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Never Again

Our country and the world should never again suffer this kind of damage and disruption from a new disease.

We know enough science and we have more than enough computer capability and data sharing capacity to identify any similar risks to us in the future as soon as they arise and to do exactly what we need to do relatively quickly to turn each new risk into a manageable experience for the world instead of doing the massive damage to us all that COVID-19 is doing today.

We have the science and the knowledge to do that work. We need to apply that science and knowledge systematically, competently and very intentionally at every relevant point in the future to keep this mess from ever happening again.

Threats will happen. We will be at risk again.

We absolutely will have new threats that could, can, will and would take us to the exact mess we are facing today if we do not respond appropriately when they happen.

Our biological reality for us as a species living on a complex planet is that new threats will constantly and periodically arise. That is inevitable. But they should never do this kind of damage again.

We need to learn from this disastrous experience and we need to be constantly on alert for the emergence of those threats. We need to be continuously aware as a country and across the planet through various sets of tools and processes to be an anchor for that detection, discernment, and rapid response process for each new threat.

We need to use all of the tools that we now have at our disposal to detect each threat immediately and then to react appropriately and effectively to each threat.

Local caregivers clearly need to be a key part of the detection team for some settings.

We need to react immediately and well when caregivers in any site tell us that damaging new diseases are emerging in their sites of care. For obvious logistical reasons, local caregivers can be our first level and earliest warning for each new threat, and we should never fail to hear their warnings again.

We also need to do constant computer-based surveillance for those threats as well through multiple streams of available data. We now have a wide range of monitoring and tracking devises — and we should use the new sets of regional monitoring tools that have been set up in response to the COVID Epidemic as a permanent core component of our full long-term protection and prevention process.

We need to have that data coming together in central utilities that we can use to track and analyze each situation and disease. Artificial Intelligence can and should help with that process.

We have extremely capable new artificial intelligence tools that can be used in very effective ways to both help us discern the emergence of a threat and then help us change the trajectories in positive ways for each new disease.

We should keep all of that data flow that we have created for COVID in place and use it both to finish and perfect our response to this pandemic and to forestall the next one from beginning.

We need to very intentionally and deliberately create the data flow needed to give us the information flow that we need to make that process work, and then the new artificial intelligence processes we now have in our tool kits can use that information to look in depth for both possible threats and immediate responses across the planet.

We should make scanning a core competence of our disease resistance teams.

We should build and maintain in place systems and constantly activated scanning levels of artificial intelligence computer functionality that will help us both immediately detect threats and almost immediately come up with the right set of containment capabilities that will allow us to deal directly with each new threat as it occurs.

We will need constantly activated potential warning systems from local care sites and from our entire flow of relevant data on the internet about any potential concerns or risks.

We should put an array of data gathering and data analysis tools in place immediately because it is very likely that will need the detection tools again and we should never be surprised again when those kinds of threats happen.

It is clearly inevitable that new deadly diseases of various kinds will either evolve on their own or will cross over from animals to humans with undesirable, but highly predictable regularity. We need to be prepared to respond immediately and effectively to the new disease each time that happens.

This is an important opportunity for international cooperation and for mutual support. We need each other to get this right.

We need a multi-national plan and approach to address these issues and threats, and we need a very explicit and focused American component of that plan that will respond most effectively to the diseases when they cross into our people.

The COVID-19 disaster has taught us that painfully and well that these diseases are not issues that can be or should be dealt with in each separate nation or setting where they originate and it has also taught us that when we know that a disease is on the way, we, as a nation, should become extremely competent at an extremely direct, functional, and logistical level in preparing our response.

We should also immediately create and implement the kind of data flow between countries that will allow each dangerous and deadly new disease to be detected very quickly and then receive the attention and reaction that we need it to have in each new setting to minimize the damage that it ultimately does to us all if it escapes those settings.

We need to make an international commitment now to keep new diseases from damaging people in every country. We need to put in place a couple of basic scanning and response tools across the planet to turn that commitment into an ongoing success for us all, and we need to take the lead as a nation to make sure the world uses those tools well when they are needed, because the only nation we can absolutely count on to do some parts of that process well is us.

Our overall science and knowledge has never been better in key areas relative to those kinds of diseases.

