One year into the Covid-19 pandemic, the New York Times interviewed scientists, public health experts, and advocates to identify what they would have done differently to address the crisis—and how they're preparing for the next pandemic. Here are their 14 key takeaways.

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1. Prepare for the unimaginable

Covid-19 took the United States by surprise, according to Lauren Ancel Meyers, an epidemiologist at the University of Texas-Austin, because "we'd spent decades planning for a pandemic that would resemble the viruses we already knew."

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We failed to plan for the need for masks, mass testing, stay-at-home orders, and more. Going forward, Meyers said, "we need to prepare for a much broader range of threats."

2. Prioritize science

The "catastrophic failure" of how this pandemic unfolded was spurred in large part by "[i]naccurate information and indecisive action on the part of the U.S. government," said Akiko Iwasaki, professor of immunobiology at Yale University.

Iwasaki cited a number of problems, including former President Donald Trump's assertion the virus "will go away and that we need not take any precautions," the "mockery of masks and social distancing," the faulty primers distributed by CDC, and the agency's initial restriction on testing, among other issues.

"To prepare for the next pandemic, Iwasaki said, "the government must put science and data above all else."

3. Determine who receives priority treatment

Noting that CDC issued vaccine recommendations just days before the first vaccine was authorized in the United States, Saad Omer, director of the Yale Institute for Global Health, said we must start developing plans on vaccine allocation and deployment as early as possible—and share them with states to implement immediately.

"During the lull before the next storm," we should prioritize two principles if and when shortages occur again: "[G]o after mortality and preserve the health system," Omer said.

4. Don’t depend on states alone

During a pandemic caused by a highly transmissible virus, "there are certain commonalities that you need, some collaboration, cooperation, and synergy between the federal government and the states," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to President Joe Biden's administration.

Amid the coronavirus pandemic, "[s]ome states just didn't pay any attention to the guidelines and just jumped right over them—to go wherever they wanted to go," he said. "That is not a recipe for success."

5. Create a focused message

Critiquing the "patchwork of different public health guidance" amid the coronavirus pandemic, Linsey Marr, an expert in the airborne movement of viruses at Virginia Tech, said the country needs a "strong, coordinated science-based federal response," as well as coordinated public health guidance for states, to send the right message.

"The virus doesn't preferentially choose people to infect based on their political party," Marr said. "We're all in this together."

6. Invest in public health

According to Anne Schuchat, deputy director at CDC, an "underinvestment in public health" was a "massive vulnerability" in the United States' response to Covid-19.

There was a need for accurate data to identify and establish the right interventions for success, Schuchat said. But she pointed out that while "[t]here are pretty sophisticated data systems for banking, media, etc.,…we haven't made those leaps in public health."

7. Get out of the fee-for-service model

The health systems that have been most resilient amid the pandemic are those "that actually understand how to keep people well and take risk—as opposed to being stuck in the fee-for-service environment," Marc Harrison, CEO of Intermountain Healthcare, said.

Health systems that can "accept complete responsibility clinically and financially for a population" can then make "all kinds of super interesting, nimble, innovative decisions" that volume-based systems aren't ready for.

8. Address social determinants of health

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The Covid-19 pandemic has "really brought [social determinants of health] to the forefront," as racial and ethnic minorities have been disproportionately affected, said Pablo Rodriguez, a member of the government committee guiding Covid-19 vaccine distribution in Rhode Island.

According to Rodriguez, it's become clear that "the health of the country" depends on our ability to address social determinants of health, something that Zenei Triunfo-Cortez—president of the California Nurses Association and National Nurses United—said requires a "robust public health system" that could "allow us to quickly implement the type of surveillance, tracing, tracking, and data collection that is critical in responding to a pandemic or any other emerging public health crisis."

9. Don't discriminate on age

From the start of the pandemic, it was fairly clear that older adults and those with certain comorbidities were at a higher risk of severe Covid-19, "yet we chose to ignore the fact that we could mitigate some of that risk by providing enough testing, staffing, and adequate personal protective equipment," Katie Smith Sloan, president of LeadingAge, said.

Instead, older Americans and their caregivers "weren't properly prioritized until very recently, when vaccines became available," Sloan said. "And what an amazing difference it has been."

10. Make sure communities are prepared

Communities shouldn't solely rely on the government and other institutions; rather, they should prepare themselves, according to Rev. Paul Abernathy, from the Neighborhood Resilience Project. "Our own community members have to be consistently incorporated into systemic responses to crises."

11. Stick with the treatments we know work

Early in the pandemic, there was a lot of uncertainty about what treatments were effective against Covid-19. But since then, "we've come to realize it's best to stick to the basics of critical care medicine, including ventilator settings, the amount of sedation and intravenous fluids," according to Gregory Martin, a critical care specialist at Emory University.

Looking ahead, instead of being "distracted" by "fringe or alternative interventions," Martin said health care providers should focus on "what we know as the foundation for patient care."

12. Don't put kids in social isolation

Social isolation is hard for everyone. But according to Marsha Levy-Warren, an adolescent psychologist and clinical associate professor at New York University, it's "especially challenging for teens and potentially interferes in their maturation."

We've since learned that teens who were able to see each other in safe social settings and were at minimum in a hybrid school setup "have done better than those who could not," Levy-Warren said.

13. Collaborate on a global scale

According to Angel Rasmussen, a virologist at Georgetown University, there need to be conversations about "working together as a global community for future outbreaks" and an elimination of the "nationalization of responses."

Mike Bowen, co-owner of Prestige Ameritech, added that the U.S. government should treat personal protective equipment (PPE) made overseas as a national security issue. "This was a fairly mild virus," he said. "Imagine if the death rate had been 20%, and China and Mexico had cut off their PPE supplies."

14. Take a moment for self-reflection

"Many people had an awakening to the people who keep society going forward, and whom we take largely for granted" because of the Covid-19 pandemic, noted Reed Tuckson, co-founder of the Black Coalition Against Covid-19. "But if you can discount the essential worker," he adds, "then think how easily you can discount any other human life," such as when people chose not to wear masks because they "couldn't give a darn."

"This pandemic has shown us who we are, at a level of clarity that is shocking to most people," Tuckson said. "It's hard to imagine there are that many people in our country who really don't care about others" (New York Times, 3/15).