intern Med. January 19, 2021. doi:10.1001/jamainternmed.2021.0050
COVID-19 forecasts: deaths. Centers for Disease Control and Prevention. Updated December 28, 2020. Accessed December 31, 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html
Wright L. The plague year. The New Yorker. January 2, 2021. Accessed January 4, 2021. https://www.newyorker.com/magazine/2021/01/04/the-plague-year
Redberg RF, Katz M, Steinbrook R. Internal medicine and COVID-19. JAMA. 2020;324(12):1135-1136. doi:10.1001/jama.2020.15145
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Published January 23, 2021 in ResearchGate Commentary and Questions, by Gary Ordog, MD.
This article in todays JAMA exemplifies how a country can spend the most, by far, in the world on "health care" and yet come up with the worst results, by far. Some of it has to do with lack of respect and hatred of the officials involved, but a lot has to do with the greed and corruption in the healthcare bureaucracy, letting 'less and less' of the money to trickle down to the actual healthcare providers. This is based upon personal experience, with the results summarized by the editor in today's Journal of the American Medical Association, Internal Medicine.
"As of January 2021, more than 400 000 people in the US will have died from COVID-19, with no definite end in sight to the tragic number of new cases and deaths. It is a national disgrace that with only 4% of the world’s population, the US accounts for nearly 20% of all COVID-19 deaths. There is a disturbing disconnect between the heroic efforts of physicians, nurses, and other health care professionals to save lives, and the practical difficulties of mobilizing widespread political and public support for common-sense actions to prevent new cases and deaths. The pandemic has made glaringly clear the risks to the nation of an inadequate public health infrastructure that would be incapable of mounting a speedy and well-coordinated national response to the next pandemic."
Moving Patient Care Forward in the Biden Era
Robert Steinbrook, MD; Mitchell H. Katz, MD; Rita F. Redberg, MD, MSc
JAMA Intern Med. January 19, 2021. doi:10.1001/jamainternmed.2021.0050
COVID-19 forecasts: deaths. Centers for Disease Control and Prevention. Updated December 28, 2020. Accessed December 31, 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html
Wright L. The plague year. The New Yorker. January 2, 2021. Accessed January 4, 2021. https://www.newyorker.com/magazine/2021/01/04/the-plague-year
Redberg RF, Katz M, Steinbrook R. Internal medicine and COVID-19. JAMA. 2020;324(12):1135-1136. doi:10.1001/jama.2020.15145
Happy New Year 2021. Here is the latest CDC numbers report, with the new definition of death due to COVID-19 or more specifically SARS-CoV-2:FEBRUARY 4, 2021COVID-19: Case count in US rises by close to 117,000According to CDC's update on February 3, 2021 12:26 pm ET, the case count of COVID-19 in the US stands at 26,277,125* cases, including 445,264* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. The CDC noted that this represents an increase of 116,915 cases and 3,433 deaths compared to the update on the preceding day. * As of April 14, 2020, CDC case counts and death counts include both confirmed and probable cases and deaths. This change was made to reflect an interim COVID-19 position statement issued by the Council for State and Territorial Epidemiologists on April 5, 2020. The position statement included a case definition and made COVID-19 a nationally notifiable disease.A confirmed case or death is defined by meeting confirmatory laboratory evidence for COVID-19.A probable case or death is defined by one of the following:
- Meeting clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19
- Meeting presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence
- Meeting vital records criteria with no confirmatory laboratory testing performed for COVID-19
- Stay safe it is still not good even though the vaccines have been out for 2 months, but their distribution is failing!!. As it may be another year before we all get our vaccinations, this may well portend the death of a million in the US alone by COVID-19 by then. Remember, only 10% of the US population has been shown to be infected to date. Many of those infected have already reverted back to non-immune status and can get it again. Let alone the new mutations that are re-infective too. Nasty situation getting worse. These numbers will actually approach those of 1918, by 2022, at the rate that things are going now. Poor vaccine roll-out has allowed history to repeat itself again!
