As Benjamin Franklin is credited with saying, “By failing to prepare, you are preparing to fail.”
Of course, the Founding Father has many quotes that remain relevant today. But the one about preparation seems particularly prescient during the coronavirus pandemic. Examples of preparation — and a lack of it — are evident throughout the country as the nation struggles with an outbreak that has contributed to about 100,000 deaths.
Among the examples of strong preparation is a fascinating exercise undertaken by Clark County Public Health. Four years ago, the department’s Ethics Committee created a ventilator allocation plan in the event of a crisis that would stretch local capacity.
A 2017 project summary states: “The surge of patients requiring intensive care during an influenza pandemic could overwhelm the medical care capacity of many communities, including ours. During a pandemic, shortages of ventilators and other medical equipment could place physicians and other health professionals in conflict with each other when advocating care for their patients.”
That was part of a plan that is now in the last stage of being finalized. And it appears farsighted in the midst of the pandemic.
Fortunately, Clark County has not been overwhelmed by a need for ventilators. Statewide stay-at-home orders have been credited with preventing hospitals from being overrun by COVID-19 patients, even as the disease has contributed to more than 1,000 deaths in Washington. But the serendipitous exercise of preparing for a pandemic has represented the ounce of prevention that can outweigh a pound of cure.
In the event of more patients that ventilators, a triage team of a critical care doctor or hospitalist, a critical care nurse and an ethicist would determine who has access to a ventilator. The team would not be informed of a patient’s name, race, gender or other identifying factor, and Dr. Alan Melnick, Clark County’s public health officer, explained, “It would not matter if you are the mayor or the president.”
Such a plan does not mitigate the impact of coronavirus, but it does reflect the necessary preparation this nation has too often eschewed. At the federal level, that is reflected in the Trump administration’s failure to plan for and react quickly to the outbreak.
In 2016, the Obama administration finalized a detailed 69-page plan for reacting to a pandemic. Critics have asserted that the Trump administration ignored that playbook; White House officials have said they replaced it with two new response plans.
Even if the administration had a robust plan, it is clear it has not been followed. The Obama playbook, which is publicly available, calls for coordinated messaging from the White House, rather than the mixed messages that have been evident. It also stresses a timeline for ensuring there are adequate supplies of personal protection equipment and for working with Congress to direct necessary funding; President Trump was months behind both benchmarks while insisting the virus “miraculously goes away.”
Viral pandemics do not simply go away. They can be alleviated and slowed with proper planning and a quick response, but they do not disappear. And the crisis fomented by COVID-19 reflects a shortcoming of American government. Be it infrastructure or disaster response or climate change, the United States has spent decades reminiscing about its 20th century glory rather than preparing for the 21st century.
And, as the coronavirus demonstrates, it has prepared to fail.