Measuring the U.S. Government's Response to the COVID-19 Pandemic

Mari Megias:

Good day everyone. I am Mari Megias, in the office of Alumni Relations and Resource Development at Harvard Kennedy School, and I'm very pleased to welcome you to this Wiener Conference Call. As we all continue to navigate the new normal brought on by the pandemic, we will be increasing opportunities for remote engagement with Harvard Kennedy School. So keep your eye on your email for more invitations to learn from HKS faculty. Also, given that we are all working remotely, we're running these calls a bit differently, so apologies in advance for any issues we may experience.

Today, we are fortunate to be joined by Juliette Kayyem, who is the Belfer senior lecturer in international security. Kayyem has spent over 15 years managing complex policy initiatives and organizing government responses to major crises in both state and federal government. A national leader in homeland security, resiliency and safety, Kayyem appears frequently on CNN as a national security analyst. Previously, she served as President Barack Obama's assistant secretary for intergovernmental affairs at the Department of Homeland Security. There, she played a pivotal role in major operations, including handling of the H1N1 pandemic and the BP Oil Spill response. She also organized major policy efforts in critical infrastructure protections and community resiliency. Before that, she was Massachusetts Governor Deval Patrick's homeland security advisor, guiding regional planning and the state's first interoperability plan, climate change policies, and overseeing the national guard. Given her expertise, we're very fortunate that she has chosen to spend some time today with HKS alumni and friends. Juliette.

Juliette Kayyem:

There we go. Thank you so much for having me. I'm so excited to be on this call. I recognize a lot of the names, and it's just a great opportunity to maybe bring you up to speed about where we are, where we all are today in an area that I have been in for a very long time. I am a senior lecturer at the Kennedy School with support from the Belfers as having their title attached to my senior lectureship, which is fantastic and have worked with a number of you. My weird expertise today, and what has sort of brought me to the forefront in a lot of these issues is both, not just my federal government experience, which included H1N1. So there was a leadership team for the President during H1N1. I'm happy to talk about those comparisons. As well as having served as a homeland security advisor for Governor Deval Patrick. So I have a strong sense of what states need and the sort of intersection between state, local and federal coordination.

At the Department of Homeland Security, I was assistant secretary for intergovernmental affairs. What that means is my job was to integrate state, local, territorial, and tribal governance systems into a national effort and that was either on policy, everything from immigration to Arctic issues, to also operations, so H1N1, BP Oil Spill, terrorism, and other issues.

I come to you now as a senior lecturer at the Kennedy School and the faculty chair of two relevant programs that have been really lucky with Bob Belfer and other support to maintain within the Belfer Center. That's relevant because homeland security has often been viewed as the, I have to admit, the lesser child of international security and I've struggled through the years to make it relevant to the way we think about America's safety and security. We tend to, in the past, have thought about it as diplomacy, war, law, and intelligence. Those are like the four buckets. As we're seeing today, our own capacity in the homeland is very relevant for our own safety and security, and honestly for our own homes.

So the two programs I run as faculty chair is both the Homeland Security Project, which we started about two years ago to just give grounding at the Belfer Center in these areas of homeland security and not just immigration, although that's relevant, and border management, but other borderless threats that we face from, of course, pandemics to cybersecurity to terrorism. The other program that we started, also with support from Bob and others, is the Security and Global Health Project that we run out of the Belfer Center. I tell you that because that's been sort of the nexus of where a lot of this activity at the Kennedy School has been happening on the security operation side, as I'm going to get into that today. So we've been really lucky to stood this thing up, stood this project up last fall, trying to get people to pay attention to us. Now we're trying to get people to ignore us, or hopefully.

I thought what would be helpful today, now that I've positioned myself in terms of my expertise, is to talk to you about where we are in terms of the coronavirus or COVID in terms of crisis management and disaster management. Because while the virus is new, actually crisis management is not. It's a skillset. There's a number of classes taught on it at the Kennedy school. It's rigorous, it's complex and complicated, but it's not rocket science in the sense that there are procedures and processes that have been tested over time. So, positioning ourselves in that might give you some grounding because I think we're all feeling ungrounded. Even someone like me who is pushing for a lot of this stuff in January and February that you're seeing now to just give us some grounding.

