Preparing for the Next Global Outbreak

A Guide to Planning from the Schoolhouse to the White House

This day has been a long time coming. Our book is officially released today!

You can access our book from local bookstores, Walmart (beginning 4/24) and many other distributors, including:

1. Through Johns Hopkins University Press https://www.press.jhu.edu/books/title/12896/preparing-next-global-outbreak.
2. Through Amazon https://www.amazon.com/s?k=preparing+for+the+next+global+outbreak&i=stripbooks&crid=1QOIUSEF2AJ7L&sprefix=Preparing+for+the+next+%2Cstripbooks%2C169&ref=nb_sb_ss_fb_1_23

In print, Kindle version or audiobook.

• As an audiobook https://www.audible.com/pd/Preparing-for-the-Next-Global-Outbreak-Audiobook/B0C1TGGDN2.

How did this book come to be?

In May of 2020, while I was learning everything I could about this novel virus and the disease it causes; providing 4 – 5 press and media interviews/day; fielding calls from friends, family and business owners seeking advice as to how to mitigate their personal or business risks; answering questions and providing education on Twitter (@drpatesblog); talking to local health care leaders; learning what I could from and asking questions of virologists, epidemiologists, immunologists, and infectious disease physicians; and serving on the Governor’s Coronavirus Work Group, my wife suggested that I write a book about all this. I remember my response: “I don’t have any time to write a book.” All of the above activities consumed every day as well as the majority of the day.

In late summer, some private schools asked for my help as they prepared for their fall opening. In October, a large public school district asked for my help the week before teachers threatened to call in for a sick day and parents had begun picketing because almost everyone was unhappy with the school district’s handling of the pandemic.

In late November, I received a call from a dear friend and colleague – Dr. Ted Epperly. Dr. Epperly is President and CEO of a network of federally qualified health centers that care for disadvantaged Idahoans and he runs the Family Medicine residency training program in Idaho. He had served on the Central District Health board – the largest public health district in Idaho – for 15 years, until the Ada County Commissioners decided to replace him with a physician who was promoting disinformation about COVID-19 and particularly anti-vax misinformation.

I remember the call well: “David, we should write a book together.” Well, now two people who were important to me were saying the same thing. I remember thinking at the time that the US and the world had gotten so much of this wrong, and I did feel that it was important to document the mistakes, the successes and the lessons learned given that a future pandemic is certain, and we cannot afford to repeat the same mistakes. I also remember thinking that there certainly have been books written about past pandemics, but not a book that had the kind of behind-the-scenes details of what happened and the lessons learned from those pandemics. Seeing the need for a book that would actually help prepare us for the next pandemic based upon the lessons from this one, I answered Dr. Epperly, “yes,” before we hung up.

What is this book?

The book contains 117 recommendations for those whose responsibilities include pandemic and public health emergency planning and for those from the World Health Organization to the CDC, to the White House, to state and local elected leaders to school leaders and their school board members. While this book should be of interest to all public health and health care leaders, many people throughout this pandemic realized that they did not often get good, reliable advice and may be very interested in the book as they realize that during the next pandemic (which I will be greatly surprised if we do not experience within a decade), they need to be in a position to discern multiple sources of conflicting information to decide the best course for themselves and their families.

This is not really a book about the COVID pandemic, rather it is a book about preparing for the next global outbreak based on the lessons learned from the COVID pandemic.

What does the book cover?

Chapter 1: The SARS-CoV-2 virus and the COVID-19 pandemic

In this chapter, we recount how the COVID-19 pandemic unfolded abroad, in the US and in Idaho. We explain a lot of the concepts about how a novel virus is transmitted, infects people and is spread across countries and continents. We introduce many essential concepts of epidemiology, virology and immunology. We also discuss the concepts of herd immunity and post-viral syndromes. We also provide our first 12 recommendations in this chapter.

Chapter 2: Pandemic Surveillance and Early Response in the Future

The COVID-19 pandemic gave us many opportunities to see how delayed our recognition of an outbreak of a novel virus can be, especially if that outbreak occurs in a closed society or highly authoritarian one, and how inadequate our current responses are to contain the outbreak. Our travel bans did little to contain the entrance of the virus into the US, in fact, the first identified case entered the US days prior to the implementation of the travel ban. We also saw how ineffective our symptomatic screenings of passengers arriving from another country were. In this chapter, Dr. Epperly and I provide 6 recommendations to improve both our surveillance and response to future outbreaks.

