When this first covid-19 wave is over, the United States will need a formal inquiry. US based doctors like me regularly receive questions from colleagues across the world who are baffled by the stunning incompetence of the US response to the covid-19 pandemic. Whether from Italy, Kenya, or the UK, these questions reflect shock over an American failure that is globally embarrassing, yet indisputable. We are asking many of the same things: 

• What happened to diminish the United States’ once-vaunted reputation for responding effectively and efficiently in a crisis, owing to its resources, deep scientific expertise, and ability to organize?
• Where has the globally renowned Centers for Disease Control and Prevention (CDC) disappeared to, the organization that has inspired similar institutions around the world and so often come to the rescue when other countries have struggled to contain disease outbreaks? 
• How did the world’s largest economy stumble and fall in the delivery of testing, contact tracing, or even the provision of basic personal protective equipment (PPE)?
• Why are we still hearing no explanation from government officials, or even a sense of emergency, about the disproportionately high death rate among members of minority and high risk groups? 

Fundamentally, the question we’re hearing is: how did the United States let it get so bad? Answering this warrants an organized, focused, and concerted investigation to catalogue everything that’s gone wrong, expose its root causes, and trace responsibility.   

Because it is bad, no matter how the Trump administration spins it and no matter how you look at it: graphs, maps, numbers, interviews with exhausted healthcare workers, photos of overflowing hospitals, and makeshift morgues.

At more than four million covid-19 cases, the US leads the world in numbers and rates of people testing positive, and yet those numbers are still surging in many places. On multiple days in July, covid-19 has killed an average of 1,000 people every 24 hours, a number some have likened to four plane crashes a day. Hospitalizations are again on the rise and ICUs in many states are at or above capacity. To be sure, we face systemic headwinds. Many of my international colleagues are aware of these, of the ways in which the US healthcare system is inefficient, even broken; how tens of millions of people lack health insurance and how our safety net is so brittle; how the public health system has been disinvested for decades; and, how racist and discriminatory structures perpetuate enormous health inequities. These realities occur on top of the “social determinants” of health.

But these features, plus the social determinants, on their own are insufficient to explain the unprecedented public health disaster that we are living through now. A full understanding requires that we look at another set of factors—the “political determinants” of health.

It is by now indisputable that any explanation for American’s failing outcomes will require an accounting for the choices made by elected and politically appointed officials whose job it was to handle the pandemic with diligence, efficiency, and integrity, both moral and scientific. The questions that demand to be asked of these leaders—in an effort to understand how it got so bad—are many.

Why were early warnings dismissed and months of possible preparation time squandered? What motivated top government officials to throw around the word “hoax” in a direct affront to science? To what end was data distorted? What drove the effort to sideline the CDC, and pressure it to amend its science-based recommendations? What explains the failure to protect essential workers, including those on the medical front lines? Why were scientists’ recommendations regarding reopening ignored? What was the case for shirking the duty to forge a national response, while at the same time actively undermining efforts by city and state leaders? What was the full death toll of covid-19? And who were the architects of this fiasco, responsible for unprecedented suffering, economic devastation, and more than 140,000 deaths (as of this writing) and counting?

Journalists and researchers have begun to tease out answers to some of these questions. But limitations on their time, resources, and attention suggest their individual efforts will never add up to the sort of comprehensive, methodical, and authoritative accounting that the situation warrants. 

Which is why I suggest we need a full-scale inquiry. It’s an approach already institutionalized in the wake of other man-made disasters, from plane crashes to security lapses at embassies that proved vulnerable to terrorist attacks. Higher-profile examples were the Kerner Commission that explored causes of America’s urban unrest in the late 1960s, and the so-called 911 Commission examining what happened on September 11, 2001.

Whether you call it the “Covid Commission” or something else, whether it’s overseen by Congress or a “Blue Ribbon” group, its work should depend on independent experts charged with digging into the US covid-19 disaster honestly, and in the full light of day, with public hearings as a prerequisite. It will be the best way to both answer the fundamental questions, and to produce a blueprint for preventing something similar from happening in the future. We know that it’s not a matter of if we will face another pandemic, but when. 

It will also serve another purpose. For all those who died totally preventable deaths, for those who fell sick and are struggling to recover, for those who will endure trauma for years to come—an investigation would represent a modicum of justice. For the mothers of those people, the dads, the grandparents, the uncles and aunts, the children, the health care professionals, the essential workers, the teachers and hospitality workers, those who worked in meatpacking plants, those in prison and those in nursing homes—a public inquiry will also serve as a tribute paid, and an apology made. We must honor the victims and the survivors by exposing the truth. 

Ranit Mishori, is professor of family medicine at the Georgetown University School of Medicine and senior medical advisor at Physicians for Human Rights.

Competing interests: None declared.