So most crises have five phases. So I want to talk through those phases with a focus directly on coronavirus. The first phase of when you think about the world, the first phase is called protection. It's sort of, what do we wish as a society we had done before that thing happens to protect ourselves? When you think about this pandemic, we wish we had had a more rigorous surveillance system, more focused maybe on food security, more support for the WHO, which was obviously monitoring this before us. So you put those things in sort of the protection docket, thinking about, okay, how do we protect ourselves from a global pandemic?

The next phase is called prevention, which is what do we wish we had put in place assuming that the bad thing is coming that would minimize the impact of it? Think about a cockpit door, a lock on a cockpit door. That's an easy way to think about prevention. You may not be able to stop all terrorists, but you can prevent them from getting into a cockpit in an airplane. There, you are all familiar with it. I'm sure you are following along. A more rigorous testing system here in the United States. The surging of resources to hospitals, greater communication to the American public, because I think many of us were quite shocked at going from “normal” to “not normal” within a day.

I think communication to state and local. I think when we look back, their lack of understanding of what was coming, what we knew to be coming and what we now understand the White House knew to becoming when it was clear China could not contain the virus. Really, I think probably exposed more American citizens than ought to have. Social distancing really did not come into play until early March with San Francisco being one of the first to rigorously enforce it. Looking at the numbers, it looks like that was a smart thing to do. But you'd think that anyone calling in from Louisiana or New Orleans, you know the Mardi Gras did go forward in February, and the mayor there will tell you that they had no clue about what everyone else was worried about.

The next phase, or I guess the intermission now is what we call the boom. Think of prevention and protection as left of boom. Think about the things we wish we could do to stop the bad thing from happening, then the boom happens. In my space, we tend to think about an all hazards approach. The boom could be anything. It could be a hurricane, two brothers at the finish line of the Boston Marathon, a cyberattack. You then respond to that. The challenge of course, as we all know of a pandemic is there's no single moment of activation. If we had been told in January, with no cases, that we all had to stay inside, again, we would have all thought that any leader, any governor or president was crazy.

A slow roll crisis like a pandemic, it becomes very, very hard to know when is that moment when you say, okay, there's a before and after. You're seeing variations of that sort of boom moment. That's one of the challenges of a pandemic is you really, there is a light switch. You, all of a sudden, go from watching this thing coming to now all of a sudden we're responding without being able to see it. Unlike a hurricane or a terror attack, we know how to mobilize for those, and may not do it perfectly every time, but we know how to mobilize.

The next phase though after the boom is where we are now, and that's the response phase. It looks familiar in some ways and very unfamiliar in others because it involves all of us. Most responses to a crisis will involve a public safety apparatus that is tested and trained and knows how to do this stuff. We are now in the flattening of the curve to slow the spread. We're in trying to, well, let me say, we are now in the assumption of vast community spread, which I think is a fair assumption without the capability of testing for who has it. Our only tool, honestly, our only tool right now is simply to slow the spread, flatten the curve, all the stuff we're doing to protect our healthcare system. It seems, that tool though, the good news is, is that tool, at least from what we're seeing some numbers out of New York right now, certainly seeing them in San Francisco and that we see internationally, it's a successful tool. So no matter how much you think this is all so horrible, it's not for not. It's actually working in terms of just lowering the shock of how many people are going to get it.

So our response is essentially a strong social distancing program. It's not national here as many of you who follow the news know. Eight states still have ... it's so hard to imagine because most of us, I guess on the phone, are probably in states that ... We've been home a while. There are eight states which have no social distancing rules right now, none or minimal ones. Nothing like what most of us are experiencing. The White House has not taken a strong hand in this in terms of its guidance. Although members of the White House science and medicine team certainly have been out there pushing for national social distancing standards, which would essentially close all schools, close all restaurants, do what most of us are doing.

That's the stage that we're going to be in as this wave comes over in the next week, two weeks, three weeks, depending on where you are, and almost all of it being done without good data. We don't even have a very sound CFR, the case fatality rate. We think it's around 1%, but we don't know what our denominator hit is in the United States. In other words, 1% of what number is exposed. We're getting better with testing, but we're not in any position to have confidence in what the exposure is.

This is where the truism about crisis management becomes reality, which is a crisis hits a nation as it is not how we want it to be. The discrepancy in access to healthcare, the racial disparities in healthcare, the economic inequities in health delivery systems are going to, not be solved by the pandemic, but be exacerbated. So, while all eyes are focused on New York, I'm looking at numbers out of rural Georgia and those are not good. They just don't have the capacity. We don't even know what the fatality ... our confidence in the fatality rate will also be in question.

