H5N1

COVID-19 heralds a new era for chronic diseases in primary care

An editorial in The Lancet Respiratory Medicine: COVID-19 heralds a new era for chronic diseases in primary care.

On March 23, 2020, the UK Government enforced a country-wide lockdown in response to the COVID-19 pandemic to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although spread of the virus has been reduced, the lockdown has created new challenges for primary care practitioners who manage patients with chronic respiratory diseases (CRDs). However, there have also been opportunities for innovation, especially in terms of digital and remote working, and these solutions could be maintained and developed further to improve primary health-care services as we recover from the pandemic. 

The threat of COVID-19 is a serious concern for patients with CRDs and their primary care providers. Challenges that these patients already face related to their illness include an increased risk of depression, and feelings of isolation and loneliness, which might have been amplified during lockdown, without the usual support from health-care providers, family, and friends. Although the virus might have acted as a catalyst for patients with CRDs to access online support groups and self-management tools to reduce feelings of isolation, and to improve their knowledge about their illness. Improved adherence to preventer medications for those with asthma and COPD has been reported, to the extent that inhaled corticosteroid inhalers were in short supply at one point during lockdown in the UK. This shift in patient behaviour provides an opportunity for primary care providers to actively promote self-management and online support.

Confused messaging about whether patients with CRDs were at increased risk of infection with SARS-CoV-2, or development of severe disease, might also have contributed to increased levels of patient anxiety. Primary care providers, a key source of advice, might themselves have been unsure of the best guidance as concerns about increased risk were somewhat eased by emerging, reassuring data. Patient communication must be clear and efficient to help avoid misinformation and unnecessary panic, and can be difficult to convey. Efforts to ensure guidance reflects the available evidence, is up to date, and is communicated through appropriate channels is therefore essential in these unprecedented times. 

Routine check-ups were disrupted by lockdown restrictions; primary care providers had to adapt quickly to maintain care for chronically ill patients and respond to acute presentations and potential COVID-19 cases. Overnight, remote consultations (telephone, video, or online) widely replaced face-to-face appointments in the UK to allow for physical distancing and to prevent spread of infection. 97% of practices now offer video consultations and 75% offer online consultations compared with just 25% offering remote consultations last year. 

This move towards a digital era will likely continue for non-urgent cases as lockdown restrictions are lifted, and care providers can then prioritise face-to-face consultations for patients who need them. Ideally, in the future, patients—in collaboration with their clinician—will have a choice in the mode of appointment that's most suitable. Some primary care practices have adopted strategies to enable patients to safely visit the facility—eg, with designated shielded sites reserved for vulnerable patients, in which physical distancing is strictly observed, or red sites where people with suspected COVID-19 can attend. Now that the peak of the pandemic might have passed, and demand for face-to-face appointments is increasing, health-care providers can adapt these measures to reflect the reducing threat of infection. 

Potential misdiagnosis of patients with CRDs being infected with COVID-19 has been a challenge for primary care physicians owing to overlapping symptoms and the initial lack of widespread testing available in primary care facilities. Physicians have to decide whether an appointment in person is necessary and worth the risk of exposing the patient to infection. 

Policy makers must learn from this experience for future pandemic preparedness, to manage any second waves, and to ensure sufficient and efficient testing is readily available in primary health-care facilities. This will not only allow improved management of individual suspected cases, but can also help physicians make key decisions about patients with respiratory illnesses, as well as identifying the risk to the general population as lockdown measures are eased. 

Although the pandemic is far from over in many countries, it is time to reflect on what we have learned from a primary health-care perspective in the management of CRDs. The shift towards increased self-management and use of digital tools could help initiate a new era in primary care—one of improved health for patients together with the flexible and comprehensive use of all available resources.

COVID-19 and flu, a perfect storm

An editorial in Science: COVID-19 and flu, a perfect storm.