We can now do rapid DNA analysis to help us to define each new disease much more quickly. That analysis can both help us figure out immediate responses and give us a head start on developing vaccines to prevent recurrences when vaccines need to be part of the tool kit over time for the disease.

We need to have to have that DNA analysis capability be sustained and we need to have it be instantly available to us whenever we need to use it.

For the longer-term responses, we also need to have our vaccine production capabilities ready to respond if the strategy we need for each disease is anchored on vaccinations. That capability isn’t automatically available for these issues — and we need to have that availability built into our overall response strategy for new Diseases.

Having that capability in place is now possible to do, because we now have extremely good new science and functional capability in that space and because we have to do something similar now each year for the Flu and we do that well.

We can figure out funding flows to have that production capacity ready to respond and be available as needed when it is needed.

At the most immediate level, we need actual care teams with sufficient supplies and with the equipment needed to take care of our patients when that care is needed.

We did that part of the response very badly for COVID-19. We should have figured out immediately what kinds of equipment and supplies would be needed — and we should then have taken whatever steps were needed to make them available.

Our basic production capabilities for materials and equipment are almost infinite in all of those areas — but the potentially infinite capability isn’t relevant or even useful if no one calls for the equipment to be produced and then put in place for patient care. We need that production capability to be activated as soon as our response team looking at the new disease figures out that it will be needed.

Our care delivery system in going through some significant changes at this point in medical history, with an increasing amount of care being delivered electronically through various care sites. The trends in that direction that are happening today toward growth in the remote electronic delivery of care are being accelerated by the distancing requirements for patients that have been created now in our country by the virus.

Care Systems

Care systems in America that did almost no electronic care before COVID-19 have now learned to do some levels of that care to stay linked to their patients. The large and more integrated care systems in our country that were approaching having half or more of their care for some conditions done electronically before COVID-19 are now getting close to 80 percent of the care done over the computer or telephone.

That trend will continue when the crisis is over. COVID-19 has made a permanent change in some areas of care delivery. Care sites will continue to deliver increasing levels of care through the internet and phone lines. We will never return to the old approach of having every piece of care being delivered in physical places of care.

The other major trend that will continue after COVID-19 is to have more levels of care done in surgery centers or in other remote care sites instead of in traditional hospitals.

Hub and Spoke care teams and linked care delivery approaches will continue to be a major care trend after the disease is fully controlled. That will change the nature of hospitals to some degree. Only the patients who need the most hands-on levels of intense care will be in the hospitals in many settings. At a macro level, that trend will ultimately require significantly fewer in-patient hospital beds needed and in place for American patients.

Many hospitals who will be recovering from the massive financial damage done by the disease disruption of their cash flow and their business processes will redesign care in a number of ways to recover from the damage and many hospitals will build a new business model for their care.

That trend is not inherently a problem. It will even improve some levels of care for some American patients.

But that highly likely change in local hospital infrastructure and facility use could be a source of major problems in the future when we have another COVID type of virus epidemic and when we need large numbers of patients to receive very high intensity care — involving respirators and other kinds of intensive care equipment that can only be delivered in person and on site for each patient, and when we have a shrinking number of those sites in our hospital settings.

That means, as part of our planning for our future epidemic response care needs, we need to build in a potential set of care sites to be made available as needed for those purposes.

We need to create an intersection between those trends and we need to both build and identify some number of sites that can be equipped and run as targeted intensive care units for the epidemic patients in the time of greatest need for each community for those units.

We need to plan our health care infrastructure to be able to respond in flexible ways when we need intensive care settings in large numbers for damaged people

We need to build that kind of thinking into our health care infrastructure planning processes. That trend will continue — but we need to face the reality that deadly new diseases could create a major need to on site intensive care and we need to design our care sites going forward to have conversion capability built into their design.

Those are longer term considerations triggered by COVID-19. We should set up our long-term response plan to include thinking about all of those issues, challenges, and opportunities.

Our most immediate need in that process will be to put systems and processes in place that will tell us immediately when the next threat is happening. We need to know very quickly that the next new disease is happening so that we can respond most effectively at every level.

The Top Priority Is Immediate Detection

The first line of defense for this entire agenda needs to be immediate detection of each new threat. That is a basic and practical response and approach. We need to constantly scan for the emergence of each threat and we need to respond very quickly to each threat as it is detected.