I want to spend a few minutes now. So this is where we are, a couple more weeks. Well, I'll talk a little bit about my family later, but all I say to people is get your head around it. It's not tomorrow that we are out of this, and I would be surprised if it were any time before mid-May. Because the more it works, remember about flattening the curve, the more we flatten, the longer the curve is. You've all seen the visual, right? So it flattens and then it extends out. That's actually a good thing. It means it's working and you're protecting your healthcare system.

I want to spend a few minutes on the counter philosophy to social distancing, which we hear a lot, especially in the business and financial community. I want to be clear here that no one who promotes strong social distancing as the only tool to fight this right now is immune to the economic impacts. The idea that we do this happily, that people in security or global health do this happily is ridiculous. We know the burdens on people, in particular low income people, in particular people who are in the gig economy. We're well aware of that. The problem is those who promote either getting out earlier or balancing the economy greater. Chance to answer two questions. Most of them, I will be honest with you, do not come from the space that thinks about long-term economics. Honestly, I think a lot of it is some just outside the box pontificating.

The two problems with coming out too early, in other words, to protect the economy is, those people who promote that can't answer two questions. One is, what happens if the healthcare system falters? In other words, if New York is only dealing with this as a surge response, they've got army personnel, they've got ships, they're changing the Javits Center, all of this stuff. If that crumbles, you can't have a functioning society if your health delivery system is not functioning. We can fix it later, but right now we just got to get through this period.

The other is, I think more significant. To have a virus novel with no strong treatment yet, I'll get to that later, and no vaccine within the year, to have it spread unregulated is going to have more economic downturns than fewer than what we're doing now, which is sort of a sledgehammer. The reason why is because pockets of outbreaks, and large pockets, will impact cities that will then have to close down if only because they're going to have lots of dead people or sick people. If anything, to stabilize the economy, we simply have to commit to various metrics that we will satisfy in order to open up, and that those metrics have to do with testing capacity, healthcare capacity. I wanted to address that because I know that that's a sentiment out there, and it's not either or. It is, obviously at some stage we're going to have to let go a little bit. It's not right now, but in the next couple of weeks and begin to get people out and about. People like me who are strong on social distancing and are not immune to the economic impact, but we also know that the economic impact is probably less now than it would be if we were to go out too soon as many of you note as we're starting to see in countries that have to, like Japan and Singapore, that have to go back to really aggressive measures because they let out too soon.

Okay. Let me then turn to, so what does the next 18 to 24 months look like? Or actually I should say two to 24 months. As I said, we're in the response phase. The next two phases in crisis management are recovery and then resiliency. So, it's protection, prevention, then the boom, then response, recovery, resiliency. As I said, it's not rocket science, but it's just the way people like me in this field think about it. No different than a military mission. This is how we do it in the homeland. Recovery is interesting because I believe that this pandemic is changing the way that we should be thinking about what recovery is. Recovery or the new normal as many of you probably think about it, really won't come until the vaccine is made, and then I got to add on two things to that, manufactured and distributed. The identification of a vaccine will probably come in the next, or vaccines, will probably come in the next couple months. You then have to test them, manufacture, and distribute them globally. That is not tomorrow, and that is why you see numbers like 18 to 24 months. When you think, when will things be back to normal? When will I not be worried about masks or school districts closing or my businesses closing, I'm telling you that date, if we're lucky, is 2021, sometime later in 2021.

That's the sort of new normal and that is what recovery looks like. But between where we are now, of course, and that date, which let's put at the end of 2021, don't despair. In other words, what we're gonna do, and this is the new concept I've been working on in terms of just maybe adding a little bit of intellectual vigor behind this chaos, is what I'm calling the adaptation phase. That actually, I would add a new phase into crisis management. That's going to be between the time that we start to come out of our homes when there's more testing, more identification, more treatments. There's going to be more tools available to us. Living differently. I think we'll go to restaurants differently. Restaurants will have different capacity. Maybe it's a while before we go to concerts or movies. We need to think about what that adaptation phase looks like because that's gonna be the longest. That's gonna be between two to three months of social distancing and the vaccine. No one’s thought much about that.

