Best and Worst Decision Made During the Covid-19 Pandemic
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In this week’s musings on decision making, I cover the best and worst decisions made over the course of the last two years on the Covid-19 pandemic. Decision making at its finest and at its most wretched was woefully exposed during the pandemic. The pandemic was a perfect example of decision making with imperfect information in a rapidly evolving situation played out in the public sphere. As a site focused on forecasting the future, we hope to learn from the lessons of the past to avoid repeating those mistakes.

Best Decisions Made

Operation Warp Speed

Vaccines funded by Operation Warp Speed

Operation Warp Speed was the public / private partnership initiated by the Trump administration to accelerate the development of vaccines for Covid-19 and is an undisputed success. Funded with only $12 billion (a small fraction of the stimulus packages used during the pandemic), the program was intended to de-risk vaccine development and manufacturing efforts by the major pharmaceutical companies, allowing them to maximize spending simultaneously on both vaccine research and vaccine manufacturing in a risk-free manner regardless of whether the vaccine was successful or not. The program led to the two gold standard mRNA vaccines being given emergency use authorization by December, an unprecedented timeline, and rapid scale up of vaccine distribution in the US by the end of the second quarter.

NBA Shutdown on March 11, 2020

While the news covered the pandemic on a daily basis, particularly of the developments in Italy and China, and markets had started spasming with respect to the news, for many folks, daily life was not impacted until March 11, 2020. Specifically, a player in the NBA had tested positive for Covid-19, and the NBA made the decision to shut down all games. This was the first major organization to shut down all activities due to Covid-19. For the NBA, it led to hundreds of millions of dollars in loss revenue, but more importantly, for the rest of the US, it led to a chain reaction that opened the flood gates to shut down and soon, lockdown.

Federal Reserve Stimulus in March 2020

US Unemployment Rate
Source: FRED

With markets spasming in late March and the economy lurching into the worst recession on record down 30% in Q2 2020 and the unemployment rate jumping to 15%, the Federal Reserve stepped in and as is now legend, turned on the money printers. With unprecedented stimulus and the introduction of a raft programs intended to fight the economic effects of the pandemic, markets sharply rebounded and the US economy avoided the 8 year overhang felt after the 2008 financial crisis. Indeed, the economy has run so hot two years after the stimulus that wage gains (and inflation) are now at its highest in decades (the verdict on whether it’s too hot and the taps should have been turned off sooner will be discussed later).

Healthcare Workers Fighting the Valiant Fight

Without a doubt, healthcare workers in 2020 were in the frontline of a war against Covid-19. Without the benefit of years of research or even solid understanding of how Covid-19 was transmitted, workers in ambulances, ERs and ICUs were forced to draw on their knowledge of body systems overlaid against the symptoms that were presented in patients and do their best. While I myself am far from the frontlines and being able to personally speak to the decision making made in those battlefields, without a doubt, the across the board response made by those workers in the face of a rapidly evolving pandemic saved millions of lives.

General Public

Despite all the headlines about anti-maskers and anti-vaxxers, and the politicization of Covid-19, I think without a doubt the majority of citizens around the world rose to the moment and accepted that a pandemic is by virtue a community driven problem, and as such, is a community driven solution. Every day folks donned up masks, got their shots and strove to protect the most vulnerable members of their community. Sadly, the good faith efforts that every person put into beating the pandemic is not discussed in the media, but collectively as a society, the efforts of the every day person is to be commended.

Worst Decisions Made

Masks Are Not Effective Messaging

Deleted tweet by the US Surgeon General Dr. Jerome Adams

While I respect the FDA, the CDC and other healthcare officials for their regulatory and research capabilities, their crisis management and communication teams sadly need a major overhaul. One of the major issues seen early in the pandemic was the coordinated attempt to dissuade the public from wearing masks, an effort that kickstarted the anti-mask movement and the politicization of the pandemic. How often have we heard the misinformation that “Masks do not protect you, they protect me”, or the idea that a N95 mask must be perfectly sealed to be effective. Certainly, many folks excuse those in power of trying to conserve the masks for medical professionals, but in a crisis, leaders must be seen as open and honest, rather than attempt to play reverse psychology and game theory. Decision making 101.

Requirement to Use CDC Covid Test Kits

Testing is an essential component of understanding how a virus spreads. During the first few months of the pandemic, the US was essentially flying blind. Despite the availability of test kits from Europe, the CDC mandated that testing centers use test kits developed and manufactured in house in Atlanta by the CDC. Not only did this severely limit surveillance capabilities, but as it turns out in many post mortems done after the fact, that not only was the CDC not staffed to scale up to manufacture test kits in numbers needed for the country, but that the tests themselves were contaminated with minimal quality control. While it certainly may not matter today, it highlights the bureaucracy involved and the poor lumbering, response to a fast changing situation

FDA Advisory Group Rejects Boosters in September 2021

More than a year and a half after the pandemic, the FDA continued to screw up their communication and messaging. Despite significant data from Israel and other countries on the importance of boosters, the FDA advisory group declined to recommend boosters in September 2021. They failed to incorporate risk management into their decision making, instead focusing on the rear view mirror and failing to project the falling efficacy of the initial series of vaccines over time. They played politics and instead of focusing on the efficacy and safety of the boosters, instead focused on vaccine inequality around the world – a decision that overstepped their purview. Sadly, this decision led to delays in booster distributions, which when Omicron reared its ugly head in December 2021 led to an under-protected population and more deaths in 2022.

Slow Approval of Vaccines for Children in 2021 / 2022

A topic that is near and dear to my heart is the infuriatingly slow rollout of vaccines for children. From requesting additional participants in the initial trials for children to sending children aged 5-11 back to school in August 2021 without vaccines getting approved until November 2021, to poor dose sizing and continue delays in vaccine approvals for children under 5, it’s inexcusable that approval for vaccines for children has taken months longer than those for adults. Certainly from a public health standpoint, statistics show that children aren’t as badly impacted by Covid-19, but from a human standpoint, every child’s life matters and each day’s delay can lead to a child’s death down the road.

Concluding Thoughts

It’s obvious that decision making is not a required skill for public health officials. While certainly some organizations and many individuals made extraordinary decisions in the face of incredible strain and duress, many of the key organizations responsible for managing the pandemic dropped the ball. While in this site we try to look forward and predict the future, we also review the past and learn from mistakes. The key lesson to learn – data is by its very nature backwards looking. Decision making and its corollary, risk management, is forward looking and requires the balanced consideration of the gray.

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