Computers can help with that process immediately in ways that were not possible until fairly recently. We are evolving in care sites across the planet to have some level of computer support at the point of care — to at least create a record of the care being delivered on that site.

Those systems function today overwhelmingly and consistently in silos, with care information kept exclusively for each site in the computer tool that serves that site, and not shared with anyone off that site. That is sadly still true in most American care sites, and it is very true as well in most of the rest of the world.

It is a new development for much of the world to have care sites everywhere actually have computers that keep track of their care, but those sites do not share that data now.

The fact that those data sites now exist, however, actually creates an opportunity for disease detection and prevention that we need to use as effectively as we can use it.

The first line of defense in every setting needs to be the care teams who are taking care of people in each setting for routine care now. That front line care team can be the most important single tool we have for detecting a new disease.

Those doctors and other caregivers in each setting know the medical reality of their care sites intimately. They know their patients and they know their diseases. equally well. That is a hugely valuable resource for this process.

Those front-line caregivers everywhere can give us the first sense that they see changes that they worry about in the care needs of their populations, and they should be encouraged and taught to have a sense as caregivers that creating that awareness for the rest of us can be an important part of what they do.

That is basic rocket science.

When people in an area develop what seems to be a new disease, we need the caregivers for those patients to identify and flag that concern as soon as possible.

That kind of assessment triggered our Ebola response activation. It was extremely useful for that disease.

That same level of local caregiver assessment could also have given us a very useful early warning in Wuhan for COVID-19 if the local government in China had not, for some reason, both stopped it from happening and then penalized the caregivers who first saw the threat emerge for their patients and who reported it to the world.

Our ability to identify that particular risk and contain it to a much smaller space on the planet could have been improved immensely if we had systems in place to respond immediately to that very first caregiver warning and assess what was happening there.

We understand viruses. We understand epidemics. We know population risk factors. That is all existing science. We had enough basic knowledge to do good things for COVID-19 if we had taken full advantage of that earlier warning about that disease.

We should never make that mistake again. We should set up expectations everywhere with both caregivers and communities that those kinds of warnings are taken seriously. We need new data flows to happen from the computers that are now at almost every care site — and we need to support local doctors everywhere in detecting and reporting those kinds of issues when they happen.

That local electronic data will be increasingly important to us as an anchor for this process if we put the right tools in place. We need our computers to be looking at a constant macro level for changes in local patient disease and care patterns and letting us know that a potential problem might exist.

We need basic artificial intelligence data bases to be looking at that care data from all care sites to let us know that relevant change is happening when it happens in any setting.

We can and should very intentionally and constantly monitor the care information flow across the planet to both look for the new disease and to monitor its spread and impact.

We should be particularly looking for changes in care patterns in those areas of the world where interactions of various kinds between animals in the wild and local humans create significant risk for cross over diseases to happen and take root.

In an ideal situation — when a disease either crosses over or mutates — we should have computer data telling us immediately that is happening and we should be able to scope out both the care changes and the relevant geographic space with the highest levels of risk both immediately and continuously.

We did a lot of things right with Ebola. It was not a perfect process — but it had some very good component parts.

We listened to local caregivers.

We identified the hot spots fairly quickly. We carefully and quickly isolated both patients and care sites.

We identified best practices on care and on disease insulation and caregiver protection approaches relatively soon. We applied best care to people who needed it as soon as we figured out what best care was. We had good people working to figure that out. It took them some time to do that, but good people were on the job immediately, and they did good work.

That extremely deadly and dangerous disease had a very different spread and expansion mechanism than COVID-19 — and it was easier to isolate — but the overall approach we took to Ebola was systematic, ultimately and finally well designed, fully supported at multiple levels, and functionally very effective.

We had no Ebola deaths in the U.S.

That was not a guaranteed outcome when we started down the road to respond to that disease. The worst-case projections for Ebola were for tens of thousands of painful deaths, if we did not keep that disease from entering other communities and settings.

The basic model we built for Ebola is right.

We did not follow that model for COVID-19, but we do need to follow it for COVID-20 and for any other equivalent dire disease that occurs.

If we do not follow that model — or something very like it we will find ourselves in this same kind of horrible situation again that we have now for COVID-19, and we will have only ourselves to blame.