I think this adaptation phase, so let me say between June of 2020 to, maybe if we're lucky, November of 2021 when we get the vaccine, is going to be a bit of a dance. It's gonna be, it's called whack-a-mole, call it what you will. It's gonna be a combination of better testing and tracing. In other words, people get tested, if they are ill, then their families and them have to isolate. It's going to be investments in treatment so that if you do get exposed, at least your respiratory system is protected, because that's really what is killing people. It's not the fevers or dehydration, it’s people can't breathe. It's going to be new technology and new tools for home care. Even if you are having problems breathing, you can do things at home or have devices at home that help you. In other words, to protect the healthcare system. And any other number of tools that, the way to think about it is, that will let us manage to live with the virus. That's the way I think about it. We're not eliminating it. We're just going to learn to live with it. It's kind of scary when you think about it because it will be different. I won't even call it a new normal. It will be like, what I've been calling the now normal. It'll just be every day, you might get a notification that your market had two employees that tested positive, so the market has to close down. It's gonna be a lot of that sort of dancing. That's what we're seeing in countries that are beginning to open up. Lots of testing, lots of triage, sort of whack-a-mole, and a slow opening, beginning with schools, which is a key to the now normal that then will get us to the vaccine.

So I hope that helps you think through the next two years of your life. There's no other way to talk about this and it's misleading, treatments are great, all these things, but it's misleading to think that there's a single cure before the vaccine. That it’s going to be a combination of tools, maybe some of the things that are being promoted now by the White House, maybe a combination of treatments that are actually being scientifically tested in meaningful ways. NPR had a story this morning that was terrific on some new treatments. So I'm hopeful that that adaptation phase will feel a lot more normal than this stuff. But it's not gonna feel like 2019, and it won't for a while. I think the only way I've learned to talk about it is just tell the truth, that planners like me, that's what I do. I'm not a doctor. I think about the threat and then what am I thinking about in the homeland, that's how we're thinking about it.

Okay, so three final things and then lots of questions we saw already came. I've got about five more minutes if that's good from the alumni team. I want to just talk about three, or actually two, because I talked about the vaccine.

Obviously everything comes down to testing. We seem to have no national agenda for a rigorous testing regime. The President pushed back on a reporter that asked, a female reporter that asked him that yesterday. We go nowhere without a testing regime. So, if you are to put your political equities anywhere, it is there. Because without rigorous testing, we simply will then expose too many people to the virus as we try to open up. This is exactly what happened in January and February. We knew that it was coming. We had not surge testing capacity, and then all of a sudden, all of us woke up to realize there was vast community spread. When people say when, I don't answer with a date. I say, here are my metrics, here's what I'm looking for. Number one is more rigorous testing capacity. I'm also looking for hospital capacity, other things like that. That's the first. Testing, as I said, in public, the failure of testing was the original sin because it gave us no time. We, all of a sudden, were inside. It is also our only salvation. It's our only way to actually be able to have a real adaptation period.

The second area, I'm going to do all three because I just want to raise something about the vaccine. Just because every day is a new moral quandary. The vaccine, I was involved with the vaccine distribution, the H1N1. This is going to be one of the most difficult governance challenges facing, either this president or the next president, because it won't happen until 2021. But vaccine distribution will happen state by state. It won't happen in a single moment. We'll get a supply. That supply will then be distributed to states who then decide whose arm it goes into. The general protocols are first responders, health responders, military, the things that makes sense in terms, cops, police officers, firefighters, things that makes sense from the sort of making things work. But after that, there's no real protocols for a nationwide vaccination program that has to be done. We set up a system known as pods in vaccine, points of distribution, that worked for H1N1, but that didn't have the immediacy that this does. That's just something to look out for. There's ethical issues. There's supply issues, but this is something that people are already thinking about fortunately.

I want to end though with the headline, which is the supply chain and the Defense Production Act. This is where, I don't mean to sound too political, but this is where someone like me looks at something and goes, “I'm not quite sure why” someone who knows how the system works, like “why is it working this way?” The supply chain and logistics are, as I said, complex and complicated. They're not intellectually hard. This is not getting a man on the moon. They are governed by expertise and systems that have been refined over the decades, taken from the military with words like ICS and NIMS and ESS and data calls. It's the way the operations are done and it's a second language to people like me.