The world is in uncharted waters for the 2020 respiratory virus season. For the first time in modern history, the Northern Hemisphere faces the prospect of the coronavirus disease 2019 (COVID-19) pandemic and a simultaneous epidemic of seasonal influenza. Each causes life-threatening illness and death, especially in older adults, people with chronic diseases, and other vulnerable populations. How can we prepare for this convergence? 

The timing and severity of a COVID-19 wave in the fall and winter are uncertain, but past experiences with the 1918 and 1957 influenza pandemics point to the possibility of a resurgence. Almost nothing is known about the interaction of influenza virus and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, the cause of COVID-19) within individuals. Does coinfection increase the risk of severe illness or amplify virus shedding? Few coinfections have been reported from China during the early phase of the pandemic. The Southern Hemisphere influenza season is just beginning, and it may provide some clues as to what can be expected in the Northern Hemisphere later this year. 

Much of the population remains susceptible to SARS-CoV-2, and the stress on hospitals will be greatest if the COVID-19 and influenza epidemics overlap and peak around the same time. It is possible that the number of individuals infected with each virus will peak at different times, reducing the peak demand for hospital beds. If a surge in COVID-19 cases occurs this fall, tightening mitigation strategies will be necessary. Social distancing and stay-at-home orders are socially and economically disruptive, but can reduce demand on hospitals and protect vulnerable populations. They will also reduce transmission of other respiratory viruses, including influenza and respiratory syncytial virus. Supplies of personal protective equipment must sufficiently meet the projected demand of a severe influenza season along with COVID-19.  

There are important differences in the epidemiology of COVID-19 and seasonal influenza, but symptoms overlap. Molecular diagnostic testing for SARS-CoV-2 is critical for all patients with acute respiratory illness, especially during periods of co-circulation. Rapid-turn-around testing is necessary to distinguish between influenza and COVID-19, guide patient care, and support a comprehensive COVID-19 control program (including isolation of cases and rapid identification and quarantine of contacts). Every effort should be made to ensure that resources will be available for combined testing for COVID-19 and influenza. These tests should be without charge to patients because they serve a dual purpose for public health and patient care. 

We do not yet have a COVID-19 vaccine, but safe and moderately effective influenza vaccines are available. Their widespread use is more important now than ever, and we encourage health care providers, employers, and community leaders to promote vaccination. Vaccine effectiveness varies by season and subtype, but vaccination offers similar protection against laboratory-confirmed influenza hospitalization and outpatient illness. Widespread misinformation on social media includes the false claim that influenza vaccination increases the risk of SARS-CoV-2 infection. Scientists, health care providers, and public health leaders must counter these claims with clear, evidence-based information on the importance of influenza vaccination during the COVID-19 pandemic.  

The prospect of a second COVID-19 wave requires planning to ensure optimal delivery of influenza vaccines starting in the early fall. Community vaccination sites are often set up for maximum volume and efficiency, and alternative approaches will be needed to maintain physical distancing and minimize the risk of SARS-CoV-2 transmission, particularly because many influenza vaccine recipients are at high risk for both influenza and COVID-19 complications. Randomized trials have shown that some enhanced influenza vaccines (e.g., high-dose inactivated vaccine and recombinant vaccines) generate greater protection in older adults compared to standard-dose inactivated vaccine. The optimal timing of influenza vaccination in patients with confirmed COVID-19 is uncertain. There are no clinical studies on the effects of influenza vaccination in patients with COVID-19, but it may be prudent to delay vaccine administration until after the acute illness has resolved. 

Over 400,000 COVID-19 deaths were reported worldwide by 6 June, including over 109,000 in the United States. The actual death count is almost certainly higher, and we are still in the early phase of the pandemic. The U.S. Centers for Disease Control and Prevention estimates that influenza has killed 12,000 to 61,000 each season over the past decade. Will there be a perfect storm of COVID-19 and influenza during the 2020–2021 season? We do not yet know, but we must start preparing in the coming months.

