During the 20th century, two world wars and numerous regional military conflicts claimed more than 150 million lives and decimated entire countries. During the past 100 years, trillions of dollars have been expended assembling armies and building military preparedness to defend homelands and protect the citizenry. However, it has taken less than three months for a microscopic virus (Covid-19) to incapacitate today’s sophisticated world and emerge as a devastating enemy that has endangered entire populations without a shot being fired. This is the first such attack in history where the international community became a petri dish almost overnight. Preparing for a different form of warfare and national defense becomes necessary for survival.

2020 will be remembered around the globe as the year of the coronavirus (Covid-19) pandemic. The 1918 flu pandemic (H1N1) killed more than 50 million people worldwide. Covid-19’s death toll, highly contagious characteristics and cause of other serious health conditions will also create a historic watershed event. The U.S. is particularly vulnerable and should begin to prepare against future assaults, natural or man-made. New dimensions of national preparedness must be a top priority. The future will be led by armies of health care professionals, equipped with modern technologies and techniques to detect, treat and hopefully prevent otherwise devastating pathogens and worldwide pandemics.

Countries have dealt with Covid-19 in various ways, few as transparent as the U.S. or as secretive as China and Russia. Regardless of politics and disaster preparedness, dedicated physicians, nurses, other health care givers and first responders have willingly risked their lives to save others. These heroes, an alarming number who became Covid-19 victims and some who have perished, are the backbone of health care for everyone. Covid-19 has brought their courage center stage for the world to see their commitment to helping others.

Governments and the private sector should have been better prepared to acknowledge and manage Covid-19. Since brushes with Ebola, H51, H1N1, bird flu, etc., warning flags have been flying. On November 1, 2005, President George W. Bush, while speaking at the National Institutes of Health, made a compelling case that the U.S. must adopt and implement a strategy to prevent and protect Americans from a pandemic. The president’s strategy had three elements: 1) detect outbreaks anywhere in the world, 2) stockpile vaccines and antiviral drugs while improving the ability to make new vaccines and treatments for novel pandemic viruses and 3) improve general readiness at the federal, state and local levels. To achieve success, the president asked for $7.1 billion in emergency funding. Contained in the president’s proposal were subsidized state-based stockpiles of antiviral drugs, possible use of quarantines and restrictions on travel and shipments of goods and possible use of the military to maintain the nation’s infrastructure. President Bush’s warning was reiterated in 2015 by Bill Gates but it went unheeded.

President Bush’s leadership received some attention, but his plan was not funded. Today, the U.S. is suffering from failing to heed the warning given in 2005. Current political divides, obsession with political conflict, personalization and blame game tactics undermine the nation’s ability to plan for future pandemics, let alone adopt well-thought-out ways to manage through and recover from Covid-19.

The crush of stay-at-home, quarantine and social distancing orders has taken its toll on many Americans. Social distancing does not mean distance socially, but it is difficult maintain closeness without physical presence. Isolation combined with economic stress and fear of Covid-19 are a recipe for disaster. Rarely has the U.S. faced a simultaneous economic, health and personal safety crisis. Assuming Covid-19 is a once-in-a-century pandemic may be ill-advised considering today’s fast pace, worldwide travel, continuous 24/7 interactions among societies and constant shipments between countries.

Covid-19 has spread ominous clouds over the earth, shed light on past errors and omissions and opened the door for leadership, cooperation and innovation. Responding to the current pandemic is priority one, followed by preparation for the next unseen enemy. This pandemic’s widespread impact sheds light on errors and omissions of the past few decades and should motivate constructive actions by all countries.

Interesting comparisons are raised by the pandemic, including 1) international commerce vs. domestic security, 2) globalism vs. nationalism, 3) short-term economic gains vs. long-term financial stability, 4) unrealistic assumptions vs. historical lessons, 5) collective well-being vs. individual rights and 6) fundamental culture beliefs vs. open-source societies. Values become more important when the natural order of things is disrupted, and Covid-19 potentially is as disruptive as a world war. Life, liberty, safety and opportunity to live as a happy and healthy person are values that are tested during a pandemic. The comparisons above come into play when survival is threatened by something that is elusive and not easily defeated.

Four of the areas requiring rethinking are summarized below:

1. Inadequate understanding of globalism and nationalism in a constantly shrinking world. Globalism should be grounded in universal understanding that the world is interconnected, and all nations benefit when there is cooperation on mutual interests and respect to the independence of individual countries. When globalism morphs into imperialism or invasion by one or more nations, the foundation for a sound and prosperous social order crumbles. Nationalism defined as loyalty to a nation that stands for peace, prosperity and international well-being supports sustainable globalism. Nationalism is counter to the interests of other countries if it evolves into biased or uncompromising commitments to a philosophy that is self-righteous and superior to all other cultural norms. Nationalism should not be confused with patriotism. A patriot is loyal to his/her nation but with the acknowledgement that every person, domestic or foreign, has the right to individual beliefs if security, safety and happiness of the body politic are preserved.

   Oppressive debt of one or more nations can upset the balance of power, stability of nations or health or safety of people. Greece is a recent example. The U.S. is approaching dangerous territory but is in a stronger position to manage its debt. The U.S. national debt exceeded the gross domestic product (GDP) once in history-in 1946 when the cost of World War II put the nation on a long recovery journey. By 1974, the national debt was reduced to 24 percent of GDP. For several years, the debt has increased to pay for daily governmental operations. By January 2020, the national debt was projected to equal the GDP by 2032. Covid-19 remapped the landscape. On April 24, 2020, the Congressional Budget Office (CBO) estimated the Fiscal Year (FY) 2020 deficit will be $3.7 trillion, more than 80 percent of the annual federal budget. The CBO projects the national debt will be 101 percent of GDP in FY 2020, excluding the latest $484 billion relief package recently enacted. A fourth relief bill is being debated and likely would further add to the debt. If interest rates rise, annual payment of interest on the debt will become oppressive.