- Gary Joseph Ordog, MD.
FEBRUARY 25, 2021
COVID-19: US records more than 69,000 new cases
According to CDC's update on February 24, 2021 2:44 pm ET, the case count of COVID-19 in the US stands at 28,065,327* cases, including 501,181* deaths, in 55 (50 states, Dist rict of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. The CDC noted that this represents an increase of 69,563 cases and 2,130 deaths compared to the update on the preceding day.
A historical note for the record, a half million COVID-19 deaths in the US, and over three months from the development of not one but numerous vaccines for it. This needs to be heavily reviewed so the next pandemic doesn't end up like this catastrophe. Thank you.
This is amazing:
The CDC is giving advice on preparing for a zombie apocalypse. Here's why experts applaud the move.
Korin MillerWed., March 3, 2021, 2:26 p.m.·4 min read
Back in the 16th century, French astrologer Nostradamus predicted that there would be a zombie apocalypse in the year 2021. And now that it's actually 2021, the Centers for Disease Control and Prevention want to make sure you’re prepared…just in case.
The CDC recently updated the Zombie Preparedness section on its website — yes, this is a thing. While the section isn’t new — it originally launched back in 2011 — it does make for interesting timing given that it's been updated in the middle of a global pandemic that just so happens to be happening in the year of a predicted zombie apocalypse.
The CDC makes it clear online that this is a joke, albeit one with a serious message about the importance of disaster preparedness. "Wonder why zombies, zombie apocalypse, and zombie preparedness continue to live or walk dead on a CDC web site?" the landing page reads. "As it turns out, what first began as a tongue-in-cheek campaign to engage new audiences with preparedness messages has proven to be a very effective platform. We continue to reach and engage a wide variety of audiences on all hazards preparedness via 'zombie preparedness.'"
The CDC offers up lesson plans for teachers on zombie apocalypse preparedness, a downloadable poster that reads, "Get a Kit. Make a Plan. Be Prepared," next to a zombie’s face, and general information about disaster preparedness.
In one related but non-zombie section on preparedness, the CDC talks about the importance of having certain tools at home, like food, water and medical supplies to last for at least 72 hours, backup power sources, medical records and an emergency supply of prescription medicine.
But the CDC also ties advice back to zombies with a blog post that lists out exactly what you need to have stashed at home, in case of a zombie apocalypse — that could also help in the event of other disasters. In addition to one gallon of water per person per day, the CDC recommends having first-aid supplies available, noting, "although you’re a goner if a zombie bites you, you can use these supplies to treat basic cuts and lacerations that you might get during a tornado or hurricane."
The CDC did not respond to Yahoo Life's request for comment.
Disaster preparedness experts and doctors seem to think the campaign is pretty smart.
"I think it’s great," John Sellick, a professor in the Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, tells Yahoo Life. "As we've seen with coronavirus, disaster preparedness is crucial."
FEMA-certified natural disaster preparedness instructor Cheryl Nelson, founder of Prepare with Cher, agrees. "I think this is brilliant," she tells Yahoo Life. "It is definitely an attention-getter and it makes preparing fun. The more creative ways we can get the preparedness message out, the better."
The CDC is simply "trying to make disaster preparedness relatable to different populations," Mitchel A. Rosen, an associate professor in the Department of Urban and Global Public Health at the Rutgers School of Public Health, tells Yahoo Life. And, he says, framing the topic around a zombie apocalypse "makes it fun to learn about disaster preparedness."
Lee Clarke, a sociology professor at Rutgers, The State University of New Jersey, tells Yahoo Life that, while zombie preparedness can seem "trite, trivial and amusing on the surface" he points out that "all the messages are there." "They just substitute 'zombie' for 'flood' or 'hurricane,'" he says. "Zombies are just more interesting, and it draws people in."
