Pandemic predictions and preparations prior to the COVID-19 pandemic

Following warnings and increased preparedness in the 2000s, the 2009 swine flu pandemic led to rapid anti-pandemic reactions among the Western countries. The H1N1/09 virus strain with mild symptoms and low lethality eventually led to a backlash over public sector over-reactiveness, spending and the high cost of the 2009 flu vaccine. In the following years, national strategic stockpiles of medical equipment were not systematically renewed. In France, a €382 million purchase of masks, vaccines and others for H1N1 under the responsibility of the Minister of Health Roselyne Bachelot was widely criticized.[3][14]

The French health authorities decided in 2011 not to replenish their stocks in order to reduce acquisitions and storage costs and rely more on supplies from China and just-in-time logistics and distribute the responsibility to private companies on an optional basis.[3] The French strategic stockpile dropped in this period from one billion surgical masks and 600 million FFP2 masks in 2010 to 150 million and zero, respectively in early 2020.[3]

Richard Horton, editor-in-chief of The Lancet, suggested that economic austerity policies played a role in the United Kingdom (UK) "failing to act upon the lessons" of the 2002–2004 SARS outbreak and of the UK being "poorly prepared" for the COVID-19 pandemic.[8]

The UK preparedness have been documented.[15]

The US government updated its pandemic plan[16] and public guidelines[17] [18] in April 2017. In January 2017 it had updated its estimate of resource gaps[19] [20] and a list of issues for the US government to consider (called a playbook).[21] The plan and guidelines were public. The estimate of resources and list of issues were not public, though they were not classified and reporters have obtained them and made them public.ref name="nat5"/>[21]

The military's estimate of resource gaps in January 2017 noted "Deficiencies and vulnerabilities... lack of infrastructure, and PPE... and limited laboratory confirmatory testing... Medical systems may be overwhelmed by a dramatic increase in patient numbers. Staff availability may also be limited as medical personnel become infected."[20] In the final year of the administration of George W. Bush, the Biomedical Advanced Research and Development Authority (a division of the Department of Health and Human Services) "estimated that an additional 70,000 machines [ventilators] would be required in a moderate influenza pandemic."[22]

The list of issues, or playbook, covered normal conditions as well as pandemic conditions. During normal conditions, there was no discussion of estimating and building up stockpiles for use in emergencies.[21] In the United States; the Strategic National Stockpile's stock of masks used against the 2009 flu pandemic was not replenished by the Obama administration or by the Trump administration.[2]

The 2017 guidelines note that a vaccine for the 2009 H1N1pdm09 swine flu virus took eight months before it was available for distribution at the end of 2009.[17] A vaccine for the 2003 SARS virus took 13 years to develop, and was ready for human trials in 2016, which have not yet happened.[23][24] A vaccine for the 2009 MERS virus took ten years to develop, and began human trials in 2019.[25] Nevertheless, the guidelines said only six months would be needed to develop and distribute a vaccine for the next pandemic, telling schools and day cares they might need to close that long.[17] However the guidelines told businesses to expect only up to two weeks of school closures, saying employees might need to stay home two weeks with their children.[26]

The guidelines did not expect any business closures, although studies had long predicted 80% drops in arts, entertainment, and recreation[27], and 5% to 10% drops in other economic activity over a year, with more severe drops in peak months.[28] The pandemic preparation studies did not address government action to help business, nor the recovery path.[29]

The guidelines anticipated "during a pandemic, infection in a localized area can last about six to eight weeks."[16]

The 2017 guidelines listed steps which could take place, up to voluntary home isolation of sick people, and voluntary home quarantine of their contacts for up to three days.[17] There was no discussion or planning for closing businesses or ordering people to stay home, which may explain officials' delays in deciding on stay-at-home orders in the 2020 COVID-19 pandemic and lack of preparation to distinguish non-essential from essential workers, and to protect essential workers. In the 1918 flu pandemic many cities closed at least bars, for up to six weeks, and most cities had mandatory isolation and quarantine of sick people and their contacts.[30] Cities with the most severe closures had the best economic recovery.[31] [32]

The guidelines told businesses to be ready to keep workers 3 feet apart, though the guidelines said coughs and sneezes can send viruses six feet.[26] Research says sneezes can send droplets 27 feet, and they can lodge in ventilation systems.[33] [34] The guidelines did not consider distances between customers or between them and workers.

Since the late Cold War, Russia has led misinformation campaigns to raise mistrust in public health authorities, and to say that the AIDS pandemic, the 2009 swine flu pandemic, the Ebola outbreaks and COVID-19 pandemic were American-created bio-weapons.[35]