World War III: Fighting an Invisible Enemy, the Coronavirus

The steps we must take to win this battle and save lives worldwide.

FamVeld / Shutterstock
FamVeld / Shutterstock

By Susan Blumenthal, M.D., and David Xiang

In America, over 55,000 people have died. In the world, 207,446 have perished. More people have lost their lives in the United States than in any other nation. But it’s not another country that is attacking us. We are at war with an invisible enemy: COVID-19. This is the Pearl Harbor of public health as our nation was woefully unprepared for this assault on the well-being of Americans. Years of neglect and underfunding of America’s public health infrastructure has left our nation extremely vulnerable to an infectious disease threat.

Despite major scientific advances in the 21st century, the major weapons in our country’s toolbox for battling the coronavirus outbreak when it emerged were similar to those used in 1918 to combat the Spanish flu pandemic—proven public health practices such as social distancing and good hygiene. Now, more than ever, our country’s response requires mobilization of all agencies of government in collaboration with the private sector, working with other countries in a coordinated battle to save lives.

Everyone is at risk and every state in the nation has declared COVID-19 as a disaster. The disease has overwhelmed our health care system, which currently has less than one million staffed hospital beds. The disease is also disproportionately affecting people of color who experience many other health disparities in the US including higher death rates from some illnesses as well as less access to health care. With COVID-19’s current mortality rate of 4.3% in America, as many as 100,000-240,000 people in the United States could lose their lives. To put these numbers in perspective, consider the US service member deaths from two previous wars. In Vietnam: there were 58,000 deaths. In the Korean War: 34,000 deaths. In fact, the projected death toll from COVID-19 in America could be double the number of lives lost during these two major wars combined.

The economic toll of COVID-19 is also staggering. On March 16th, the stock market fell nearly 13%, with the Dow losing 3,000 points, its largest one day drop in history. More than 22 million Americans have lost their jobs in the last four weeks. Major car companies have closed their plants in the U.S., while shopping centers and restaurants across the country have shuttered their doors. Unemployment could reach 32%, the highest rate since the Great Depression.

World War III is not being fought against foreign countries. It is being fought in our homes, workplaces and hospitals. In response to state and local mandates, 95% of Americans are now hunkering down in their homes although of great concern is that some regions are beginning to loosen these restrictions. Facemasks are in urgent demand, testing is not occurring at scale, ventilators which are crucial for keeping those severely affected by coronavirus alive are in short supply, and hand sanitizers are running out. The federal stockpile of medical supplies is almost depleted. The production of these resources is lagging behind demand for these lifesaving products. Hospitals across the country are running dangerously low on supplies such as gloves, N95 masks, and disinfectants, putting both health care workers and patients at risk. This would be like sending soldiers into war without helmets and armor.

There is much we must do to fight back, to effectively mitigate and manage the impact of COVID-19. Proven public health practices like social distancing and good hygiene are now being combined with the technological and scientific advances of the 21st century. Senators called on the President to enact both the Stafford Act, making this pandemic a national emergency as well as the Defense Production Act (DPA) of 1950, granting him the authority to repurpose manufacturing plants for the mass production of crucial medical supplies. And while the President enacted both laws, he must now fully implement the DPA by directing clothing, car and cosmetics manufacturers among other businesses to produce these crucial medical resources including personal protection equipment, diagnostic and antibody tests at massive scale, as well as ventilators to save American lives. While some private sector companies have valiantly stepped up to this challenge across the country, the need is so great that more industries must be marshaled for this purpose.

Additionally, novel methods for testing, vaccine and treatment production are urgently needed and at last are being developed and deployed. The United States has the technological expertise to lead a revolution in scientific discovery to fight this public health crisis and our universities and biotech industries are now at the forefront of this battle. A new generation of molecular biology techniques and high thru put platforms are being mobilized for large scale testing. Given this national emergency, the FDA has lifted regulations on production of these tests and given emergency approval for some of them. Rapid diagnostics have recently been produced giving results in minutes not days as well as antibody tests that let people know they have recovered. Accurate home tests for detecting disease as well as documenting recovery are essential if America’s communities are going to recover from this viral assault. The first home test was given FDA emergency approval yesterday. However, if these antibody tests are going to be used as markers for recovery and return to work, it is crucial that their effectiveness be determined by the FDA including what a positive result means about having immunity to the disease.  Contact tracing using armies of trained professionals and volunteers as well as technology is needed. Medications used to treat other diseases are now being evaluated in clinical trials for their safety and effectiveness as coronavirus therapies and new drugs must be developed as well. And as data about the clinical course of the disease is collected, we must ensure that it is analyzed for sex and racial/ethnic differences—important variables that have been overlooked for all too long—so that interventions and policies can be enacted to meet the needs of the diverse populations affected by the pandemic.