While the packaging is quirky, Sellick points out that the underlying message — to be prepared for the unexpected — is important, and incredibly relevant right now. "Bottled water, flour, disinfectant spray, toilet paper…a year ago, it didn’t matter how much money you had. You couldn’t get your hands on certain things," he says. "Having a stockpile at home could have helped carry some of us through. Clearly, most of us did not have adequate supplies of things."
Plenty of people have joked about a zombie apocalypse happening, but "2020 made something like that not seem so impossible anymore," Nelson says, adding, "It creates the mindset, 'Well, gosh. If a global pandemic happened, what's next — zombies?! Maybe I should prepare.'"
Even though the zombie apocalypse is unlikely to actually happen, Nelson says families should consider their own disaster preparedness plan. "Did you ever think a global pandemic would happen in our lifetime? Don’t you wish you had had a disaster prep kit with items like hand sanitizer, wipes, masks and the ever-so-necessary toilet paper when the pandemic hit?" she says. "Take a time out and prepare now. If you don’t want to prepare for yourself, prepare for your loved ones. Do it for them. They'll be thankful you did."
Today in JAMA, they agree with me:
The JAMA Forum
March 16, 2021
2020 Revealed How Poorly the US Was Prepared for COVID-19—and Future Pandemics
Gail R. Wilensky, PhD1
Author Affiliations Article Information
- 1Project HOPE, Bethesda, Maryland
JAMA. 2021;325(11):1029-1030. doi:10.1001/jama.2021.1046
It was not obvious when 2020 began what a grim year it would turn out to be. The first reported US case of coronavirus disease 2019 (COVID-19) was on January 19, 2020, in a man who had returned from Wuhan, China, 4 days earlier. The next day, the US Centers for Disease Control and Prevention started screening at 3 major airports hosting international travelers (John F. Kennedy International Airport, Los Angeles International Airport, and San Francisco International Airport). The first cases that were not related to travel were confirmed on February 26 and 28, 2020, signaling that COVID-19 was not limited to cases being “imported” by travelers from China and was thus much more of a threat to the US.
By the time 2020 ended, the number of cases and deaths in the US totaled more than 20 million cases of COVID-19 and more than 346 000 deaths. The surge in cases and deaths continued in January 2021 as a result of holiday travel for Christmas and New Year’s that health officials repeatedly warned against.
Of course, COVID-19 has also destroyed what had been an economy that had reached a half-century low unemployment rate—3.5%—in February 2020. By April 2020, the unemployment rate was 14.7%, with 20.5 million people having lost their jobs and more than 20% of the labor force filing for unemployment benefits. Although the unemployment rate started to decline by May, the damage was still substantial going into the summer, with 15 million fewer jobs in June than had existed in February. The decline in the unemployment rate continued, reaching 7.9% in September and stabilizing at 6.7% for November and December.
However, the stability in the overall unemployment rate late in the year masked the very different experiences of men and women in both labor force participation and unemployment. Women lost more than 5 million jobs in 2020, and 2.1 million women have left the workforce since the pandemic started, which means they are no longer even counted among the unemployed. Many of these women needed to leave their jobs because they have primary caregiver roles in families, a role exacerbated by the closure of so many schools.
December’s economic numbers clearly reflect the disproportionate harm that the pandemic has had on working women. The US workforce lost 140 000 jobs in December, but this number reflects a loss of 156 000 jobs for women, with a net gain of 16 000 jobs for men—meaning that job losses for women accounted for all of the increase in employment occurring in December. This differential response does not always happen during recessions. Frequently, recessions occur in male-dominated industries. This time, however, the decline in the demand for workers occurred primarily in female-dominated businesses, such as restaurants, retail, and hospitality.
Although the explosive growth in cases and deaths has been the cause of so much pain in the country, some important positive developments have also occurred during this period, the most obvious example being the unprecedented speed in producing 2 vaccines from Pfizer-BioNTech and Moderna that meet standards of the US Food and Drug Administration (FDA), even if only on an Emergency Use Authorization (EUA) basis. The FDA used EUA as a yardstick in the absence of approved and available alternatives and in cases where the known and potential benefits outweigh the known and potential risks. Treatments for COVID-19 have also improved over the course of 2020.