So what we know or what we're experiencing in the U.S. is the country's first 50 state disaster. What I mean by that, it was obvious that all 50 States are actually activated. In other words, like we've had disasters that impact or that are national in scope, 9/11 obviously, Hurricane Katrina, Sandy, the BP Oil Spill, but in those instances, maybe five, six states are activated in terms of people working it. The general rule during those crises has always been, well, if a state's capacity gets overwhelmed under a mutual aid agreement, they'll just turn to the next state and ask for help. So it's why, those of us in Massachusetts right now, it's why you'll see stories about the wildfires in California. And it's why we can send 80 firefighters from Massachusetts to California. California requested them under a mutual aid compact, and Massachusetts is more than happy to send them because they're, but for the grace of God, go, I, as Massachusetts, then one day we’ll be asking California for help. It's the same mechanism that worked during the Boston Marathon. We had 297 needs for hospital care. Three people, of course died at the finish line, but 297, many of them with a lost arm or lost limb, needed hospital care. Rhode Island, Connecticut, New Hampshire area hospitals opened up under mutual aid agreements with a cost share provision. That's the way it works.

You can't do that in a 50 state disaster. No governor or very few governors, although we've seen a little bit of it, would be willing to give up too many resources to the next state. That's why you really do need a strong federal national hands. You need someone to take management of resource allocation, and that's what you haven't seen. That's what I wrote in The Atlantic as you know this is the Articles of Confederation disaster response, right? Every state, either working around the White House or getting very frustrated by the lack of organization, supply chain organization, at the top. That includes, and I'll end with this, with the failure of the President to meaningfully invoke the Defense Production Act, the DPA. Most of you probably have read about it by now, but it's a Korean War Act. Though it has been amended to include homeland security efforts that allows the President to do two things. I think we're focused only on one of them, but actually the second I think is more relevant. It allows the President to direct manufacturing. Companies get paid. This is not a taking, this is not socialism. They get paid, fair market value, to change their manufacturing priorities. So this is what you're hearing about ventilators and other masks and other things. That's great, but the President has not really, honestly, there's been a few things that have been pressed, but mostly the changes you're seeing are voluntary. The problem with voluntary is, gets to my second issue, which is the other thing the Defense Production Act does, which makes it a really smart statute for times like these, is it forces the fair market value of the price, because it's a sellers-market, you've got desperate buyers. You've got States that are desperately wanting to save the lives of their people and protect their healthcare frontline with PPE, personal protective equipment. What you would want to see is the fair market value of those commodities that are already in the market be capped, and you're not seeing that. There's lots of gloves as you'll read. There's lots of gloves in the market. The problem is, is that they're being sold at such high prices because the seller can do so. One of the benefits, if the President did invoke the Defense Production Act, would be to make sure that price gouging does not occur.

I can't explain to you why it has not been used. There are theories. I'm not going to get into them. It's just good for you to know that there are tools that ought to be used in a 50 state disaster that are not being used. All that means is that, just is going to delay our capability to get to the adaptation phase, which we should all care about because we're all getting sick of each other at home.

Without further ado, I talked probably too long, but this is, I'll end where I began. The virus is new, but crisis management is not. I hope this at least grounds you in where we are. Because like all of you, I do find this a little bit jarring. Thank you.

Q: How are you as an expert and your family preparing for several more months of isolation?

Yeah, that is such a good question. I saw that on the list. I thought, oh my God. I think my first call for a national social distancing was in, when I started to see the numbers, was in mid-February. That's just the nature. One would hope that an expert would see something before everyone else does. In some ways, one of my sons said to me in a moment of trying to get him to talk to me because he's a teenage boy, said, "Well, it kind of helps that you're my mother." In other words, I was asking him how he felt, and I guess I was talking about it a lot at home.

So, a couple of things. Early on, I prepared the kids for not a date certain and prepare them for not going back to school. I think that was the hardest thing. I have one daughter at Brown and two, one in high school at the local Cambridge Rindge & Latin, and another one in middle school. If they got back to school, that'd be great, but I needed them to psychologically prepare for that. Because I think we don't know how this is impacting kids. For those of you with kids, if you want to know this, I've asked my kids. The only thing, I'm not very demanding in terms of homeschooling, I'm just working too hard. So there's a lot of screen time here, but I do have them journal a couple minutes a day just because I don't know how this impacts kids of that age, let alone younger kids and stuff.

We prepared for all the things that I urge people to prepare for in terms of provisions, although I should tell you the supply chain outside of healthcare is working. There's not been a massive drop off. There's been shortages. Most of those shortages are because people panicked. You don't need more toilet paper presumably or that much more toilet paper. Just people panicked, and so if something's out is only because of the panic purchasing.