COVID-19 in the DRC: Dr Muyembe fears large-scale contamination of healthcare workers

Via Actualite.cd: Covid-19: Dr Muyembe fears large-scale contamination of healthcare workers. The Google translation:

The coordinator of the Covid-19 response team in the DRC, Professor Doctor Jean-Jacques Muyembe Tamfum, this Monday, June 8, has raised concerns about the massive transmission of the disease in hospitals, especially among staff caregiver.  

His fear is based on the weakness of preventive measures in sanitary facilities.  

"I think that there is a great weakness, it is in the prevention and the reduction of the risks of transmission of the epidemic in healthcare. This is a weak point to be reinforced not only for Ebola but also for the COVID-19 I am afraid that the infection could reach a large number of nursing staff and create panic in the healthcare setting and therefore demoralize the nursing staff. in hospitals," said Dr. Muyembe when meeting with the European Union delegation. 

Janez Lenarčič, European Commissioner for Crisis Management, Philippe Goffin, Belgian Minister for Foreign Affairs and Defense and Jean-Yves le Drian, French Minister for Europe and Foreign Affairs, have been staying in Kinshasa since Monday June 8. This visit is part of a "humanitarian airlift" initiated by the European Union to support the fight against Covid-19.  

Upon arrival, they spoke with Doctor Jean-Jacques Muyembe at the National Institute for Biomedical Research (INRB). They will be received this same Monday by the President of the Republic Félix-Antoine Tshisekedi Tshilombo.  

The delegation led a shipment of three flights from the EU humanitarian airlift to the DRC which includes water purifiers, nutritional support and general medical supplies. Also laboratory equipment, masks, gloves and personal protective equipment.

Protecting US nursing homes would have significantly slashed COVID-19 deaths

Via The Washington Post: The Health 202: Protecting U.S. nursing homes would have significantly slashed coronavirus deaths. Excerpt:

The full picture of the coronavirus’s toll on U.S. nursing homes is finally becoming clear. 

It is enormous.  

Data updated yesterday by the federal government now show that nearly 32,000 American nursing home residents have died of the virus — a figure certain to grow, with 12 percent of all facilities yet to report their totals. Nearly 700 nursing home employees have also died. As of Thursday, more than 106,000 Americans overall had died of the disease.

It may turn out that as many as 4 in 10 covid-19 deaths occurred among nursing home residents. 

“We have failed the residents and we have failed the staff as a society,” Michael Wasserman, president of the California Association of Long Term Care Medicine, told The Post’s Peter Whoriskey, Debbie Cenziper and Will Englund. 

For the first few months of the pandemic, information about nursing home cases and deaths was murky. Several dozen states refused to make the information public, leading to lawsuits across the country. On April 30, the Centers for Medicare and Medicaid Services stepped in with a rule requiring nursing facilities to report information not only on cases and deaths, but also equipment and staffing shortages. 

The agency released an initial trough of information on Monday, showing that about 25,000 residents had died. Yesterday’s update not only upped the death count but also provided a better window into the supply shortages many facilities faced as they tried to contain outbreaks and isolate infected patients.  

“We wanted to be as transparent as possible with the American people,” CMS Administrator Seema Verma told reporters.

Hundreds of facilities reported shortages in nursing staff and supplies. 

Nearly 2,000 facilities reported insufficient nursing staff and more than 2,200 said they lack enough surgical aides, according to a database created by CMS. More than 500 said they don’t have any N95 masks, and more than 250 said they don’t have any masks at all. 

“The data released Thursday covers nearly 9 in 10 of the country’s 15,000 federally certified nursing homes,” my colleagues report. “It does not include assisted-living centers and other types of elder-care facilities that are not certified by CMS.”

The CDC waited ‘its entire existence for this moment.’ What went wrong?