On the other hand, the distribution of vaccines has had a bumpy start, although the reasons why it has been so challenging for some states is not clear. States had been invited to submit plans for vaccine distribution in September and given a mid-October deadline. Historically, the preservation of public health has been primarily the responsibility of state and local governments, with the authority deriving from the state’s general police powers. The problem with setting up the distribution plans and sites for COVID-19 vaccination may be more a problem of states not having been given adequate resources during the pandemic and the economic slowdown that followed as opposed to their not being accustomed to having this responsibility. In fact, having the states determine the distribution may have provided an important level of flexibility on how the distribution occurs. Because the 2 vaccines that have been authorized each require 2 doses, the amount needed to vaccinate a given population size is double what it would otherwise be. These vaccines also need to be transported and stored at different and specific temperatures, which complicates their distribution.
Another positive development is the Biden administration’s plan to reestablish a senior position on global health at the National Security Council, a position that the Trump administration notoriously eliminated in 2018, moving its responsibilities to the US Department of Health and Human Services. What is less known is that since the early 1990s, this office has been repeatedly established after a national health scare and then disbanded by the successor administration, as had happened in 2018.
The past year’s experience in dealing with COVID-19 points to other measures that should be addressed, including rethinking the stockpiling of supplies and their deployment with an eye toward future pandemics, as well as developing strategies for providing surge capacity for medical facilities and trained personnel. Epidemiological findings that provide data regarding populations that are most vulnerable to a new disease threat should help drive policy regarding where vital resources should be directed. Better strategies are needed (as has been demonstrated by the resistance of many in the US to wear masks and physical distance, which are key measures for curbing COVID-19 spread) to encourage individuals to perceive the behaviors as important contributions needed to bring COVID-19 and future outbreaks under control.
Attempting to understand the positive as well as the negative experiences associated thus far with the COVID-19 pandemic is essential because disease threats are likely to be part of the country’s future and as serious to the country’s security as threats from traditional enemies. It is crucial that President Biden and his closest advisers address this challenge.
Thank you and stay safe, Gary Joseph Ordog, MD March16, 2021.
March 20, 2021: Today in JAMA:
The JAMA Forum
March 16, 2021
2020 Revealed How Poorly the US Was Prepared for COVID-19—and Future Pandemics
Gail R. Wilensky, PhD1
Author Affiliations Article Information
- 1Project HOPE, Bethesda, Maryland
JAMA. 2021;325(11):1029-1030. doi:10.1001/jama.2021.1046
COVID-19 Resource Center
It was not obvious when 2020 began what a grim year it would turn out to be. The first reported US case of coronavirus disease 2019 (COVID-19) was on January 19, 2020, in a man who had returned from Wuhan, China, 4 days earlier. The next day, the US Centers for Disease Control and Prevention started screening at 3 major airports hosting international travelers (John F. Kennedy International Airport, Los Angeles International Airport, and San Francisco International Airport). The first cases that were not related to travel were confirmed on February 26 and 28, 2020, signaling that COVID-19 was not limited to cases being “imported” by travelers from China and was thus much more of a threat to the US.
By the time 2020 ended, the number of cases and deaths in the US totaled more than 20 million cases of COVID-19 and more than 346 000 deaths. The surge in cases and deaths continued in January 2021 as a result of holiday travel for Christmas and New Year’s that health officials repeatedly warned against.
Of course, COVID-19 has also destroyed what had been an economy that had reached a half-century low unemployment rate—3.5%—in February 2020. By April 2020, the unemployment rate was 14.7%, with 20.5 million people having lost their jobs and more than 20% of the labor force filing for unemployment benefits. Although the unemployment rate started to decline by May, the damage was still substantial going into the summer, with 15 million fewer jobs in June than had existed in February. The decline in the unemployment rate continued, reaching 7.9% in September and stabilizing at 6.7% for November and December.
