Thankfully, the COVID-19 situation in the United States is improved. It's easy for us to be grateful and move on. However, I think it is important to reflect on what went wrong and study how we can improve our response. I am certain another pandemic or international disaster will happen again, and we need to learn constructively from this crisis. The year went by in a blur and it would be so easy to strike it from memory. Nevertheless, I believe many things went awry and caused serious harm to individuals and our society.

This is not my expertise. Crisis management, infectious disease epidemiology, and public policy are complex disciplines. But I am sharing my voice as someone who cared for the sickest of coronavirus patients from the beginning when we knew so little, as someone who struggled when the health care system got overwhelmed, and as someone who held the hands of dying patients and called their grieving families.

One challenge is identifying the start to a potential pandemic. Pandemics spread exponentially, and time is crucial in containment. The difficulty, unfortunately, is that threats are constantly arising. Most of us do not know this. But new pathogens and mutations in old microbes are appearing all the time, and scientists have to determine how much of a threat they could become. Thus, surveillance is tricky. If we are too cautious and shut things down at every potential outbreak, we will have disruptions all the time. But if we miss the "next big one" we might have a situation like COVID-19.

Once scientists determine that a rapidly spreading pathogen is causing an epidemic, public health agencies and governments need to act swiftly. As we saw in COVID-19, geographies that contained spread early did remarkably better than places that dragged their feet. The Bay Area was one of the earliest places in the United States to initiate a dramatic lockdown, and we avoided the spring surges seen in other parts of the country. There is no doubt in my mind that this saved significant lives, not only in reducing the number of people who contracted COVID, but also in giving hospitals time and bandwidth to prepare. Early decisive decision-making can change the long-term course of an outbreak.

This decision is so difficult because of limited information. At the start of a potential epidemic, data isn't streamlined and expertise isn't shared. So we need to set up systems such that key players and decision makers can collaborate. Federal and state governments, local public health agencies, academic research centers, and on-the-ground surveyors have different skill sets and collect different data, but each perspective only has a limited lens on the actual problem. Only with communication between these players can we identify patterns in a timely fashion.

Furthermore, data needs to be reliable. At the beginning of the pandemic last year, we were hamstringed by the scarcity and limitations of diagnostic tests. For frontline providers like myself, I depend so much on reliable, accurate, and precise tests. In a new disease whose full clinical manifestations aren't completely known but whose symptoms overlap with many other common conditions, physical exam and history can only take us so far. So when the next pandemic happens, we need our health care system, research scientists, and industry partners to draw on resources to develop, validate, manufacture, and distribute tests as quickly as possible. It is a daunting but crucial task because diagnosis is absolutely necessary not only to treat individual patients but also to isolate the infected, limit spread, and characterize the course of the outbreak.