Furthermore, since this is now the third major coronavirus threat over the past twenty years following SARS and MERS that has negatively impacted the health and economies of countries around the world, we need a vaccine that can prevent transmission of a new coronavirus epidemic that may occur in the future.  Scientists should develop a universal coronavirus vaccine that could protect us from this deadly enemy in the future. The creation of a national vaccine production center in the U.S. would also be an important investment. Moreover, new information technologies and social media are being innovatively harnessed to share information, track disease spread in real-time, provide telehealth services and facilitate professional training and research collaborations across communities and countries.

Our nation’s health is linked to our economy. Last month, the Congress passed a $2 trillion economic stabilization bill. The legislation includes a Marshall Plan to help our hospitals and health care facilities, but it will require additional funding to achieve this mission. Additionally, the bill provides support for workers who need pay including those in the gig economy and independent contractors, as closures and social distancing are directly impeding their ability to make a living as well as other businesses that are being devastated by this pandemic. The Congress also passed a measure to provide billions of dollars to provide people with paid sick leave, and to ensure free coronavirus testing and treatment. Yesterday, the Senate approved a roughly $484 billion relief package with additional funds for small business, hospitals and testing.

Lastly, we must invest in building permanent pandemic preparedness infrastructure and resilient health systems in America and around the world. We urgently need a national and global plan that coordinates key components of the response between the government and private sectors.  We must continue support for the World Health Organization (WHO) that serves an important international role. The lessons learned from this devastating disease outbreak in America and worldwide must be institutionalized for the future. The establishment of a permanent office in the National Security Council in the White House with the appointment of a pandemic and bio-threat coordinator is needed who would work with all government agencies, other nations, and the private sector to ensure that our response infrastructure remains resilient and ready to address the next infectious disease pandemic that will invariably occur. Additionally,  expanding existing federal workforce programs such as AmeriCorps and FEMA CORE in order to assist vulnerable Americans—including the food-insecure, elderly, and the homeless—during this outbreak would be important and has been proposed. A National Health Response Corps of medical providers, engineers, computer scientists, construction workers, and other professionals working alongside our country’s active duty and reserve uniformed services should be established.  The US Public Health Service is creating a reserve corps whose members would also bring their skills to fighting the pandemic. Such programs reflect America’s strong history of national service by mobilizing our people as a cornerstone of a whole-of-government and societal response to addressing the COVID-19 pandemic and future threats to our nation’s public health and safety. And lastly, a Commission needs to be established as was done after 9/11 to review the problems  in our national response to this pandemic, elements that were successful, and how to accelerate modern testing, treatment and vaccine production including the policies that must be put in place for the future.

Throughout history, infectious diseases have killed more people than wars. We need a 21st century response and prevention paradigm that combines the most cutting-edge technologies for surveillance, testing, treatment and vaccine production with proven public health practices. Each one of us must fight this war working together so that someday COVID-19 is a disease found only in the history books.

Rear Admiral Susan Blumenthal Markey, M.D. (ret) is former U.S. Assistant Surgeon General, Senior Medical Advisor at amfAR, The Foundation for AIDS Research, Senior Fellow in Health Policy at New America, and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. She also serves on the Visiting Committee of the Harvard TH Chan School of Public Health and the Advisory Council of the MIT Media Lab. Admiral Blumenthal is the co-founder and  Chair of the Scientific Advisory Committee of the #BeatTheVirus education campaign. She has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her important contributions to advancing health in the United States and globally.

David Xiang, a former health-policy intern at New America, is a senior at Harvard University. He will be a first-year medical student at Harvard Medical School this fall. In 2015, he was selected as a National Student Poet, America’s highest honor for youth poets.

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