How an outbreak became a pandemic

The defining moments of the COVID-19 pandemic

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What happened, what choices were made, and what can we learn?

In physics, a “moment” is defined as the change in direction produced when a force acts to move a system around a pivot point. The moments we describe here are the critical junctures which changed the direction or nature of the force of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the pandemic it caused. Some are discrete moments in time; others are more extensive. Together, they account for where we are today, and why.

The Panel has ranged widely in its investigations, consulting experts within and beyond the health sector, hearing from those on the frontline, from midwives and nurses to city mayors, obtaining the perspectives of women and youth, the private sector and people living with chronic diseases. Its analysis synthesizes the evidence from hundreds of studies of responses to the pandemic and its impact. That volume of information is daunting but, as the Panel compiled it all, key themes emerged clearly and were held in common across the world, despite the very different lived realities of the COVID-19 pandemic in different countries.

The evidence the Panel gathered showed that decisions mattered and had consequences. It also showed that prior conditions mattered — there was much more freedom to act and more choices available in those places where a robust and resilient health system existed, where social and economic protections were solid, and where governments, scientists and citizens trusted one another to do their best.

It is a basic human trait to make sense of new information on the basis of past experience. We could not function any other way. But when we encounter something genuinely new, that trait can lead us astray. We alternate between the paralyzing anxiety of indecision, when faced with something truly unpredictable, and the temptation to impose our old models on the new events, whether they fit well or not. This pandemic has seen plenty of evidence of both reactions.

As the Panel submits its report, nearly one-and-a-half years into this pandemic, it is tempting to assert that it is “obvious” what should have been done at each stage in the past, based on the knowledge we have gained now. But that temptation fails to respect the difficulty of decision- making when a new disease is emerging and the radical uncertainty about how it will unfold.

Our account of 13 defining moments on which the response to this pandemic has turned is based on a meticulous examination of the evidence and the evolving knowledge. We look at the state of preparedness prior to this pandemic, the identification of the virus (SARS-CoV-2) and the disease it caused (COVID-19) and responses globally, regionally and nationally, particularly in the pandemic’s early months, and the wide-ranging impact and social and economic crisis it has precipitated up to today.

The pandemic is not yet over. It is continuing to surprise us. The moments described below will therefore have a sequel. The “defining moment” of the end of the pandemic is the most important one of all, but that is yet to come. How we approach that moment will depend on how willing the world is to take stock honestly, but without blame or rancour, and determine what could have been done better, and how to ensure that is the path that is taken in the future.

Health care workers help to register people for their vaccinations at a community clinic Credit: Watsamon Tri-yasakda