'Nobody knew exactly what to do': 5 years on, what scientific lessons were learned during COVID?

The pandemic stretched us — our communication, our science, our distribution networks, even what it means to be a good citizen amid rapidly developing knowledge.

With bird flu encroaching and the first measles-related deaths in a decade, the potential for another pandemic is ever-present. Our response to COVID-19 offers a sense of how prepared we are — or aren't. And it's a mix of both, experts say.

The early days of the pandemic were a scramble, as scientists worked to understand how to approach the novel coronavirus while health care workers, facing limited resources, were inundated with patients.

"In the first six months of the epidemic, things were confused," said Donald Burke, former dean of the Pitt School of Public Health and a longtime disease epidemiologist. "Nobody knew exactly what to do. We didn't have a vaccine. The only option we had was to reduce person-to person contact."

Local responses

Lee Harrison was there in the beginning, working as an attending physician at UPMC Presbyterian, specializing in infectious diseases. He remembers that it was "striking" how many people were occupying ICU beds with COVID and on ventilators in April 2020.

As chair of the Allegheny County Board of Health at the time, he had regular meetings with then-County Executive Rich Fitzgerald and former director of Allegheny County Health Department Debra Bogen, who is now state Health Secretary. His lab at the University of Pittsburgh was also in charge of testing patient samples for COVID early on.

"I think we did quite well," he said. "There were a lot of good people working together to make the best decisions. It wasn't politicized at that time, so we were just concerned with, 'What are the data telling us? What is the best approach based on what we know?'"

Allegheny County Health Department (ACHD) officials used Microsoft Teams to establish a virtual "Emergency Operations Center" and coordinate large, daily calls with emergency medical services, school districts, the medical examiner's office and top physicians at Pittsburgh medical institutions throughout the pandemic, a change from business-as-usual communication. This allowed them to quickly pivot public health policy when needed.

"These partnerships and flow of information has since been retained," Annie Nagy, a public health administrator with ACHD, said via email.

Local response wasn't perfect, said Burke, but it wasn't perfect anywhere.

While Burke said he wasn't directly involved in the early pandemic response, his local legacy spread far and influenced many who were on the front lines. Neil Ferguson, director of the School of Public Health at Imperial College London, released a paper in March 2020, one of the first correctly predicting around one million U.S. deaths from COVID.

"Everybody was shocked by these numbers," said Burke. "But the software he used was one we developed together."

To date, COVID has led to 7 million deaths worldwide.

Lessons learned, lessons failed

The pandemic tested communication, coordination and rollout of resources, stretching the limits of existing technology and often pushing agencies toward more efficient methods.

ACHD discovered that communicating case and disease information via a public dashboard was superior to what was standard before the pandemic — publishing long reports about annual trends, which the general public wasn't always aware of. It's since kept the dashboard approach, as well as strengthened partnerships with pharmacies and community vaccine clinics, said Nagy.

Health experts interviewed all agreed that the swift vaccine development — and its rollout — was a shining star in terms of pandemic successes. While scientists had been studying mRNA vaccines since the 1990s, there were issues with the stability of the mRNA code and subsequent inflammatory responses, per a 2023 article from the National Institutes of Allergy and Infectious Diseases. (The agency also shows a timeline of mRNA research, stretching back more than 50 years).

Then COVID stressed the limitations of our current vaccine technologies, and scientists got to work perfecting mRNA technology.

"Operation Warp Speed was one of the greatest achievements of the Trump Administration, and it's something he deserves credit for," said Adalja.

Carnegie Mellon computer and data scientists also learned hard lessons.

"We learned our data systems are not as good as they could be," said Roni Rosenfeld, head of the machine learning department at CMU, a professor of machine learning and a member of the leadership team at the university's Delphi Group. "We could do better next time there's a pandemic or other epidemics if we had improved data systems."

