Playbook For Early Response To High-Consequence Emerging Infectious Disease Threats And Biological Incidents

In March 2020 POLITICO reported that after the Ebola outbreak in 2014, the Obama Administration's National Security Council had prepared a detailed, thorough "pandemic playbook" that was available to Trump administration officials, who treated it dismissively and did not draw on it during the response to the coronavirus. The leaked 69-page PowerPoint is reproduced in full color in durable hardcover landscape format, a crucial resource for understanding the Trump administration's response to COVID-19.

The Playbook describes itself as follows: "a decision-making tool that identifies: (1) questions to ask; (2) agency counterparts to consult for answers to each; and (3) key decisions which may require deliberation through the Presidential Policy Directive (PPD)-1 process or its successor National Security Council process." This is a document with an optimistic view of its role in the world. It is not clear that policy leaders in any Administration are actually interested in outsourcing their decision-making to a tool developed by a previous admninistration. To the contrary, policy-makers typically place a great deal of emphasis on getting their own people in place to ask the right questions.

The main body of the Playbook is comprised of two major sections, one for international events that have not yet reached the US and one for events with a US locus. For each, a "Rubric" is provided that "is not intended to serve as a comprehensive concept of operations or replace national or pre-existing U.S. Government response structures, but rather to serve as a proposed guide based on existing authorities, guidance, and response frameworks for staff monitoring emerging infectious disease threats and interagency planning and response, should the need arise in the future." The key words are "for staff monitoring emerging infectious disease threats..." -- in other words, this document was intended for use by staff who are monitoring things, rather than for policy makers who are deciding them.

The Rubrics explicitly spell out key assumptions--for example, on the domestic side that "the U.S. Government will use all powers at its disposal to prevent, slow, or mitigate the spread of an emerging infectious disease threat..." The drafters did not include any language such as "unless it might hurt the stock market." Both Rubrics contain exhaustive lists of important questions and decisions that correspond well with what we know now to have been important in the response to COVID-19.

An Appendix contains several useful resources, including a laundrty list of "declarations and mitigation options" -- things that the US government or other agencies can declare and do, specifically including pharmaceutical, medical, travel-related and community interventions. Some of the latter will seem remarkably familiar:

a. Voluntary home isolation of the ill and home quarantine of the exposed

b. Dismissal of students from schools

c. Social distancing measures, such as telework

d. Cancellation of large public gatherings; and

e. Widespread use of personal protective devices

A section on Communications envisages the Secretary of HHS as the primary spokesperson. No mention is made of daily 5 pm press conferences with the President.

Readers who enjoy works like THE GREAT INFLUENZA, CONTAGION, and THE ANDROMEDA STRAIN will find this a fascinating look behind the curtain. Also an ideal gift for that "no masks" relative who just will not read the peer-reviewed science that you patiently email to them!