I started wearing a mask about a week ago. I'm rigorous on social distance. The kids can go for walks with the dog as long as they don't see anyone. I let the two older kids take the car just to get some fresh air, but I do do mask now. That is just, I think both, part of that is signaling, part of that is, I can't talk about mask on CNN and then not wear one.

Otherwise, then just trying to make the house as normal as one could, given the situation. But I do not give them a date certain. I'll just end with this. My sarcastic, unhappy 16-year-old son turned to me the other day and he said, because we always do these big family trips every summer. It's the only time I get to have all five of us together, and we were supposed to go down South Africa for safari this summer, which I canceled. And he said, "I just want you to know, mom, there was no family vacation this summer. We've had enough family time." I was like, "You're probably right. We will do five different houses for our family vacation." I think they're ready for at least through May.

Q: Hi. Thank you. My name is Dan, I’m a physician in Nashville and Italian. Thank you. Thank you for your usual thoughtfulness. I was really interested to hear some additional thoughts. I really liked the adaptation phase that you outlined. I think, as somebody like you, well appreciates, and as we sort of appreciate in the healthcare field, there's not going to be a day on the calendar where we go back into some old year. Whether it's the new normal or now normal, as you said, things are going to be different for a long time, maybe perpetually. For a society that has essentially in brace position or has been, or at least most of us hope we all are, can you talk about, from your leadership perch, how do you message that to the general public in a way that is credible and in a way that hopefully, avoids the general public saying, at some point, "Ah, the heck with this. I'm done with this"?

Yeah. Thank you, and I just want to pick up, and thank you for what you do. I just want to pick up on that last piece. A bunch of things are going to happen and I'm preparing for it. One is obviously if social distancing is working, it will look like people like me overreacted. So how am I going to prove that absolute social distancing, if we can keep the numbers below 120,000. In my head, I'm at about 200,000 dead just looking at the metrics. If we can keep it below that, it will look like we overreacted. There's going to be a sort of reckoning there and we're prepared for it. People in my field, you never get praise for solving something.

The other thing is, if the testing, this is why I'm so focused on testing, takes too long, people are going to just get frustrated with the social distancing and we're going to have basically what happened in Singapore, which is people, you just come out too early, so we don't want that.

Ways that I message it, and I'm lucky to have platforms with The Atlantic and CNN and NPR, so I'm able to, at least try to counter this idea of either a wonder drug. There might be a wonder drug, but there'll be multiple wonder drugs and a date certain. Ways that I message it, and I should say that, to praise the Kennedy School again, but one of the major programs we have out of the Kennedy School, of course, is the Bloomberg Cities Program. Bloomberg pivoted, within like two days, I must have gotten a phone call like two days after social distancing started in Massachusetts. We now have a vertical within the Bloomberg Cities that’s solely focused on this. I've done three weeks of training, three classes, a couple hundred mayors each, President Bush, President Clinton have both shown up to sort of do the rah, rah. So, the work at the Kennedy School, we're trying to get to that tactical level in terms of communications. So what I told the mayors is, in your messaging, it's not a date certain, its metrics. And here's what you're looking for. The other is you got to ground in yesterday, today, and tomorrow. This is where Cuomo has been really successful. His press conferences are not as oh, he's such a smart guy, just riffing. If you actually look at the format, it is, here's where we were yesterday, here's what's happening today, and here's what we hope for tomorrow. It's got that narrative, which is I think very helpful for people to ground.

Then the third piece is, I do talk about this now normal. Get your head around it, whatever. You have to be honest with people because the worst thing would be for people to imagine that there's a light switch turning back on. The analogy might be better as a dimmer or whack-a-mole that there's going to be this adaptive dance. Getting people grounded in today is helpful, but also tomorrow will be a different now normal depending on what we see. But it's new. It's a new way of trying to communicate disaster because a hurricane, you have the buildup. I see a category five, okay, everyone evacuate, then you have the response, here's what we're doing, and then one day you're in recovery. That happens in, unless it's a Hurricane Katrina, but that happens, you're done in seven days. Your worst hurricane, Sandy. Sandy, from the moment it forms to the moment you're in recovery, it's seven days with two to three days of horrible in terms of tragic response. It's hard, but that's what we have to do. Clarity, honesty, the things you're getting from Fauci and others is key and the quick fix, I think that's the harmfulness of, forget the drug itself, but I think that's some of the harmfulness of some of the President's statements is that idea of a quick fix. I just think that's not happening. It's going to be a lot of short term fixes.

