A lot has gone wrong during the coronavirus pandemic as the virus tore through a polarized country and public health leaders, politicians and elected officials scrambled to respond.

Chronic underinvestment in public health at the federal, state, and local levels has only made matters worse. All told, more than 1.1 million people have died from Covid-19 in the United States, and more than 1,000 continue to die each week.

More than three years after the Trump administration declared the virus a public health emergency in January 2020, the government’s pandemic response is entering a new phase. On Thursday, the Biden administration will allow the state of emergency to expirewhich offers a moment to take stock of how the nation has responded to the worst public health crisis in a century.

Here are some lessons from the country’s fight against the virus.

Get the right news.

Public health experts say that when managing an infectious disease outbreak, communication is not part of the response. It Yippee answer.

The coronavirus pandemic has shown this confusing messages it can exacerbate the spread of disease and erode trust in public health institutions. But messaging during a pandemic is a tricky business. The science changes often, sometimes by the day, and the guidance from public health officials—to mask or not to mask? — must also change, which can cause confusion and a lack of trust.

Experts say the key is for public health leaders to bring their audience on board by explaining that the guidance they give today could change tomorrow — and then acknowledging that what they said yesterday could be poorly.

“When you’re in a day-to-day conversation with the public, you can explain these mistakes and what you learned from them,” said Dr. Richard E. Besser, former acting director of the Centers for Disease Control and Prevention. The Obama administration. “You can own them.

Make it easy to share data.

The CDC was crippled by outdated data systems during the pandemic and inconsistent data sharing between the federal government, states, and health care providers. And unlike Britain and Israel, which have national health care systems, the United States has no mechanism for the free flow of data between public health agencies and private providers.

Responding to a rapidly mutating virus that poses different risks to different populations requires better and faster data, experts said.

“We were in the awkward position of having to call the UK and Israel or South Africa to find out what was going on – how many people had contracted this new infection, what the variant was,” said Dr. Anthony S. Fauci. , who helped lead the response to the pandemic under both the Trump and Biden administrations. “How many people were vaccinated and what was the effect of this data? We literally had to wait months instead of getting it in real time.”

Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, cited school closures as an example where real-time data would help.

Some variants of the coronavirus were more deadly to children than others, he said, adding that if officials had access to timely data on the effects of the virus on children, they might be able to tailor school closures to when students were most at risk.

“We need immediate data to know what’s going on,” said Dr. Osterholm, who advised President Biden’s transition team. “And as conditions change, we must change.

Think carefully about closing schools.

School closings have been a particularly contentious topic, but many experts now agree that some schools were closed too long and that millions of children were suddenly removed from America’s classrooms. had harmful effects on their emotional and intellectual health.

How Dr. Fauci, so Dr. Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania, said the pandemic showed that officials should carefully consider closing schools and keep them to a minimum. Both said better indoor air circulation could be one way to safely keep schools open.

“One of the things we’ve learned is that we’ve been closing schools for much longer than other countries, and we’ve had such a terrible impact on educational attainment and we’ve seen test scores go down,” said Dr. Emanuel, who also advised Mr. Biden’s Transition Team.

Dr. Fauci said that at the beginning of the pandemic, “at a point when hospitals were literally a day or two away from being overwhelmed,” closing public places like restaurants, bars and schools was important to keeping health care systems running by slowing the spread of the virus.

“But once you put a damper on the acceleration,” he said, “then you really have to examine how we’re keeping kids in school safely.”

Store vital supplies.

In the first months of the pandemic, health workers were on the front line dramatic shortage of suppliesforcing them to reuse face masks, wear ill-fitting personal protective equipment, or go without it altogether.

The federal government has since substantially expanded its stockpile of pandemic supplies, giving it a head start in response to another devastating wave of the coronavirus or another viral outbreak that would require similar resources.

Before the pandemic, government purchases of the strategic national stockpile were heavily strained protects against bioterrorist agents such as anthrax. As of March 2020, there were 13 million N95 masks in stock. At the beginning of this month, it had 352 million. During the same period, the number of ventilators increased to approximately 150,000 from 12,700.

Invest early in vaccines.

Experts point to Operation Warp Speed, the Trump administration’s coronavirus vaccine development program, as a model for responding to future pandemics. Initiative brought effective vaccines to Americans in record time – in part, said Dr. Fauci because the federal government has spent years investing in basic science research.

Federal officials in the Warp Speed ​​program made huge bulk purchases of missiles that were still in development. The federal government has funded or supported clinical trials conducted by Moderna and Pfizer, makers of two widely used coronavirus injections. And it lent expertise to companies with clinical trial specialists, epidemiologists and budget experts.

Quickly set up large randomized trials.

Early treatments for the virus, such as hydroxychloroquine and convalescent plasma, were approved by the Food and Drug Administration without strong data from large randomized controlled trials — considered the gold standard of evidence that regulators use to clear drugs and vaccines.

Trials for treatment stopped due to lack of funds or participants. Scientists, doctors and federal regulators relied on foreign data such as UK study on dexamethasonea steroid used to treat Covid-19.

“Britain prepared large randomized trials with very loose entry criteria, thousands of patients,” said Dr. Emanuel. “Within 30 to 60 days, we learned that steroids actually saved people who were hospitalized or very sick.”

Dr. Walid F. Gellad, a drug safety expert at the University of Pittsburgh, pointed out current court conducted by British researchers, who he said would soon produce results on the effectiveness of Paxlovid, Pfizer’s antiviral drug for Covid-19 that is widely used in the United States.

“We didn’t have the data collection infrastructure that we needed to make decisions,” he said of the U.S. response to the pandemic.

But don’t just rely on vaccines.

Vaccines have proven to be the most effective barrier against hospitalization and death from Covid-19. But attention to vaccination has often overshadowed efforts to develop and deliver treatments, public health experts said. Antibody drugs critical for Immunocompromised Americans are no longer approved for use by the FDA, and experts say more antiviral drugs are needed.

The Biden administration has focused heavily on the introduction of booster shots, which have seen fewer and fewer users since the first round was approved in the fall of 2021. But other strategies to prevent the spread of the virus, such as improving indoor air quality, have been adopted. relatively modest attention.

“A short-sighted focus only on vaccines to the exclusion of other areas that are really low-hanging fruit for a much better response — it’s like saying you’re going to build a house with one wall or no roof,” said Dr. Luciana. Borio, a former FDA chief scientist who advised Mr. Biden’s transition team.