This is very sad. Via The New York Times: The C.D.C. Waited ‘Its Entire Existence for This Moment.’ What Went Wrong? Excerpt:

WASHINGTON — Americans returning from China landed at U.S. airports by the thousands in early February, potential carriers of a deadly virus who had been diverted to a handful of cities for screening by the Centers for Disease Control and Prevention.  

Their arrival prompted a frantic scramble by local and state officials to press the travelers to self-quarantine, and to monitor whether anyone fell ill. It was one of the earliest tests of whether the public health system in the United States could contain the contagion. 

But the effort was frustrated as the C.D.C.’s decades-old notification system delivered information collected at the airports that was riddled with duplicative records, bad phone numbers and incomplete addresses. For weeks, officials tried to track passengers using lists sent by the C.D.C., scouring information about each flight in separate spreadsheets. 

“It was insane,” said Dr. Sharon Balter, a director at the Los Angeles County Department of Public Health. When the system went offline in mid-February, briefly halting the flow of passenger data, local officials listened in disbelief on a conference call as the C.D.C. responded to the possibility that infected travelers might slip away.  

“Just let them go,” two of the health officials recall being told.  

The flawed effort was an early revelation for some health departments, whose confidence in the C.D.C. was shaken as it confronted the most urgent public health emergency in its 74-year history — a pathogen that has penetrated much of the nation, killing more than 100,000 people. 

The C.D.C., long considered the world’s premier health agency, made early testing mistakes that contributed to a cascade of problems that persist today as the country tries to reopen. It failed to provide timely counts of infections and deaths, hindered by aging technology and a fractured public health reporting system. And it hesitated in absorbing the lessons of other countries, including the perils of silent carriers spreading the infection. 

The agency struggled to calibrate its own imperative to be cautious and the need to move fast as the coronavirus ravaged the country, according to a review of thousands of emails and interviews with more than 100 state and federal officials, public health experts, C.D.C. employees and medical workers. In communicating to the public, its leadership was barely visible, its stream of guidance was often slow and its messages were sometimes confusing, sowing mistrust.  

“They let us down,” said Dr. Stephane Otmezguine, an anesthesiologist who treated coronavirus patients in Fort Lauderdale, Fla. Richard Whitley, the top health official in Nevada, wrote to the C.D.C. director about a communication “breakdown” between the states and the agency. Gov. J.B. Pritzker of Illinois lashed out at the agency over testing, saying that the government’s response would “go down in history as a profound failure.” 

“The C.D.C. is no longer the reliable go-to place,” said Dr. Ashish Jha, the director of the Harvard Global Health Institute.  

Even as the virus tested the C.D.C.’s capacity to respond, the agency and its director, Dr. Robert R. Redfield, faced unprecedented challenges from President Trump, who repeatedly wished away the pandemic. His efforts to seize the spotlight from the public health agency reflected the broader patterns of his erratic presidency: public condemnations on Twitter, a tendency to dismiss findings from scientists, inconsistent policy or decision-making and a suspicion that the “deep state” inside the government is working to force him out of office. 

Mr. Trump and his top aides have grown increasingly bitter about perceived leaks from the C.D.C. they say were designed to embarrass the president and to build support for decisions that ignore broader concerns about the country’s vast social and economic dislocation. At the same time, some at the C.D.C. have bristled at what they see as pressure to bend evidence-based recommendations to help Mr. Trump’s political standing. 

Located in Atlanta, the C.D.C. is encharged with protecting the nation against public health threats — from anthrax to obesity — and serving as the unassailable source of information about fighting them. Given its record and resources, the agency might have become the undisputed leader in the global fight against the virus. 

Instead, the C.D.C. made missteps that undermined America’s response.  

“Here is an agency that has been waiting its entire existence for this moment,” said Dr. Peter Lurie, a former associate commissioner at the Food and Drug Administration who for years worked closely with the C.D.C. “And then they flub it. It is very sad. That is what they were set up to do.”

MSF opens coronavirus COVID-19 centre in Venezuela

Via MSF.org: MSF opens coronavirus COVID-19 centre in Venezuela.