Chapter 3: The Intersection of COVID-19 and Society

We saw the profound impact social media played in this pandemic. Further, we saw how politics dominated the pandemic response, including at the highest levels of the federal government to the most local of politics – school boards. We provide 17 recommendations in this chapter.

Chapter 4:  The Haves and Have-Nots

We have known that there are intrinsic racial and ethnic disparities embedded in the US health care system long before this pandemic. However, these became amplified during the pandemic. While much has been written on this general topic, we provide 4 recommendations with respect to the handling of the next pandemic.

Chapter 5:  The Growing Fire

In this chapter, we discuss the public health reactions and interventions and the public push-back to those measures. We make 7 recommendations for the future.

Chapter 6:  Man versus Virus

In this chapter, we explore examples of differing public health responses on the part of countries, states and even counties and the resulting outcomes achieved. We make 2 recommendations in this chapter.

Chapter 7: Needed Changes to the Federal Response

In this chapter, we make 9 recommendations for changes to the federal preparedness and response to future pandemics. One huge issue that is not receiving near enough attention is the vulnerabilities of our national stockpiles and supply chains.

Chapter 8:  The Future Role of the States

The COVID-19 pandemic demonstrated that, absent changes to our federal approach to future pandemics, states will carry the heaviest burden. States must make changes to their public health emergency plans accordingly, and we would recommend a reevaluation of the state’s public health structure and infrastructure, including considerations of state stockpiles.

Chapter 9:  Preparing Future Doctors, Nurses, and Public Health Workers for the Next Pandemic

This current pandemic exposed national and regional shortages of health care professionals, and also demonstrated the pressures that could be placed on our health care capacity due to health care workers being infected or exposed to the virus. In our careers, neither Dr. Epperly or I have ever seen the amount of hostility and disrespect shown to health care and public health workers. As a consequence, we are seeing the early retirements, resignations or change in type of work in all of these groups of professionals that is further threatening pre-existing shortages. We make 10 recommendations in this chapter that are of urgent and great importance given that we don’t know how much time we have until the next pandemic.

Chapter 10:  Preparing Public Health Departments for the Next Pandemic

Since the many advancements in the 1900s involving sanitation, water quality and food handling, the investments in public health have dwindled. The new threats of global travel, ecological pressures resulting from man’s continued encroachment on wildlife habitats and the increasing proportion of new, emerging infections that are the result of zoonotic transmission (animal -> human) have been underappreciated and under-funded by legislative bodies. We make 12 recommendations in this chapter relating to improving and strengthening our public health infrastructure and functioning in preparation for the next pandemic.

Chapter 11:  The Rejection of Science

During the pandemic. We experienced an overwhelming push of misinformation, disinformation and conspiracy theories, often promoted by well-organized, well-funded groups, as well as foreign adversaries, in a very coordinated manner that undermined our public health efforts to a very significant degree. We provide 6 recommendations to better confront these efforts in the next pandemic.

Chapter 12:  Dangerous and Erroneous Approaches

In this chapter, we review two failed approaches to bringing this pandemic under prompt control – the sequestering of elderly and high-risk individuals and the promotion of infection in the others in order to achieve “herd immunity,” and the considerations involved in these two approaches for future pandemics. We make 3 recommendations.

Chapter 13:  Vaccines and Variants

We first review considerations for the development of new vaccines in response to a future novel virus, as well as some recommendations on implementation of vaccination programs. We then discuss the risk for development of variants with failure to control the wide-spread transmission of a novel virus, especially RNA viruses. We provide 5 recommendations.

Chapter 14:  Preparing Schools for the Next Pandemic

This is my wife’s favorite chapter, and I suppose mine as well. It is a critically important chapter because schools play a critical role in the transmission of epidemic and pandemic viruses. It is our favorite chapter because we provide new and original recommendations that I developed while advising schools that are effective and can be of tremendous benefit to school leaders and board members who are generally ill-equipped to manage a pandemic response with poor guidance from federal public health authorities. We provide 6 recommendations in this chapter.

Chapter 15:  Leadership Lessons from the Pandemic

There are many leadership lessons resulting from how various leaders at all levels of government and the US health care system handled the pandemic. Some leaders excelled during this time, many failed, and most were in between. We discuss these leadership lessons and attributes and provide our final 10 recommendations.

Chapter 16:  Recommendation Checklists

In this chapter, we pull out all of our 117 recommendations and conveniently group them by type of organization that will be involved in the preparedness for the next pandemic and management of it. This is intended to assist all these types of organizations as they hopefully will now update their pandemic plans.