After disasters, responding agencies typically complete “after action reviews” to assess what happened and why, to identify successful and unsuccessful practices, to learn how to sustain strengths and improve on weaknesses, and to disseminate critical lessons. For a catastrophe on the scale of covid-19, this agency-level approach will not suffice. If the review is to be accepted as comprehensive and objective, it must be prepared by a trusted organization committed to the national good and to avoiding political bias. This entity must have adequate resources, sufficient staff and unquestioned access to information.
Such a report must not be limited to assessing when officials knew, or should have known, about covid-19 and its likely scope. These are intelligence issues, and although they are important, there is far more to understand. In national security, it is not enough to know that an attack is coming. Intelligence about an imminent attack is best utilized by a nation with appropriate resources to respond.
By analogy, the scope of the covid-19 assessment must be broad enough to learn what the pandemic reveals about our ability to deal with health crises. That includes understanding how the impact of the outbreak in the United States was shaped by how we prepared our resources: the state of our public health system; the ways we deliver health care across the nation; the roles, responsibilities, and resources of our health agencies; how we do and do not support hospitals and health-care workers; and our medical and pharmaceutical supply lines and purchasing policies.
A model for such an organization is the National Commission on Terrorist Attacks Upon the United States, also known as the 9/11 Commission. The independent and bipartisan commission was created by congressional legislation signed by President George W. Bush. The commission was charged with preparing a complete report on the Sept. 11, 2001, attacks, including assessments of national preparedness and response, and providing recommendations for improvement. Just under two years later, the commission delivered a final report with 41 recommendations that reshaped the U.S. domestic security and preparedness system, including the creation of a new Cabinet-level agency, the Department of Homeland Security.
It already is clear that the U.S. experience in the covid-19 pandemic warrants such an assessment. The United States now has the world’s largest number of confirmed coronavirus cases, and more citizens have died from covid-19 than were killed in the 9/11 attacks. The projected economic impact of covid-19 likewise exceeds that of 9/11. The nation has inadequate testing capabilities and shortages of personal protective equipment. Authorities struggle to find much-needed patient beds, health-care equipment and supplies, and trained health-care workers to care for our citizens. States are taking unprecedented steps to limit public activity. We must learn from this event to better prepare for crises.
For these reasons, now is the time for Congress and the president to appoint and adequately fund an independent, bipartisan commission to prepare a complete report on the nation’s response to the pandemic. Clearly, such a report will not be completed while the outbreak rages. But by immediately creating and funding a Covid-19 Commission, the president and Congress can take steps essential to that commission’s success, including:
· Appointing commission members and assembling their staff so that they can outline their report, pose questions that must be answered and identify information resources, while recognizing that questions and resources will change as the outbreak progresses;
· Requiring departments and agencies to maintain records of meetings and other decision-making processes, data collected and actions taken in their covid-19 responses, and to make those available to commission staff;
· Encouraging state and local governments, relevant nongovernmental response organizations (such as the American Red Cross) and business organizations (such as health device and pharmaceutical manufacturers) to likewise maintain records and make those available to the commission; and
· Allowing commission staff or designated representatives to embed within departments and agencies during response efforts to facilitate data collection.
Creating a Covid-19 Commission now might seem like a distraction from the response. It is not. The information and personal observations needed for effective after-action assessments are best collected while they are fresh, a fact recognized by the Army. In April 2010, even before the World Health Organization declared that the 2009 H1N1 pandemic was over, the White House directed departments and agencies to prepare after-action reports of their individual performance. Many states did the same. We should create the Covid-19 Commission and get it working now.