Dr. Sanjay Gupta: While monkeypox cases rise, why are we waiting for the cavalry
The pandemic, which has held the United States and almost every other country in its grip, should have taught us valuable lessons about how to manage a public health emergency, but it seems we are making some of the same mistakes we made not even three years ago, when the SARS-CoV-2 virus started to spread.
As I have learned over the past few years, there is a significant difference between preparedness and response, even though the two are often conflated. The United States is extraordinarily prepared, ranked No. 1 for pandemic preparedness in the 2021 Global Health Security Index.
Instead, we are leading in a different way. As of today, we have the most confirmed cases of monkeypox on the planet, more than 5,000. That is almost 25% of the global numbers, even though we are just under 5% of the world’s population.
It is now clear: Preparedness alone does not guarantee a rapid response. With Covid-19, and now monkeypox, we were too slow to respond. It was as if we are sitting in a turbo-charged Ferrari, capable of massive acceleration, but instead only idling in the driveway.
Cavalry culture
Over the past three years, we have witnessed something counterintuitive. It was predominantly wealthy countries that were hit hardest during the Covid-19 pandemic. They had some of the highest death rates, despite their enormous resources.
While there are many reasons for this, including misinformation, lack of public trust, and the entangling of public health and politics, I think there is something else, as well: We have adopted what I call a “cavalry culture.” We wait for the cavalry to ride in and rescue us, instead of taking smaller preventive steps — such as establishing modern and reliable data systems, mastering our supply chain along the way, and acting early to head off the outbreak in the first place.
If that sounds familiar, it’s because we too often do the same with our personal health matters. According to research published in The Lancet Public Health, nearly half of chronic disease in the United States is mostly preventable, with lifestyle changes. Even knowing that, however, the medical system is set up for the cavalry to come in with expensive medications and high-tech interventions, instead of providing equitable access and incentives for preventative care.
There are a couple of important axioms in public health. One is, by the time you think you must act to contain an outbreak, it is already too late. And, if you think you are overreacting, you are probably reacting just the right amount. In the case of Covid, and now monkeypox, we seem to have forgotten those basic public health principles. And, the real question now seems to be: When will the government finally hit the gas pedal on our highly tuned Ferrari?
I don’t want to suggest any of this is easy. There are significant issues of uncertainty and unpredictability. Much like a hurricane forming at sea, we often don’t know exactly where or how hard it will hit. We want to be measured, calm in our response and to cause as little disruption as possible. We want to be thoughtful and gather as much information as is available.
And therein lies one of our biggest problems: basic data. I have often wondered, how is it that a numbers-driven, high-tech country like the United States can’t get basic data right?
Data disaster
As long as I’ve been reporting on the Covid pandemic, I have always had to offer the caveat that case numbers are probably off, sometimes wildly so. We have probably never had a clear vision on just how widely the virus was spreading at any given time in the United States, and going into the fall 2022, the situation isn’t really any better.
In early July, the Institute for Health Metrics, a research center at the University of Washington, released a model suggesting that actual Covid-19 cases are seven times higher than reported cases. At times, it seems the tech platforms for Snapchat and Twitter offer more data analytics than the patchwork of state and federal systems that underpin the public health of our country.
“First, there’s a lack of data access needed to understand where disease outbreaks are spreading. This is due to data collection limitations that Congress needs to fix,” said Dr. Tom Frieden, president and CEO of Resolve to Save Lives and a former director of the US Centers for Disease Control and Prevention.
He said there is also a need to update analog systems and connect them to each other — getting them to speak the same language. Right now, it’s the Tower of Babel.
“Second, we lack sufficient numbers and, in some cases, skills of people and systems at the federal, state and local levels that can deliver services and communicate effectively with communities. Finally, we are in perpetual panic and neglect funding cycles,” he said.
As a result of all of the things Frieden is describing, our current data collection and reporting system leaves important information fractured into dozens of states and territories,…
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