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Illustration: Sarah Grillo/Axios

The novel coronavirus outbreak has caught the U.S. and the world off guard, and now threatens to break through all containment efforts. But far from being a surprise, the potential pandemic was utterly predictable, as scientists have long warned.

The big picture: The world had its chance to prepare. We failed — and now we'll pay the price.

Flashback: Last October the Johns Hopkins Center for Health Security (JHCHS) put on a high-level pandemic simulation focusing on a fictional global outbreak caused by a novel coronavirus that spilled over from animals to humans.

  • Called Event 201, the exercise brought together policymakers and disease experts to debate how they would respond to the simulated pandemic, in an effort to map out how they could combat a real one.

Along with other reporters, I was there to observe the proceedings. What happened during the fictional pandemic eerily presaged the challenges and conundrums the world is facing with COVID-19.

  • Governments agonized about whether to ban public gatherings and block travel from infected areas.
  • Misinformation — accidental and deliberate — spread over social media, and participants in the exercise struggled to control messaging.
  • The economic effects of attempts to control the pandemic were as devastating as the disease itself, a dilemma compounded by the fact that participants had to make vital decisions with imperfect information about the virus—just as officials must do today.

The final results of the Event 201 simulation were horrific, with 65 million people dying in the exercise.

Why it matters: There's no way of knowing yet whether COVID-19 can cause damage on anything close to that scale. But Event 201 and other predictions about the rising threat from new infectious disease gave us plenty of warning about what the world is facing today.

  • Despite that, in the years before the coronavirus outbreak, the Trump White House dismantled the National Security Council's global health security unit and drastically cut the CDC's global health section.
  • Local health departments lost more than 55,000 workers between 2008 and 2018, according to the Trust for America's Health.
  • "There are major global vulnerabilities and challenges in pandemic preparedness and it will require collaboration between global business, governments and international organizations to address them," said Tom Inglesby, director of JHCHS.

If the current coronavirus can't be contained, the world will fall back on mitigation. But few countries are adequately prepared for what would come next — including the U.S.

  • Problems with tests have slowed the diagnosis of suspected cases in the U.S., giving the virus time to gain a foothold.
  • HHS official Robert Kadlec told a Senate hearing on March 2 that the U.S. had just 10% of the respiratory masks needed to combat a "full-blown" pandemic.
  • "At this point it's tricky to think that this will be kept from becoming endemic," said Jonathan Quick, a former WHO official and the author of The End of Epidemics.

The bottom line: Too often our response to public health disasters cycles between "crisis and complacency," in the words of a 2019 report from the Center for Strategic and International Studies. But we can see these catastrophes coming all too well.

Go deeper

Ina Fried, author of Login
1 hour ago - Technology

Epic's long game against Apple

Illustration: Sarah Grillo/Axios

Epic's Apple lawsuit is costing the company dearly, but the game developer has its eye on a valuable long-term goal: prying tomorrow's virtual worlds loose from the grip of app store proprietors like Apple.

Between the lines: Epic isn't spending a fortune in legal fees and foregoing a ton of revenue just to shave some costs off in-app purchases on today's phones. Rather, it's planning for a future of creating virtual universes via augmented and virtual reality — without having to send a big chunk of their economies to Apple or Google.

Updated 1 hour ago - Health

The race to avoid a possible "monster" COVID variant

Illustration: Rae Cook/Axios

Slow global COVID-19 vaccination rates are raising concerns that worse variants of the coronavirus could be percolating, ready to rip into the world before herd immunity can diminish their impact.

Why it matters: The U.S. aims to at least partially vaccinate 70% of adults by July 4, a move expected to accelerate the current drop of new infections here. But variants are the wild card, and in a global pandemic where only about 8% of all people have received one dose, the virus will continue mutating unabated.

Caitlin Owens, author of Vitals
2 hours ago - Health

Democrats are still looking for a plan on drug prices

Illustration: Rae Cook/Axios

Democrats have no workable plan to tackle the cost of prescription drugs, even with full control of Washington and after campaigning on the issue for years.

The picture: Voters still care about the cost of drugs, but Democrats don't have a feasible legislative strategy yet — or an agreed-upon policy to fit into a legislative strategy.

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