“Action speaks louder than words but not nearly as often.” ~Mark Twain (1835-1910)

COVID-19, often referred to as coronavirus, has dominated the news as this new viral threat spreads across the globe as the latest major pandemic. Pandemics are nothing new in world history:¹ HIV/AIDS pandemic (at its peak, 2005-2012) 36 million dead, flu pandemic (1968) one million dead, Asian Flu pandemic (1956-1958) two million dead, flu pandemic (1918) 20 to 50 million dead, sixth cholera pandemic (1910-1911) 800,000 dead, flu pandemic (1889-1890) one million dead–and the sordid list continues into recorded history. Any student of medical history is not surprised by this latest plague beyond the fact that it did not happen sooner.

Yes, improvements in the general hygiene (in the developed world) of humans on this planet and the incredible contribution of vaccinations (thank you, Edward Jenner–smallpox vaccine, 1798) has improved general health and accounts for many human plagues being eliminated or at least uncommon. Unfortunately, the diabolical simplicity of viruses and their ability to evolve and propagate within a human population, preying on our basic customs and interactions, is the stuff of a horror movie. Furthermore, traditional barriers to viral spread, geographic distance and oceans have been overcome and rendered meaningless through modern modes of travel. Viruses do not respect borders, walls, gates, political affiliation, religion, race or even wealth.

Article 1, Section 8 of the U.S. Constitution holds the legislative branch of our government to “provide for the common defense and general welfare of the United States.” No government on Earth has produced an organization as successful and powerful as our Department of Defense to protect our population from enemies foreign and domestic. This taxpayer expense is well-founded since there is no shortage of countries and/or organizations that would do harm to our society and way of life. Wikipedia suggests that approximately 2.85 million Americans have died in all this country’s conflicts from 1775-2019. Pandemics typically achieve this butcher’s bill in just a year or two.

While you will get no argument from me that the world is a dangerous place and we must be prepared, I am not sure we are preparing for the most lethal enemy we face. Si vis pacem, para bellum is the classic Latin for the phrase, “If you want peace, prepare for war.” Based on the sheer volume and scale of death throughout history attributed to ‘disease nonbattle injury,’ it would seem the lion’s share of our investment in defense should be preparing for war against pandemics.

Going to “war” against these viral pandemics may be cliche, but this is an enemy far more insidious or dangerous to America than any enemy soldier or terrorist could hope to be. You cannot see this enemy as it attacks, capitalizing on the most innocuous of human interactions like a handshake. After it has invaded your home, it indiscriminately strikes your family, adult and child alike, and it kills without reason or remorse with the only goal of replicating and moving on to the next victim. The viral adversary does not have an agenda, a cause to defend or an ideology, nor does it negotiate. It simply replicates, moves on to the next host, killing a percentage of the individuals it happens upon. As an aside, the 1918 influenza mentioned earlier killed between 2% and 3% of those infected, which explains why that percentage regarding the COVID-19 outbreak is so prominent in the news.As an Army Reserve Officer Training Corps student in college during field training problems, we were taught that, when ambushed, the absolute worst response was paralysis, and the best reaction was to attack the ambushing enemy with as much violence as achievable as quickly as possible. Attacking an ambush is against basic human instinct that would have you run from the danger. If leaders expect their troops to respond appropriately to an ambush, the attack response must be ingrained in them through training, if they have any expectation to successfully survive. The COVID-19 virus certainly seems like an ongoing ambush to me. Perhaps a viral illness is not as evident as a human ambush. However, I think I have developed the argument that it certainly is no less deadly. The federal medical response should be no less violent and determined.

“So what do we do? Anything. Something. So long as we just don’t sit there. If we screw it up, start over. Try something else. If we wait until we’ve satisfied all the uncertainties, it may be too late.” Lee Iacocca’s comments on decisiveness fit nicely concerning how I feel our federal government should be responding to this latest viral threat. I have been underwhelmed by our national response to this crisis thus far, mainly since it appears we have greater concern for the threat impacting our financial markets as opposed to aggressive action to attack this viral assault. The $8.3 billion tax dollars recently appropriated for government agencies dealing with the COVID-19 is an excellent start, but this is reactive rather than proactive. Multiple Presidential budgets have called for cuts in the Centers for Disease Control and Prevention, although wisely Congress has prevented this action. Based on the historical risk to American lives represented by pandemics, that far outstrips risk perpetrated by human enemies, it would seem prudent to double down on our investment in federal resources, like the CDC, that is capable of assaulting a viral ambush of this country.

I have discussed in previous editorials our government’s rather anemic response to infectious disease outbreaks, such as the viral Zika outbreak transmitted by mosquitoes. I believe the same investment expense we make willingly in super aircraft carriers and stealth aircraft should be directed toward preparing for pandemics. That investment would likely translate into considerably more protection to the American public. As federal healthcare providers, we are the footsoldiers on the frontlines of this latest attack. Certainly, we should be teaching best practices to protect ourselves and our patients from viral contagion, (i.e., handwashing, avoiding close personal contact and staying home when sick). These are all passive measures after the outbreak. I think it is time that we become more aggressive in our understanding of viral threats, the development of vaccines and efforts to attack viral epidemics at their source. COVID-19 will not be the last pandemic, and we need to invest and train to attack the viral ambush.

¹https://www.mphonline.org/worst-pandemics-in-history/. Accessed 6 March 2020.