Q: Hi, I'm a mid-career from 2005. Thank you so much, Juliette. It's very calming to hear your voice. My question, I'm beginning to get concerned obviously with the elections and having poll workers getting sick and some states that seem very partisan that they may go forward with an election like Wisconsin. What do you think about our national election? Do you think that we're looking at that already? If you're talking about 2021 as the timeframe, that really concerns me that something could happen at the national level.

Right. I think there's reason to be concerned and so I'll do my worst case scenario, which is, I thought the Supreme Court's ruling, those of you not following, in Wisconsin was crazy. Here's the Supreme Court of the United States, which is in isolation. The Supreme Court has closed down for the rest of the year insisting that the Wisconsin Supreme Court, which denied the delay for mail and voting supporting the Wisconsin Supreme Court. So you're seeing pictures today of that distancing. There's fewer poll places open. People can't take that time off. So I do think that this is going to be an issue. So, states that can manage to change their rules and time, there's no federal prohibition of mail and voting. We can do it. Two states only do it, right? So, we know how to do this and secure it. States that have the political desire will do that.

I think though the November date, so okay, so then you think about the summer. I think both conventions will be canceled. I think they ought to be, I think it's probably good modeling. You can do something virtually, have the candidate figure out a way in which this is done. But I think the idea of bringing every political leader of both parties together by July or August, even though the Democrats have delayed, I think it's unlikely. Even though we'll be out of our homes, I just think that kind of interaction may not be that smart.

I do think by November if we have the testing right, we'll probably be fine. In the sense of some combination of early voting, mail and voting, and in-person voting, we'll have capacity for that because by then, we'll be long have been managing. We'll be in adaptation phase. I think Wisconsin, but that's November, today, I cannot believe that the Supreme Court did not give Wisconsin a few more weeks. Honestly, the hypocrisy of it. The Court closed down, and yet they're making voters vote. It's just like, it's like, okay. But I'm hopeful for November.

Q: So my question is, I think the Belfer Center is uniquely placed to see the intersectionality between diplomacy, intelligence, homeland security, and the other functions of international relations that you discussed. During this adaptive phase, we were going to need a lot of internal focus. I think that's playing out for instance, with the Teddy Roosevelt and what was happening in the Pacific. What would you be considering in terms of our external approach, whether it's through international organizations or else-wise to allow us to have that internal focus? Do you have concerns about our adversaries taking advantage of this at this time?

Yes, I do. You're already seeing it on health disinformation. In fact, the program I was telling you about Security and Global Health, we have a paper out on health disinformation. The same way that the anti-vax movement is promoted by Russia as a way to disaggregate the communities or disunite communities. We're seeing that now, both from China and Russia.

On the more physical side, maybe it's a blessing, maybe it's a curse, but because every country is inwardly focused, the aggression is unlikely to play out right now. Iran is in really bad shape. Even if the numbers they're telling us are true, they're in really bad shape, one has to assume that they're not true.

I think though, where the long-term national security implications are going to be, how did we get out of this? If the US ends up being the most dysfunctional, the most highly impacted, which I think we already are, the most geographically dispersed, high concentration of cases, so that's the thing that worries me from a planning perspective. Again, I'm not a doctor, but I just, we've got lots of cases in lots of different places in the United States as compared to say, Italy, which was able to isolate and in China, to a certain extent. And we come out of this much later than everyone else. That's a statement to the world, our allies as well as our adversaries that maybe this experiment wasn't so good. In other words, if China and more authoritarian governments emerge, let me be clear here, I don't believe China's numbers either, but if they emerge stronger, then I think that is, to the same extent that we saw the orientation of the world head towards China anyway, I think that just increases it.

It's just too early to tell what our numbers will be like. I'm probably, as I said, between the 100,000 and 200,000 range, like Fauci.

Q: Yes. Hi, I'm in New York City. I have a question about what you think about the varying death rate in the various countries. Do you think that these are actual numbers or it's just a matter of how the records are kept? For example, I understand that in Germany, I read this somewhere, I don't know if it's true, but in Germany, if you had an underlying condition and you passed away, then your cause of death might be recorded as pneumonia as opposed to COVID, and in the US I guess it's the opposite.

