Defending himself against the increasingly indefensible handling of the coronavirus by the federal government, President Donald Trump has consistently said that “no one” could have predicted or prepared for a deadly pandemic that could strike at any time.
But the man now tasked with leading President-elect Joe Biden’s new administration saw it coming – and according to public health officials, he may be the only person with the first-hand experience to reverse it. during an unprecedented public health emergency.
“Ron Klain did something that was unprecedented in modern American history, in stark contrast to what President Trump did with COVID,” said Lawrence Gostin, director of the O’Neill Institute for National Law and Global Health at Georgetown University, at The Daily Beast. . “Klain turned a calamity into a triumph.”
Klain, newly announced as Biden’s chief of staff in the White House, is neither a doctor nor an infectious disease expert. But his actions as the leader of the US response to the Ebola outbreak in West Africa in 2014 are credited by luminaries in the field for saving hundreds of thousands of lives – and are viewed by hopeful doctors and public health experts as a potential plan to reverse the disaster that was the Trump administration’s response to COVID-19.
“The principles are: you watch the scientists, you follow the recommendations, you have a pandemic plan and you follow it,” said Dr. Arnold Monto, professor of epidemiology and global health at the University of Michigan and former advisor. at the World Health Organization. “These are the principles he followed, and this is what we need to move forward.”
With the title of Ebola Response Coordinator at the White House – which meme based mockery from those who doubted a non-doctor could lead the government’s response – Klain was the architect of a new contact tracing program that tracked all travelers entering the United States from West Africa, gave them cell phones to maintain contact, and tested their temperatures for three weeks after entering the United States.
Klain also ordered the government to provide massive training exercises to major medical centers across the country to ensure that should an Ebola case arise, these hospitals would have the knowledge to provide care without accidentally spreading the pathogen. highly contagious in the process. Before the program, only three US medical centers were trained and prepared to treat Ebola patients. In three months, nearly 50 people had been trained to do so.
Outside the US, Klain pushed the US military in Liberia into a supporting role, urging his allies to do the same – and prompting Trump, then a subdued reality TV star, to call for isolation. world of West Africa, the death toll be damned.
Public health experts say the protocols have been a huge success. Only one person has died from Ebola in the United States, and the CDC’s most dire predictions of the outbreak remained a nightmare instead of a reality
“Before the Obama administration actually engaged in West Africa, there was a calamity unfolding in West Africa that could easily have spread to North America and the world,” Gostin said. “By the time we signed up, the CDC had predicted that if the course went as planned, there would be 1.1 million cases, most of them dying, in West Africa, which would have spread quickly to Africa and around the world, including the United States. “
Instead, the global death toll was 11,325 people, about one percent of the worst-case scenario.
“Going forward for any future pandemic or disease policy, it will be important for someone who has this experience to have already dealt with Ebola and understands the science behind it, and to work with countries … is to his advantage, ”said Professor Anna Yeung-Cheung, professor of pathology and epidemiology at Manhattanville College. “People panicked, but it is very important, at the beginning, to control pandemics, especially this type of virus, to meet the virus first where it is.”
Had the Trump administration listened to Klain last fall, experts said, the nation might not be on the verge of what Biden called a “gloomy winter,” with a record number of COVID-19 patients hospitalized across the board. the country and forecasts of more than 100,000 new deaths by 2021.
“In a few weeks, a month, a year, a group of dark-faced assistants will go into the Oval Office and tell the President of the United States, whoever he is at that time, that a million people have died in a relatively short period of time in a remote corner of the world, as refugees are fleeing this disaster and facing closed borders, ”Klain told a The Daily Beast forum on global health on the 24th. October 2019, during a forum on potential public health crises.
“There are a lot of things that could cause such a nightmare scenario: a climate catastrophe exacerbated by climate change, a dirty bomb set off by terrorists, a biochemical attack from a rogue state,” Klain continued. “But of all of these things, the thing most likely to create this scenario over the next 10 years is a dangerous epidemic or pandemic.”
