A lot has gone wrong during the coronavirus pandemic as the virus spreads through a polarized nation and public health leaders, politicians and elected officials have struggled to respond.

Chronic underfunding of public health at the federal, state and local levels has only worsened the situation. In total, more than 1.1 million people have died from Covid-19 in the United States, and more than 1,000 people die every week.

More than three years after the Trump administration declared the virus a public health emergency in January 2020, the government’s response to the pandemic is now entering a new phase. On Thursday, the Biden administration will allow the emergency to expire, providing 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 message right.

Public health experts say that when dealing with an infectious disease outbreak, communication is not part of the response. This is answer.

The coronavirus pandemic has shown that confusing messages can exacerbate the spread of the disease and undermine confidence in public health institutions. But messaging during a pandemic isn’t easy. Science changes often, sometimes from day to day, and the instructions from health officials are to mask or not to mask? — must also change, which can create confusion and distrust.

Experts say the key to success is for public health leaders to captivate their audience by explaining that the advice they give today may change tomorrow, and then admitting that what they said yesterday may not have been correct. .

“When you talk to the public on a daily basis, you can explain these mistakes and what you have learned from them,” the doctor said. Richard E. Better, former acting director of the Centers for Disease Control and Prevention during the Obama administration. “You can own them.”

Simplify data sharing.

During the pandemic, the CDC was hampered by outdated data systems and inconsistent data sharing between the federal government, states, and healthcare providers. And unlike the UK and Israel, which have national health systems, the United States does not have a mechanism for the free exchange of data between public health agencies and private providers.

Better and faster data is needed to respond to a rapidly mutating virus that poses different risks to different populations, experts say.

“We were in the awkward position of having to call the UK, Israel or South Africa to find out what was going on – how many people got this new infection, what was the variant of it,” the doctor said. Anthony S. Fauci, who helped lead the pandemic response during the Trump and Biden administrations. “How many people were vaccinated and how did this data affect? 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 could help.

He said some variants of the coronavirus were more deadly to children than others, adding that if officials had access to timely data on the impact of the virus on children, they could tailor school closures to times when students are most at risk.

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

Think carefully about school closures.

School closures have been a particularly contentious topic, but many experts now agree that some schools have been closed for too long and that the abrupt removal of millions of children from American classrooms has had a detrimental effect on their emotional and intellectual health.

both Dr. Fauci and 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 school closures and limit them as much as possible. Both said that improving indoor air circulation could be one way to safely reopen schools.

“One of the things we’ve learned is that we’ve been closing schools for much longer than other countries and we’ve had a terrible impact on education levels and we’ve seen test scores go down,” the doctor said. Emanuel, who also advised Mr. Biden’s transition team.

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

“But once you limit the acceleration,” he said, “then you need to really look into how we keep kids safe at school.”

Stock up on vital supplies.

In the early months of the pandemic, frontline healthcare workers faced a severe shortage of funds, forcing them to reuse face masks, wear inappropriate personal protective equipment, or go without such equipment at all.

The federal government has substantially expanded its stockpile of pandemic supplies since it gave it the edge in responding to another devastating wave of coronavirus or another virus outbreak that would require similar resources.

Prior to the pandemic, government procurement for the Strategic National Reserve was heavily focused on defense against agents of bioterrorism such as anthrax. In March 2020, there were 13 million N95 masks in stock. As of the beginning of this month, he had 352 million. During the same period, the number of ventilators rose from 12,700 to 150,000.

Invest in vaccines early.

As a model for responding to future pandemics, experts point to Operation Warp Speed, the Trump administration’s coronavirus vaccine development program. This initiative enabled Americans to obtain effective vaccines in record time. Fauci said because the federal government has been investing in basic scientific research for years.

Federal officials under the Warp Speed ​​program made huge bulk purchases of shots that were still in development. The federal government has funded or supported clinical trials being conducted by Moderna and Pfizer, makers of two widely used coronavirus vaccines. And it has provided experience for companies with clinical research 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 conclusive evidence from large randomized controlled trials, which are considered the gold standard of evidence used by regulators to test drugs and vaccines.

Trials of treatments have stalled due to a lack of funding or participants. Scientists, physicians and federal regulators have relied on foreign data such as the UK study on dexamethasone, a steroid used to treat Covid-19.

“Large randomized trials have been set up in the UK with very vague inclusion criteria, involving thousands of patients,” the doctor said. Emmanuel said. “Within 30 to 60 days, we learned that steroids do save people who have been hospitalized or very sick.”

Dr. Walid F. Gellad, a drug safety expert at the University of Pittsburgh, pointed to ongoing litigation is being conducted by British researchers who he says will soon produce results on the effectiveness of Paxlovid, Pfizer’s antiviral for Covid-19, which is widely used in the United States.

“We didn’t have the infrastructure to collect the data we needed to make decisions,” he said of the US response to the pandemic.

But don’t rely on vaccines alone.

Vaccines have proven to be the most effective treatment against hospitalizations and deaths from Covid-19. But according to public health experts, attention to vaccination often overshadows efforts to develop and implement treatments. Antibody-based drugs critical to immunocompromised Americans are no longer approved for use by the FDA, and experts say more antivirals are needed.

The Biden administration has placed a lot of emphasis on rolling out booster shots, which have steadily declined since the initial round was authorized in the fall of 2021. But other strategies aimed at preventing the spread of the virus, such as improving indoor air quality, have received support. comparatively little attention.

“Myopically focusing only on vaccines, to the exclusion of other areas that are actually lightweight fruits for a much better answer, is like saying you are going to build a house with one wall or no roof,” the doctor said. Luciana Borio, former FDA acting chief scientist who advised Mr. Biden’s transition team.