However, the stability in the overall unemployment rate late in the year masked the very different experiences of men and women in both labor force participation and unemployment. Women lost more than 5 million jobs in 2020, and 2.1 million women have left the workforce since the pandemic started, which means they are no longer even counted among the unemployed. Many of these women needed to leave their jobs because they have primary caregiver roles in families, a role exacerbated by the closure of so many schools.
December’s economic numbers clearly reflect the disproportionate harm that the pandemic has had on working women. The US workforce lost 140 000 jobs in December, but this number reflects a loss of 156 000 jobs for women, with a net gain of 16 000 jobs for men—meaning that job losses for women accounted for all of the increase in employment occurring in December. This differential response does not always happen during recessions. Frequently, recessions occur in male-dominated industries. This time, however, the decline in the demand for workers occurred primarily in female-dominated businesses, such as restaurants, retail, and hospitality.
Although the explosive growth in cases and deaths has been the cause of so much pain in the country, some important positive developments have also occurred during this period, the most obvious example being the unprecedented speed in producing 2 vaccines from Pfizer-BioNTech and Moderna that meet standards of the US Food and Drug Administration (FDA), even if only on an Emergency Use Authorization (EUA) basis. The FDA used EUA as a yardstick in the absence of approved and available alternatives and in cases where the known and potential benefits outweigh the known and potential risks. Treatments for COVID-19 have also improved over the course of 2020.
On the other hand, the distribution of vaccines has had a bumpy start, although the reasons why it has been so challenging for some states is not clear. States had been invited to submit plans for vaccine distribution in September and given a mid-October deadline. Historically, the preservation of public health has been primarily the responsibility of state and local governments, with the authority deriving from the state’s general police powers. The problem with setting up the distribution plans and sites for COVID-19 vaccination may be more a problem of states not having been given adequate resources during the pandemic and the economic slowdown that followed as opposed to their not being accustomed to having this responsibility. In fact, having the states determine the distribution may have provided an important level of flexibility on how the distribution occurs. Because the 2 vaccines that have been authorized each require 2 doses, the amount needed to vaccinate a given population size is double what it would otherwise be. These vaccines also need to be transported and stored at different and specific temperatures, which complicates their distribution.
Another positive development is the Biden administration’s plan to reestablish a senior position on global health at the National Security Council, a position that the Trump administration notoriously eliminated in 2018, moving its responsibilities to the US Department of Health and Human Services. What is less known is that since the early 1990s, this office has been repeatedly established after a national health scare and then disbanded by the successor administration, as had happened in 2018.
The past year’s experience in dealing with COVID-19 points to other measures that should be addressed, including rethinking the stockpiling of supplies and their deployment with an eye toward future pandemics, as well as developing strategies for providing surge capacity for medical facilities and trained personnel. Epidemiological findings that provide data regarding populations that are most vulnerable to a new disease threat should help drive policy regarding where vital resources should be directed. Better strategies are needed (as has been demonstrated by the resistance of many in the US to wear masks and physical distance, which are key measures for curbing COVID-19 spread) to encourage individuals to perceive the behaviors as important contributions needed to bring COVID-19 and future outbreaks under control.
Attempting to understand the positive as well as the negative experiences associated thus far with the COVID-19 pandemic is essential because disease threats are likely to be part of the country’s future and as serious to the country’s security as threats from traditional enemies. It is crucial that President Biden and his closest advisers address this challenge.
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Corresponding Author: Gail R. Wilensky, PhD, Project HOPE, 7500 Old Georgetown Rd, Ste 600, Bethesda, MD 20814 ([email protected]).
Conflict of Interest Disclosures: Dr Wilensky reported being on the board of directors of United HealthGroup, Quest Diagnostics, and ViewRay.
Previous Publication: This article was previously published in JAMA Health Forum at jamahealthforum.com.
Despite the acute challenges that the pandemic has thrown our way, we must now take this opportunity to rebuild in a more age-inclusive manner. Reforming long-term care systems to ensure ageing with dignity, and decent work for those involved in long-term care must be at the heart of these efforts.