More than 100 professionals from different disciplines have set up a specialist COVID-19 centre in a wing of the Ana Francisca Pérez de León II hospital in Petare, northeast Caracas, Venezuela. 

The plan to rehabilitate the hospital’s infrastructure and create an inpatient unit, including intensive care beds, where COVID-19 patients can receive medical and psychological care, is being carried out by Médecins Sans Frontières (MSF) in collaboration with Venezuelan authorities and the hospital's management team. Hospital staff have also received personal protective equipment (PPE) and training.    

MSF staff working with hospital staff across disciplines 

A team, made up of MSF and hospital staff and including doctors, nurses, epidemiologists, psychologists, technicians and transport and maintenance staff, has already begun caring for patients with COVID-19 symptoms. 

“It has been hard work and not without its challenges, due to the urgency of the situation and the need to adapt the hospital structure to the biosecurity measures, without compromising the rest of its emergency activities,” says Isaac Alcalde, coordinating MSF's emergency responses in Caracas and Miranda. “This has been possible thanks to the willingness of MSF staff and the hospital’s management team to find the best solutions for patients. It's a new situation for everyone.” 

Challenges in providing protective equipment 

So far, one of the biggest challenges for MSF in our global response to COVID-19 has been the shortage of PPE for our medical teams.

“We know that, in many countries, health workers have been exposed to risk, and there have been many infections due to the lack of PPE,” says Alcalde. “We will do our best to ensure that this does not happen here.”  

“But even with sufficient protection, the medical teams will face very difficult situations, both personally and professionally,” continues Alcalde. “We will make sure to provide them with all the support they need, including psychological support, to minimise the impact of this extraordinary situation.”   

MSF providing contact tracing, psychological care 

People arriving at the Ana Francisca Pérez de León II hospital with suspected COVID-19 are received by a medical team and questioned about their symptoms before being tested, either with a rapid test or with a polymerase chain reaction (PCR) test. Those who test positive are taken to the isolation area to be stabilised and to receive medical and psychological care. 

An MSF team visits patients’ families to provide health information and psychological support, while actively tracing the patient’s contacts and searching for other people with symptoms within their community. 

The COVID-19 centre has 22 beds, including 16 inpatient beds and 6 intensive care beds. We are also operating three ambulances, and have rehabilitated a further five public ambulances, for transporting patients between hospitals and between local diagnosis centres and hospitals. These are available not only for coronavirus patients but for patients suffering from other medical emergencies.

China publishes plan for dealing with future pandemics

Via Sixth Tone: China Publishes Plan for Dealing With Future Pandemics.

The COVID-19 pandemic has laid bare the shortfalls in China’s public health system, and “mending the weak parts” is now an urgent priority for the country, the Chinese government said in a policy document released Wednesday.  

Improving the country’s testing capacity for infectious pathogens is a major focus of the plan. Authorities’ efforts to respond to the initial COVID-19 outbreak in the central city of Wuhan were hampered by an inability to conduct tests quickly, according to multiple media reports.  

China will ensure there is at least one biosafety level three — or P3 — research laboratory in every province and one P2 laboratory in every city, according to the document jointly released by the National Development and Reform Commission and two other ministries. 

Laboratories are assigned biosafety levels from one to four depending on the containment measures they employ to prevent the spread of dangerous pathogens, with four indicating the highest level of protection.  

SARS-CoV-2 tests in China have to be conducted in P2 labs or above, but many primary hospitals don’t meet the requirements. The lack of eligible testing facilities was a key issue at the start of the epidemic, according to Chen Xi, associate professor of health policy and economics at the Yale School of Public Health.  

“Many people have been discussing the malfunction of the early warning system, which actually has a lot to do with the limited testing capacity at the local level,” Chen told Sixth Tone. “When you’re unclear about the nature of the virus — such as the genome sequencing of the pathogen — there’s no way to develop a testing kit. And without a testing kit, you don’t know who’s been infected.” 