In the exchange – which in hindsight makes Klain look less like a government bureaucrat than an oracle – Klain said preparing for the next Ebola would require a greater investment in public health infrastructure, the ability to use Stafford law in response to infectious disease. epidemics, a willingness to treat infectious disease outbreaks abroad as national security crises and, most importantly, “we need to invest in global health security.”
“We’re as safe here in the United States as the world’s most vulnerable healthcare system is doing to us,” Klain said at the time.
Trump’s response at the time, Klain said at the time, was exactly the wrong way to deal with the outbreak – and a grim harbinger of his administration’s handling of COVID-19.
“Isolation is death,” Klain said, noting that as a private citizen Trump was “one of the most vocal critics” of the Obama administration’s handling of Ebola, calling it the president of “stupid” for allowing Ebola patients to be treated in the United States. and for sending American troops to fight the epidemic.
“The idea that Trump said in 2014 – that Ebola responders who contract the disease should be left in Africa to die – is an inhuman philosophy, but it is also a dangerous philosophy,” Klain said. “There is no wall we can build that is high enough or wide enough to prevent infectious diseases from entering our country.”
Another trap Klain warned of was treating a virus as an immigration problem, citing the reaction he received from some on Capitol Hill as the mosquito-borne Zika virus that swept through various parts of the country. North and South America in 2016 and 2017.
“Just keep immigrants out, keep people with the disease out of the country,” he said, as the virus was already raging in Puerto Rico, part of the United States. “There is no wall we can build that is high enough or wide enough to prevent infectious diseases from entering our country. We need to fight these diseases where they are and we need to have a global perspective. “
Clearly, the Trump administration has sprinted in the opposite direction: withdrawing from the World Health Organization, allowing China to deny entry to international medical teams following the first outbreak of COVID-19 , and undermine science-based public health guidelines in favor of wishful thinking and harmful nonsense.
These actions at the start of the pandemic mean it may be too late for the practices Klain pushed during Ebola to make a difference, experts said.
“If the administration had acted like the Obama administration by quickly getting test and tracing programs with good data systems, it would have been transformational and probably would have saved 100,000 lives in America,” Gostin, who has known Klain since. for years and appeared with him on the October panel, said. “But I’ve been in public health for 30 years and have never seen any tests and tracing used to bring an outbreak under control once it has arrived too late… It’s just too common.
“We’re a bit late then,” Yeung-Cheung conceded. “It’s not going to reverse a lot of the damage that has been done.”
Public health experts have repeatedly pointed out that Ebola and COVID-19 are very different beasts, and that specific practices to prevent the spread of the former – are spread almost exclusively through close contact with bodily fluids of symptomatic carriers – and the last – spread by aerosols with high frequency of asymptomatic infection – could not be compared directly.
“The response to Ebola cannot be directly applied to the response to COVID-19,” warned Dr. Jeffrey Klausner, assistant professor of epidemiology at UCLA and former CDC, who stressed that the coordination of the response by Klain went hand in hand with the implementation of the plan by his former agency.
“A ‘whole-of-government response’ requires high-level coordination and communication, but operations need to be led by people with experience and skills like the CDC,” said Klausner, another area in which he believes that the Trump administration escaped the pandemic.
“The CDC’s lack of leadership in the current response to COVID-19 has been devastating,” Klausner said, “and in my opinion, has resulted in tens of thousands of unnecessary deaths.
Yet Klain’s appointment has inspired cautious confidence on the part of those who know him and credit him with halting the deadliest outbreak of one of the scariest viruses known to man – if the The Trump administration’s refusal to commit for the next two months does not leave him. nation in shambles ahead of time.
“The hope would be that we are going to go in that direction,” said Monto. “My concern is this: can we wait until January 20?”
– with additional reporting by Jackie Kucinich
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