We are working now to survive the current epidemic. Getting through this mess to the least damaging outcome is our top priority today, and that focus needs to continue. This crisis is in full swing, and we do not know yet how it will end.

We don’t know yet what all that we will need to do now to work through this crisis because it is complex and the disease is very widely distributed to far too many people at this point in time.

Many people will die. Significant damage will happen.

It is particularly sad that we will see major economic, structural, functional, and societal damage done at a number of levels because of the impact of a disease spread that absolutely should not have happened. COVID-19 would not have spread this badly if we had responded quickly and if we had contained it quickly in the first settings where it crossed over to people and became a human disease.

That needs to be our new mantra at this point in time.

Mantra

We should say clearly to each other

1) This mess did not have to happen.

2) It should never happen again.

We have the tools, knowledge, science, capabilities, and abilities to make sure it does not happen again.

But we need to use those tools in systematic ways and we need to use them from this day forward to give them the ability to succeed and to protect us from ever going through this level of misery and damage again.

We need to do it together.

We need a best plan as a nation to deal with the remaining elements of the mess we have now.

We could change the way we buy care to make sure that we require team care, data supported care, and continuously improving care as a nation. That is possible to do — but it will require us to make some changes in the way we buy care and have us buy care by the package and not just by the piece. That proposal for enhancing the way we buy care deserves to be discussed as part of our COVID response.

We did a terrible job on setting up the logistical support processes inside our own country for COVID-19. We need to fix those logistical deficiencies as quickly as we can for this crisis — and we need to make sure they do not happen again.

We should make team care support a key part of the way we buy care as a country so that we do not have the massive confusion we have now for far too many COVID patients.

We also very clearly need to put in place simple logistical planning for each disease that allows us to predict and prepare for the care supplies that will needed for those patients who do happen — including sufficient numbers of respirators, masks, sufficient protective equipment for care givers, and sufficient quantities of whatever other supplies are needed for patients and caregivers in our care settings.

We could and should have projected all of those equipment and logistical issues earlier in the progression of this disease, but we did not have anyone in place who has that role for us as a country ready and prepared to do that work.

The right response for COVID-19 did not happen, because no one was charged with making it happen.

That deficit is easy to solve.

We need to do what was suggested at the end of the Ebola crisis as part of what we learned from that disease and we need to put a team in place to do that work for the future.

We should have a department and a team of people always in place to do that monitoring, projecting and logistical planning for us as a country, with the information created and used as needed to help as needed in each area of the country that needs their help.

If this was our very first epidemic, we could be forgiven for not having people or processes in place to deal with it.

However, it was not our first epidemic — and it won’t be our last epidemic or our last dire disease — so let’s make that investment now in that capability so that we are never surprised again when it happens again.

We know from history and we know from basic biology that it will happen again.

We all need to recognize that epidemics are a real and ongoing risk and that they are a common enemy of us all, and we all need to support each other in achieving that common enemy’s defeat.

Let’s start now by having that team assembled from the right sets of people from this crisis response team, and let’s ask them to both tell us the plans we have for

getting the rest of this epidemic handled and to be ready for the next one that happens.

We need that team in place now.

We need it for more than just building our response to the next disease. We are actually probably not going to be done with this particular pandemic, because the sad biological truth is that it simply might not go away. Even if we find a vaccine, we don’t know how long that vaccine will last.

There is a significant likelihood that this particular disease will do just like the flu, and it will mutate and change annually.

That same kind of regular mutation for COVID-19 might not happen, but it easily could — and that would require us to build vaccines that will respond to each year’s version of the disease in addition to the initial vaccine that we are working to build now.

We need to build the right response team to do that all of that work on the current pandemic to guide it to its next stages and impact levels.

We should make the commitment to ourselves to do that work on this disease and the next one as well as it can be done using our best science and our best analytical functionality to help achieve the Optimal outcomes possible for that process.

Optimal is possible for the next stage of our response.

Optimal outcomes are never accidental.

Optimal has to be created. It never happens on its own.

We need our Congress and our Administration to give us a plan and a team to do that work and to give us Optimal and continuously improving results.

We can do this.

It is all work that can be done. It is all things that we know how to do.

So.

We should do it.

This damage and dysfunctionality should never happen again.

We have only ourselves to blame if it does.