The document also lays out measures to ensure that China has the health resources to cope with future public health  emergencies. It says public venues should be able to quickly convert into treatment and quarantine facilities like fangcang shelter hospitals during a crisis. It also states that China should strengthen its frontline public health facilities, including primary care facilities at the county, township, and residential community level. 

Cities have been given targets for increasing the number of hospital beds capable of accommodating patients with infectious diseases and making them available for immediate use in the event of a future outbreak. Cities with over 5 million residents, for example, must have at least 600 such beds available, according to the document. 

Many Chinese cities expanded their infectious disease hospitals in the aftermath of the 2003 SARS epidemic. During the COVID-19 outbreak, however, there was still a significant shortage of beds capable of admitting infected patients, Cai Weiping, a doctor and National People’s Congress delegate, told Chinese media outlet Caixin. 

While the plan focuses mostly on improving China’s public health facilities, the section regarding potential reforms to the China CDC lacks specific details, according to Chen. Experts have called for the organization to be given a greater role in decision making during responses to future outbreaks. 

Environmental changes are increasing the risk of virus spread, making it essential for all governments to take action to prepare for future pandemics, Chen added.  

“Public health precautions can effectively reduce the risks of a pandemic,” said Chen. “Climate change is global. This time it (the outbreak) happened in Wuhan, but we don’t know where one might emerge next time.”

Mass testing in Wuhan uncovers over 200 asymptomatic COVID-19 cases

Via Caixin Global: Update: Mass Testing in Wuhan Uncovers Over 200 Asymptomatic Covid-19 Cases. Excerpt:

Authorities in Wuhan have found more than 200 asymptomatic cases of the new coronavirus since launching an ambitious plan earlier this month to test all of the city’s approximately 11 million residents. 

As of Saturday, the central Chinese metropolis had conducted 6.68 million so-called nucleic acid tests (NATs) and discovered 206 asymptomatic cases across more than 10 districts, according to notices from the municipal health commission. Disease control authorities announced the initiative on May 11, making Wuhan, where the pandemic erupted last year, the first major Chinese city to roll out mandatory mass testing. 

The new cases underline the difficulties of restoring normal life in disease-hit cities. Although asymptomatic patients don’t get sick with Covid-19, the deadly disease caused by the coronavirus, they can still spread the pathogen to others.

The risk of asymptomatic cases have drawn the Chinese leadership’s attention. On March 30, Premier Li Keqiang stressed that the nation must prioritize control and prevention of those showing no symptoms. 

Zhang Wenhong, a top epidemiologist at Huashan Hospital of Fudan University in Shanghai, said in an article posted on social media that based on his team’s research, 18% to 31% of all infected cases are asymptomatic.  

This means that two to four of every 10 infected cases are asymptomatic, he said. Those who are infected but develop very light symptoms could also be identified as asymptomatic cases for calculating quarantine periods.  

Aimed at preventing a resurgence of new infections, Wuhan’s testing capacity has skyrocketed from 42,000 NATs conducted on May 12 to a high of 1.47 million on Friday, according to Wuhan Deputy Mayor Li Qiangzeng. 

A staff member at Wuhan’s disease control center, who requested anonymity due to the sensitivity of the issue, told Caixin that logistical problems combined with the less-than-perfect accuracy of the tests made it hard to know for certain how many people in the city had the virus. However, mass testing in itself “definitely has advantages for controlling the spread of the disease,” they said.

COVID-19: China publishes plan for dealing with future pandemics

Via Sixth Tone: China Publishes Plan for Dealing With Future Pandemics. Excerpt:

The COVID-19 pandemic has laid bare the shortfalls in China’s public health system, and “mending the weak parts” is now an urgent priority for the country, the Chinese government said in a policy document released Wednesday.  