   Long-held economic theories are being tested. Many economists believe excessive governmental spending (creating larger deficits) will crowd out private investments, drive up interest rates, impede growth in the economy and ultimately create economic breakdown. The U.S. road to unsustainable deficits is complicated by Covid-19. Families and businesses could be wiped out. Poverty may worsen. Pensions could evaporate. Economic security could be at risk. It is not unrealistic that some governments might fail. Fallout from the devastating depression which began in 1929 could be exceeded in less than a century. The U.S. government and private sector are better positioned to utilize tools available today and should lead the nation through this deficit/debt/Covid-19 crisis.

   Financial policies and world economics take various paths during and after a significant, disruptive event. Equity market downturns, revenue losses, cost increases, liquidity pressures, indebtedness and supply shortages influence nations’ views and actions internally and on the world stage. Inequities, vulnerabilities, shortages and gaps identified from Covid-19 provide clarity to issues that must be addressed within countries and globally.

2. Emphasis on short-term profits and the expense of domestic jobs, economic growth and long-term stability. Many countries, including the U.S., have relinquished fundamental drivers of economic growth and long-term prosperity to foreign nations. The U.S. economy would be brought to a standstill if countries such as China closed their borders and stopped all imports into the U.S. When companies moved domestic manufacturing, assembly functions and services to save money, they give up control over their own destiny. U.S. businesses should reassess their vulnerabilities and take steps to become reasonably self-sufficient with respect to essential products, equipment, technologies and services. In critical areas such as defense, health care, security and communications, the U.S. is ill-afford to be dependent of foreign countries.

3. Practices that inadvertently create shortages, price volatility and lack of predictability. Management of expenses is important for all economic ventures. Many companies and organizations reduced warehousing and stockpiling capacity to avoid non-revenue-producing inventory in storage. The downside to this cost-saving strategy is greater dependence on suppliers. When suppliers are foreign, downside risks are magnified. Shortages, price gouging, political leveraging, quality control and supply chain management are compromised. Taken to the extreme, dependence on foreign suppliers becomes a national security risk.

   During the latter decades of the 20th century, hospitals and other companies adopted a “just-in-time” philosophy for inventory management. In some ways, this practice saved money and made supply chain systems more efficient. It also made providers susceptible to shortages (real or manufactured), price hikes and other predatory actions by suppliers. Covid-19 brings into focus the imperative to strike a balance between efficiency, protection and ability to respond to extraordinary situations. The Covid-19 experience has re-emphasized an old lesson — “the supply chain is as strong as its weakest link.”

4. Inadequate systems, physical resources and health care workers to provide health care in extraordinary circumstances. Taking infrastructure for granted can be an easy road to travel but it also is dangerous. Proper maintenance, replacement, provisions for growth and planning for the future take a back seat when too much comfort is given to the status quo. Fixed assets, supplies, personnel and technologies are vital for health care providers to deliver lifesaving services to patients every day and in times of unforeseeable demands.

   Obsolescence in health care is a constant challenge. New equipment and technology surfaces weekly and sometimes daily. Keeping up with every development is virtually impossible. The Covid-19 pandemic has produced at least one stark reality—the old normal in delivering health care will be replaced by a new normal that utilizes practices, virtual technologies and settings that are more digitally based, user-friendly and patient-driven. Digital health, telehealth, home monitoring, home deliveries, etc., used extensively during the pandemic will extend beyond the official emergency period into routine daily practice. This transformation will change behaviors of patients and providers. Space age virtual technology will become commonplace in health care.

   Getting back to the old normal probably will not occur. The new normal likely will involve new practices, use of virtual and other technologies and innovative solutions from people creating ways to cope with challenges like the ones created by Covid-19.

Covid-19 has been a shocking wake-up call to the U.S. and other countries to prepare for their economic and social survival. Failing to act on lessons learned from the pandemic would be a colossal failure. Covid-19 should be a catalyst to move forward and build resources and relationships that transcend politics, profits and past policies. Resolving potentially fatal shortcomings, planning for immediate and long-term solutions, and executing sound strategies will prepare the world for future pandemics, epidemics and disasters. Leadership, funding and follow-through will be at a premium.

Health care is all important when a person’s health is threatened or when a disaster of major proportions occurs. Covid-19 taught us that Americans will make sacrifices when it is in their best interest to do so. At the same time, they also have expectations for economic security, access to health care services and living freely. This crisis has created an unprecedented opportunity for explosions in cooperation, innovation, ingenuity and trust. It is up to all nations’ elected officials and private leaders to fulfill that destiny. It involves a more balanced view of mutual interest and self-interest.

Although economic or social collapse is unlikely, economic and social changes will be more dramatic than imagined or even possible before Covid-19. Just as the significance of Neil Armstrong’s historic first step on the moon united the country and profoundly affected global perspectives regarding space exploration, the international impact of Covid-19 will have a similar effect on health care preparedness around the world. On September 12, 1962, President John F. Kennedy delivered a memorable address on the nation’s space program. He emphasized a sense of urgency and destiny, and has been frequently remembered for his often-quoted statement, “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard. . . . because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.” Forty-eight years later, the commitment from the president who took us into space can be applied to our determination to overcome the current pandemic.

The best of people has been highlighted many times over during the pandemic. One of the most impressive things to come out of the Covid-19 experience is the courage of health care providers and their unselfish commitment to all of us. For that we can be thankful.

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