Right. That's exactly right. That's such a good question. We do not have a reliable CFR, case fatality rate. It's somewhere between 1% and 2%. I will say that in terms of who was exposed, but then as I was saying earlier, we don't even have competence in that number. It'd be very unlikely that the United States is below 1%. There's theories about smoking, but we have more obesity. So if you think about cardiac issues, then any doctors on the call are probably thinking through all the preconditions that matter here in the US, but if Italians smoke or vape more, we eat more, so how that cuts across. So I don't have confidence in terms of the exact number. All I know is I have yet to see a country that's below 1% however they're counting it.

This is a deadly, deadly virus, 10 times more than the flu, and the way people die is horrible. All of us are either one degree now removed or probably two degrees removed from knowing someone. I'm in that range, and that's a big range. That's the difference between 400,000 people dying in 200,000 people dying, but I've never seen anything under 1%.

Q: Hi, my name is Regan Smurthwaite, I'm an MPP from 2019, and I was curious, so the title of this presentation was measuring the federal response to COVID-19, and so I was wondering if you had any thoughts about beyond a success, keeping the death toll to a minimum, the speed at which a vaccine is developed, tested and distributed. How do we measure success?

Yeah. This is such a good question, and I wrote about this because in disaster management, your success is, remember the Imperial study, the thing that got, I think the White House to now focus, is Imperial study was a report done out of Britain that put our death toll between 1.2 and 2 million. That was the thing that when things started to change at the White House was, so anything under that, this is the problem with crisis management, anything under that looks like a success. Boston Marathon, you have, 297 people didn't die, right? The 297 people who were sent to area hospitals, if you made it to a hospital, you didn't die. Three people died at the finish line, is that as success? How do I even say that? Three people are dead, but it's a horrible metric. The way I describe it is, in homeland security, unlike the military, in the military, we have metrics based on acceptable losses, right? Do you invade Normandy? Well, I'm going to weigh the number of service members I'd lose compared to the benefit of being on Continental Europe during World War II. I have some number in my head and it's a high number. We don't have acceptable losses in the homeland. I have three kids. You're going to tell me one of them is, no one thinks like that. I think that's, when you say what success? That's going to be the hard part. What I do know, so I do know success, as you said, is going to be testing and it's going to be keeping my fatality rate lower, availability of ICU beds available, availability of respirators, ventilator masks, protection of healthcare first front-liners and first responders and then, can you get your economy back to 60% or 70%?

I will say, I follow all of the econ people, both of the Kennedy School, but also Goldman Sachs and stuff just to get a sense. Those of us in disaster management, we're kind of cracking up when they say we're going to come roaring back in Q2 or Q3, and you look at what they're projecting out, there is no roaring until, if we're lucky, late 2021 because the metrics are so difficult to judge at this stage.

Q: Hi, I was also going to ask you about the interaction with the politics, the November election. How confident are you that we'll be largely out of the woods by then in the sense that some of the epidemiologists that I've been hearing talked about a second wave? I work in philanthropy around politics and elections and decisions about migrating to a fully mailing all registered voters a ballot, would basically have to be taken now because it's quite a complicated transition. Yeah, so eager for your thoughts.

I think, as I said before, I think I feel more confident about November because again, we're just buying time now. All I want is more tools available so that there was either, this round or second wave, I'm able to trace it, track it, manage around it, accommodate it, whatever I'm going to do with the virus until we have a vaccine. So, I think we'll be fully in that stage, even if there is a second wave that the second wave will probably not be, I think we're just smarter about second wave than we were in 1917, and are looking out for it.

It is dependent, as you know, on a very rigorous testing system and the fact that the media is not focused on this one issue, it's the only thing that's going to get us out and about. I have confidence that we'll get our act together. I just think it's going to take longer than we want. That's something I would want the national media to focus on, but the President can't delay the November. November is in the Constitution. They'll probably be lots of shenanigans going on as we saw in Wisconsin. I think there'll probably be less than we're fearing right now. I'm hoping.

Mari Megias:

Great. Well, thank you very much for that answer, and thank you very much for joining us on today's Wiener Conference Call, Juliette. I would like to apologize to everyone that we did not get to, but you can please call into our next call, which is Thursday, April 16th at noon with Amitabh Chandra, who will discuss the market behaviors in developing treatments and vaccines for infectious diseases. Thank you very much.

Juliette Kayyem:

Thank you.