Improving the country’s testing capacity for infectious pathogens is a major focus of the plan. Authorities’ efforts to respond to the initial COVID-19 outbreak in the central city of Wuhan were hampered by an inability to conduct tests quickly, according to multiple media reports.  

China will ensure there is at least one biosafety level three — or P3 — research laboratory in every province and one P2 laboratory in every city, according to the document jointly released by the National Development and Reform Commission and two other ministries. 

Laboratories are assigned biosafety levels from one to four depending on the containment measures they employ to prevent the spread of dangerous pathogens, with four indicating the highest level of protection.  

SARS-CoV-2 tests in China have to be conducted in P2 labs or above, but many primary hospitals don’t meet the requirements. The lack of eligible testing facilities was a key issue at the start of the epidemic, according to Chen Xi, associate professor of health policy and economics at the Yale School of Public Health.  

“Many people have been discussing the malfunction of the early warning system, which actually has a lot to do with the limited testing capacity at the local level,” Chen told Sixth Tone. “When you’re unclear about the nature of the virus — such as the genome sequencing of the pathogen — there’s no way to develop a testing kit. And without a testing kit, you don’t know who’s been infected.” 

The document also lays out measures to ensure that China has the health resources to cope with future public health  emergencies. It says public venues should be able to quickly convert into treatment and quarantine facilities like fangcang shelter hospitals during a crisis. It also states that China should strengthen its frontline public health facilities, including primary care facilities at the county, township, and residential community level. 

Cities have been given targets for increasing the number of hospital beds capable of accommodating patients with infectious diseases and making them available for immediate use in the event of a future outbreak. Cities with over 5 million residents, for example, must have at least 600 such beds available, according to the document. 

Many Chinese cities expanded their infectious disease hospitals in the aftermath of the 2003 SARS epidemic. During the COVID-19 outbreak, however, there was still a significant shortage of beds capable of admitting infected patients, Cai Weiping, a doctor and National People’s Congress delegate, told Chinese media outlet Caixin.

COVID-19: US has three months to rebuild medical supplies stockpile, Obama administration scientists warn

Via The Guardian: Exclusive: US has three months to rebuild medical supplies stockpile, Obama administration scientists warn. Excerpt:

Nine top scientists who advised Barack Obama in the White House are warning that the US has just three months to rebuild its national stockpile of emergency medical supplies or risk further drastic shortages of testing kits and protective gear should coronavirus strike again in the fall. 

The dramatic warning from Obama’s former science advisers contains an implicit criticism of Donald Trump’s handling of the pandemic. In a seven-page missive, the group says that federal government preparations for a possible resurgence of the disease must be triggered immediately if a repeat of the “extraordinary shortage of supplies” that was seen in March and April is to be avoided. 

“Preparation for a resurgence needs to be initiated now. It needs to be at a national level, in close collaboration and coordination with state and local officials,” the letter says. 

The nine authors, led by John Holdren, Obama’s White House science adviser throughout his two terms in office, criticise the Trump administration for failing to act on numerous studies urging replenishment of the Strategic National Stockpile (SNS) in preparation for just the kind of health emergency unfolding today. 

“The United States was unprepared for the supply needs of the spring 2020 Covid-19 pandemic,” the group says.  

The scientists add: “There has been a persistent shortage of ventilators, testing kits, masks and other PPE [personal protective equipment] … In recent years the nation has let down its guard.”  

The group of nine are among the most pre-eminent scientists in the country. In addition to Holdren, now at Harvard, they include Eric Lander of MIT and Harvard, Chris Chyba of Princeton and Susan Graham of UC Berkeley.  

All nine were members of the Council of Advisors on Science and Technology assembled by Obama at the start of his presidency. Between 2009 and 2016 they co-wrote six reports for the president that touched on viral pandemics.  

Though many other experts have offered advice on dealing with Covid-19, the connection between the nine and Obama sharpens their intervention. The former president is not responsible for any of the scientists’ findings, but he has been kept informed about the group’s progress since its inception.