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Disease outbreaks come and go. Outbreaks of coronavirus alone have appeared three times in the last eighteen years. In 2002, Severe Acute Respiratory Syndrome (SARS-CoV) accounted for 744 deaths across 17 countries. Middle East Respiratory Syndrome (MERS-CoV) was first reported in 2012 causing 860 deaths in 21 countries (McLeod, 2020). Of course, there was the Ebola virus with major illness implications appearing in the outbreak of 2014–2016, although it was first discovered in 1976. Numerous outbreaks of bird flu (H5N2) have occurred in several countries, most recently in 2020, and in 2019, swine flu (H1N1) was identified in several countries. At issue is the fact that disease outbreaks can vary a great deal in how they are transmitted and how humans perceive their risks and how they subsequently react to them. COVID-19 is not a disaster simply because it is a pandemic, its widespread destruction is also due to the world’s lack of preparation and ill-advised responses to it. Moreover, a keystone of a pandemic is that it is more than a “contagion that is determined by the virulence of organism” (Dasgupta & Crunkhorn, 2020, p. 1), it is spread at various rates depending on the social and behavioral tendencies of human hosts.

How predictable was the outbreak of COVID-19? A number of individuals have strongly suggested that the virus is a Black Swan event, an extremely unpredictable incident with catastrophic consequences. As facts have come to light, COVID-19 was anything but a Black Swan, with multiple advanced warnings and predictions offered for something like a virus pandemic of this magnitude. According to the New York Times, “Three times over the past four years the US government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action” (Sanger et al., 2020). In 2005, Laurie Garrett, a scientific reporter testifying before the US Congress warned that

“highly virulent, highly transmissible pandemic influenza that circulates the world repeatedly for more than a year” would end up killing more people than all the known weapons of mass destruction “save, perhaps, a thermonuclear exchange”; she observed that “scientists have long forecast the appearance of an influenza virus capable of infecting 40% of the world’s human population and killing unimaginable numbers.”

(Renda & Castro, 2020, p. 2)

More recently in 2020, the television news magazine, Sixty Minutes and the New York Times reported on a simulation exercise designed and executed by the Trump administration designated with the code name “Crimson Contagion.” The exercise was highly complex, involving multiple federal agencies and 12 states simulating the effects of a large pandemic and the United States’ capacity to respond to such an event. Results from the simulation were produced in a draft report in October 2019. Crimson Contagion was not released until much later, but many high-ranking officials now had fair warning that an extreme event like a coronavirus would create dire conditions.

Effective surveillance that produces solid and actionable intelligence is key to addressing epidemics or pandemics. A tool that is referred to commonly is the Global Health Security (GHS) Index, which is intended to serve as a comprehensive assessment and benchmarking measure of health security and related capabilities across 195 countries. The GHS Index is a project of the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security and was developed with The Economist Intelligence Unit (https://www.ghsindex.org/about). An advisory panel of 21 experts from 13 countries developed the framework that is organized across six categories presented in Table 1.1 below.

Table 1.1 GHS index.

Prevention: Prevention of the emergence or release of pathogens.Detection and Reporting: Early detection and reporting for epidemics of potential international concern.Rapid Response: Rapid response to and mitigation of the spread of an epidemic.Health System: Sufficient and robust health system to treat the sick and protect health workers.Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms.Risk Environment: Overall risk environment and country vulnerability to biological threats.

According to its sponsors, GHS Index is expected to serve as a crucial monitoring resource and risk assessment tool as extreme events (medical, meteorological/climatological, terroristic, and others) continue to impose their destructive forces on humanity. However, results from assessments around the world were not encouraging as regards pandemic readiness and preparation: “National health security is fundamentally weak around the world. No country is fully prepared for epidemics or pandemics, and every country has important gaps to address” (https://www.ghsindex.org/report-model).

These disappointing trends are reflective of a position taken by one of the author teams in this book. Chen, Li, Ji, Stacks, and Yook argued that “that the pandemic crisis morphed from a ‘natural cause’ (i.e., an animal virus transferring to a human virus) … into socio-political, economic, and cultural crises.” Their position was that through mistakes and missed opportunities to identify and mitigate vulnerabilities, a medical crisis morphed into something unimaginably more complex. A somewhat similar viewpoint was taken by another chapter in this book where Real, Gregory, Hamilton, and Zborowsky (this book) contended that the US healthcare system, in particular, is ill-equipped to handle extreme events like pandemics based on their short-term view healthcare delivery. Healthcare systems operate from a just-in-time strategy that is more cost-efficient driven under normal operating conditions. When the system becomes stressed, as with epidemic and pandemics, it simply does not have the capacity to withstand the surge of patients.