Thanks to an $18 million grant from the CDC, Delphi Group has been developing a "one-stop shop" for infectious disease data indicators, including COVID, flu, measles and HIV. Called the Delphi Epiportal, it's helping to visualize important components of disease transmission to better inform and equip both civilians and health departments for future outbreaks.

"Not everyone knows where to find data that already exists," said Rosenfeld. "We've actually made a big push in the last few years to not only get data sources and extract new, meaningful indicators from them, but also to make sure that people who are looking for information can find it."

And a key lesson from the pandemic wasn't about the virus at all.

"Modeling the virus was the easy part," said Burke. "Modeling people was the hard part."

People didn't react how scientists expected, which threw a wrench in typical modeling and forecasting. It's a factor that's going to play a crucial role in the response to future epidemics and pandemics.

"To this day, I don't know that anybody has convincingly looked back at those first six months and said, 'This is what we should have done,'" said Burke.

It's an issue that Rosenfeld and his colleague, Peter Jhon, have experienced firsthand.

"We learned that a lot of the pandemic evolution depends on people's behavior, and we did actually fail to appreciate how big of a role this plays, and how big of a role it's played in this particular pandemic," said Rosenfeld.

It's largely about trust.

"In some sense, we slid backwards, because now, even if we do have a sense of what normal behavior is like, because of the traumatic impact of the pandemic on different parts of the population, people don't all trust the same source, and they are not all behaving the same way," he went on. "Different people behave in different ways based on the sources that they trust. So we have a fragmentation and breakdown in the societal response, and that complicates things immensely."

Future proofing

Are we better prepared for a future pandemic than we were for COVID?

When asked, Adalja quickly replied "no."

"I don't think any of the lessons have really stuck," said Adalja. Now that infectious disease has become politicized, it's harder to make rational decisions and rely on the experts, he said.

Burke, who has spent five decades studying infectious diseases, is worried about the dismantling of important surveillance tools and communication channels: the U.S. withdrawing from the World Health Organization, the widespread firing of CDC officials and the implementation of a health secretary who has sowed distrust in vaccines and holds false scientific beliefs, such as that HIV does not cause AIDS. (It does.)

"To see all of this dismantled without any thinking is just deplorable," he said. "There are going to be a lot of dead kids as a consequence."

The federal layoffs and buyouts are part of the president's plan, aided by Elon Musk and the newly formed Department of Government Efficiency, to substantially reconfigure the size and structure of the government's civilian workforce — about 2.4 million employees, per the Associated Press. The impact on agencies including the CDC and National Institutes of Health remains unknown, as legal challenges make their way through the courts.

Aside from the humanitarian angle, stripping the CDC, USAID and other main surveillance and disease response organizations of funding and resources is simply a poor strategy for pandemic preparedness and security, Burke said.

"It's counter to the U.S. national interest to do this," said Burke. "They are actively taking apart the things that are most vital to our national security."

A new administration, a new frontier

Rosenfeld and Jhon said the first two years of their five-year federal grant have been funded. They're unsure about the fate of the next three years.

"The mRNA technology, the surveillance of wastewater, the use of computational modeling, a lot of these things will be there for the next time around," said Burke. "But let me emphasize: Those all grew out of the very institutions that we're starting to dismantle."

Not only that, but vaccine mis- and disinformation post-COVID have changed the way the public responds to health guidance from authorities.

That's evident even in Pennsylvania's COVID vaccine rates, which are at about 24%, per CDC data up to Feb. 22.

There's also evidence that routine school-age vaccinations are suffering from a decline in uptake from distrust and misinformation, despite a preponderance of evidence that they are safe and effective for children.

With current tracking of bird flu and measles, the former of which has shown some ability to infect humans, and the latter of which has killed two in a recent outbreak, these trends are on Burke's mind.

"I have been in West Africa, and I have stood at the graves with a father, where his kids died of measles because they didn't get a measles vaccine," said Burke. "I've watched the tears on his face as he asked, 'Can't we do more about this?' And the answer is, we can."

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