What Covid Tried to Teach us — and Why it Will Matter in the Next Pandemic

Stat News | By Helen Branswell
 
Five years ago this week, STAT was interviewing nervous infectious disease scientists about a mysterious disease spreading in the central Chinese city of Wuhan, located roughly 500 miles west of Shanghai. On Jan. 4, 2020, we published the first of what would become a torrent of articles on the disease now known as Covid-19. 

The intervening years have both sped and crawled by, too busy at times to take stock of all that has changed, too plodding to believe we have arrived at this anniversary already. (The first case of Covid in the U.S., in a person who had traveled to Wuhan, was not confirmed by the Centers for Disease Control and Prevention until Jan. 20, 2020.)
What do we have to show for the time that has passed? Not enough.

There’s a saying attributed to all sorts of people that one shouldn’t waste a good crisis. In public health, especially, learning from disease outbreaks and environmental disasters is critical; figuring out what worked and what didn’t is fundamental to emergency response planning for the next time. Much as we all might hate the idea, the fact remains that there will be more pandemics. We cannot wish them away and we imperil ourselves if we do not prepare for them. Already, there are renewed concerns about the potential for an H5N1 flu pandemic, with the virus tearing through U.S. dairy cow herds over the past year and also infecting at least 66 people in this country, most of them workers exposed to infected cows or poultry. 

And yet there haven’t been the types of post-mortems or after-action inquiries that normally follow an event of the magnitude of the Covid pandemic. In 2021 a group of experts in public health, science, and other fields began to lay the groundwork for what they thought would be an independent commission looking into the handling of Covid. When the Biden administration decided not to appoint such a body, the group turned its work into a book that was published in the spring of 2023. “They didn’t have an agenda in mind. They could not articulate even to themselves internally as to how the system should change,” the lead author, Phillip Zelikow, said at the time of the administration’s decision to forgo an inquiry.

We appear to be trying to teach ourselves the lessons of Covid the hard way. 
So as we ruminate on the fact that a half-decade has passed since Covid entered our world, here are some thoughts about things we will likely have to deal with when the next pandemic hits — realities that can be traced back directly to the Covid experience.
Public trust in public health institutions has cratered

The CDC has long been the world’s preeminent public health agency. It’s not a coincidence the Chinese, European, and African equivalents are called China CDC, the ECDC, and the Africa CDC. But at the beginning of the Covid pandemic, when the United States was trying to identify newly infected individuals to limit transmission, a test devised by the CDC — the only one in use at the time — failed. Mistakes happen, but that was a bad mistake to make at a very bad time to make it. A successful test would not have stopped Covid. But the unsuccessful test made the CDC look inept just when the country turned to it to chart the path forward.

Later, messaging from officials at the CDC and elsewhere in the government discouraged the public from wearing masks, in part — though this was not generally acknowledged out loud — to preserve scarce supplies for health care workers who were forced to reuse disposable surgical masks for days on end because hospitals couldn’t replace them. Then the guidance shifted and people were urged to mask up even out of doors, with the CDC’s website offering instructions on how to make a mask using hair elastics and T-shirt fabric. A surreal read even back in 2020, those instructions can still be found in the agency’s online archives…

How the DOGE Agenda Could Impact Medicaid, Veterans' Healthcare

Fierce Healthcare | By Noah Tong 

Axes and chainsaws, not butter knives and chisels.

That’s how Department of Government Efficiency (DOGE) commission co-chair Vivek Ramaswamy describes the approach he and world’s richest man Elon Musk will take to reducing the size of the federal government.

Musk has said he wants $2 trillion slashed from the budget, a figure that borders on ambition and an impossibility depending on who you ask. Benefits to Medicaid could be on the chopping block.

The duo outlined their goals in a Wall Street Journal op-ed. DOGE will work with the Office of Management and Budget (OMB) to rescind regulations and cut costs, they say, on the belief that recent court cases give them authority to reverse prior executive overreach under other administrations.

They also want to reduce the head count of federal employees at agencies by skirting civil service protection norms, mandate in-person work (with support from some senators and despite union pushback) and move agencies out of Washington, D.C.

Lastly, Musk and Ramaswamy intends to “take aim” at unauthorized spending from Congress to eliminate funds to Planned Parenthood. If possible, Trump and co. are looking to sidestep the 1974 Impoundment Control Act, which ensures a president cannot refuse to release congressionally appropriated funds to programs. The strategy to fight impoundment law in the court system is endorsed by former House Speaker Newt Gingrich.

Lawmakers fluctuate on how they hope to accomplish the DOGE’s plans. Some say entitlement programs like Medicare and Medicaid won’t be touched, while others make no such promises. Outgoing Rep. Michael Burgess, R-Texas, suggested the DOGE eliminate redundant departments (PDF) within the the Centers for Medicare & Medicaid Services.

Fierce Healthcare took a closer look at the healthcare implications of the DOGE and recent comments made by Ramaswamy and other Republicans on Medicaid and veterans’ care.

