U.S. mishandling of Covid response costs tens of thousands of lives, Hildreth says

Dr. James Hildreth, CEO of Meharry Medical College and a member of the new U.S. COVID-19 Health Equity Task Force, offered a pointed assessment of the nation’s early response to the COVID-19 pandemic, criticizing a lack of coordination among its 50 states and missed opportunities to protect the country’s most vulnerable populations that led to avoidable deaths.

“It is an understatement to say that, at least early on, the pandemic was handled very poorly on a national level,” Hildreth said Friday, speaking at a virtual forum hosted by Nashville-based Pinnacle Financial Partners for banking clients. “If we’d had a coordinated mitigation strategy, where all of us did the same things at the same time and focused on the most vulnerable populations, tens of thousands of people who are dead would still be with us today.”

As of March 5, the Centers for Disease Control and Prevention reported more than 517,000 people have died from COVID-19 in the U.S., a country that makes up about 4 percent of the world’s population and 20 percent of its COVID-19 deaths. Former President Donald Trump looked to governors to determine how to mitigate virus spread in each state, leaving a patchwork of varying policies across the country at the same time mask wearing became politicized.

Hildreth, an infectious disease doctor, has become a leading local and national expert on confronting Covid-19. He advised Mayor John Cooper on Nashville’s approach to the virus and is a member of the U.S. Food and Drug Administration panel that has approved vaccines for overcoming the virus. He urged Gov. Bill Lee to issue a mask mandate in August.

Hildreth, who did not mention Trump by name, described the FDA and Centers for Disease Control and Prevention as “handcuffed by politics,” which was “a huge problem” for combatting the virus, along with having 50 different approaches to the virus.

He said the same mistakes of decentralization have been made with vaccine distribution and he recommends vaccinating the most vulnerable groups first, a strategy that he said has been complicated by politics and issues of race. He is hopeful that a strong vaccine supply will alleviate the shortcomings surrounding vaccine rollout and said there is now a coordinated national response on both the virus and vaccines.

Hildreth pointed out that the number of global cases and deaths is climbing to levels seen during the 1918 pandemic, a time when hospitals lacked ventilators, infectious disease doctors, intensive care units, antibiotics and antiviral drugs.

“Imagine 100 years later, with all the technology and expertise we have, the pandemic has reached the same levels it did in 1918,” he said. “That makes some serious statement about how we’ve handled this.”

The U.S. must not repeat the same mistakes when another coronavirus spreads, Hildreth warned. He said there are nearly 40 strains of coronavirus that exist in bats, which could also eventually be transmitted to people.

“I hope that one of the things that comes out of this is that this will be the last time we are so unprepared for a public health crisis,” he said. “I don’t think this will be the  last pandemic we will deal with, and so we’ve got to be better prepared next time.”

The virus has also exposed inequities in U.S. health care, Hildreth said, criticizing the lack of focus on populations more susceptible to COVID-19. The greater impact of COVID-19 on Black and Hispanic populations in the U.S., where rates of cardiovascular disease, hypertension,  obesity, diabetes and cancer are higher, was “predicted and predictable.” He pointed to death rates in states across the U.S., where Black residents died at much higher rates than white residents, at times at ratios of 10 to 1 or 6 to 1.

“It’s an understatement really to say there has been a disproportionate burden of disease and death for minorities in the United States,” he said.

While Hildreth criticized the nation’s lack of a unified response in the early months of the pandemic, he praised the coordination he has witnessed among scientists globally and he highlighted the new partnership between Merck and rival drugmaker Johnson & Johnson meant  to expedite vaccine production.

“You have collaborations between scientists in different countries like we have never seen before,” he said. “Many scientists who worked on other things put their own research on pause to join the fight against Covid-19.”

While there has been skepticism surrounding the Johnson & Johnson vaccine because of its lower efficacy rate, 66 percent globally and 72 percent in the U.S., compared to about 95 percent with Pfizer and Moderna vaccines. Hildreth emphasized that the most important data point to focus on is its effectiveness in preventing hospitalization and death related to Covid. It can also be stored more easily and only requires one shot.

“This vaccine, like Moderna and Pfizer, offered complete and total protection against hospitalizations and deaths,” he said, repeating the data point for effect. “That is what we should be focused on.”

Hildreth said masks will need to be worn until there is a “high level of confidence” that herd immunity has been achieved. He also emphasized the need for supporting vaccination efforts in countries with fewer resources as a means of eradicating the threat of COVID-19, which could once again overwhelm the wealthier countries if a variant emerges that does not respond to the established vaccines.

“The world has become a small place and until everyone on the globe is protected, none of us are,” he said. “If the virus is not controlled in those places, a variant may arise that is a disaster scenario, that the vaccines have no effect against, and the world will be starting all over again. It’s in everyone’s best interest that we vaccinate the whole planet as soon as possible.”