Healthcare for veterans 

On Nov. 13, just over one week after the presidential election, Ramaswamy denounced expired government programs that account for $516 billion each year.

“There are 1,200+ programs that are no longer authorized but still receive appropriations,” he said on X. “This is totally nuts. We can & should save hundreds of billions each year by defunding government programs that Congress no longer authorizes. We’ll challenge any politician who disagrees to defend the other side.”

Top of the list of these programs is the Veterans’ Health Care Eligibility Reform Act of 1996, costing the government $119 billion a year. This law continues to self-authorize and receive discretionary funding each year through spending bills. The law expired in 1998 but continues to provide medical benefits to veterans today.

Does Ramaswamy actually want to de-fund this program, which has the potential to be politically devastating to his party?...

Medicaid 

If the DOGE and the Trump administration are looking for cuts wherever they can find them in the $6.75 trillion federal budget, and all of discretionary funding accounts for $1.7 trillion, they will have to look toward Social Security, Medicare or Medicaid for further action.

Ramaswamy is leaving the door open to reform Medicare and Medicaid by eliminating waste and fraud through program integrity measures, reported multiple news publications. He has also called on reducing duplicative payments for individuals enrolled in Medicare Advantage and veterans’ healthcare.

Republicans could be shy to cut benefits to Medicare and Medicaid, but lawmakers seem to be keeping an open mind. Rep. Ralph Norman, R-South Carolina, said “nothing is sacrosanct” following a closed doors DOGE meeting with Musk and Ramaswamy in early December. Other lawmakers—like Reps. Brett Guthrie of Kentucky and Mark Alford of Missouri, as well as Sens. Rand Paul of Kentucky, John Cornyn of Texas and Chuck Grassley of Iowa—say various options of federal program reforms are possible.

Cuts to Medicaid could be pushed in one or two big reconciliation packages where only a simple majority is needed, said Kristin Wikelius, chief program officer at United States of Care, a think tank advancing expanded health access. Medicaid policies will likely mirror Trump’s first term. 

There is likely to be return to work requirements for state Medicaid programs, said Eric Levine, associate principal at Avalere. Those requirements normally look different on a state-by-state basis

“You can see redder states implementing them as a way to reduce enrollment for a populations who would be deemed able to work and to not divert resources from the traditional Medicaid population,” he explained…

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Input Needed on the Impact of Ageism in Health Care

Comments due Saturday, March 15, 2025

The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality is seeking information regarding the impact of ageism in health care. This request is open to the public and is part of an effort to better understand and quantify the impacts of ageism on health care quality, including aspects related to safety, timeliness, patient-centeredness, equitable distribution, and care outcomes. They are also seeking to understand how the effect of ageism differs across population groups and are interested in identifying efforts and innovative strategies and programs that address and mitigate ageism to optimize older adults' health.

Details on how to submit comments are available in the Federal Register notice.

For additional information, email [email protected] or call 301-427-1364.

Go to Federal Register

National Alliance for Care at Home Statement on the Death of Jimmy Carter, 39th President of the United States 

National Alliance for Care at Home / Press Release

(Alexandria, VA and Washington, DC) – The National Alliance for Care at Home (the Alliance) extends its deepest sympathies to the Carter family and the American people for the loss of Jimmy Carter, the 39^th President of the United States and the Founder of the Carter Center. We mourn this profound loss. 

President Jimmy Carter devoted his life to service above self. As a young man, he had a distinguished career as a Naval officer before serving as Governor of Georgia and later, as President of the United States. After his time in office, through the Carter Center, President Carter and Former First Lady Rosalynn Carter led incredible efforts to increase peace and improve health around the world.  

Consistent with his life of service and leadership, President Carter made the courageous decision in February 2023 to publicly share his choice for hospice care. Since then, he received hospice services from the comfort of his home surrounded by loved ones. By making his choice public, President Carter once again led by example, showing Americans how to embrace a stage of life that many don’t want to think or talk about. He showed the nation how hospice helps patients live full lives at the end of life.  

In 1979, Carter was President, and the budding hospice movement was growing. There was no Medicare Hospice Benefit, so hospices ran on volunteer work and donations, meaning access was quite limited. The Carter Administration ran demonstration programs at 26 hospices to test how hospice might work as part of Medicare. Those demonstration projects helped prove the model and led to Congress passing the law under the next administration that created the Medicare Hospice Benefit we know today. Carter’s leadership as President helped create today’s hospice care, and even through his death, he continued to light the hospice path for all of us.  

“On behalf of every member of the Alliance, thank you to the late President Jimmy Carter and the entire Carter family for bringing hospice care into the national conversation and helping everyday Americans become better equipped to think and talk about their end-of-life journeys and wishes,” said Alliance CEO Dr. Steve Landers.  

Join us in recognizing and thanking President Carter for his impact on social media by using the #CandlesforCarter hashtag.