Why has it gotten so bad?
The coronavirus, COVID-19, is now a pandemic. The number of cases is expected to increase, not just globally, but here at home. This brings forth numerous questions about what is being done to protect American lives. Unfortunately, the federal government isn’t doing enough to get a handle on limiting the spread of the infection. What are they doing? What should they be doing, but aren’t? What does the go forward look like?
Obviously, fighting a new infectious disease is not an easy feat for any government, but certain actions, or in this case, the lack thereof, can make matters much worse. One thing that we know for sure is that what the United States has tried so far isn’t working and the longer containment efforts fail, the harder they become to implement. The response of the federal government has been incredibly slow and has impeded our ability to beat back this pandemic. This is very concerning because in previous disasters, the response has been unified across federal, state and local governments. Until the beginning of March, the situation was mainly being handled by states, businesses and academia. This administration’s failure to contain COVID-19 means the spread of the disease is most likely more far reaching than it would’ve had it responded the way previous administrations had in the past to other public health issues. Also, it means the new virus may be here to stay.
What do we know?
As of the morning of March 23rd, at least 428 patients with the virus have died in United States and there are over 33,000 people in all 50 states, Washington, D.C., and Puerto Rico that have tested positive for coronavirus, COVID-19, with over 32,000 of those cases coming from an undeterminable source. According to a recent study released in The New England Journal of Medicine by the National Institute of Health (NIH), Center for Disease Control (CDC), University of California Los Angeles (UCLA) and Princeton University, COVID-19 can remain for several hours to days in the air and on surfaces. The scientists found that it was detectable in the air for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. This means that people can easily acquire the virus through the air or after touching contaminated objects. Another factor that is extremely concerning is that it’s possible to spread the virus before showing symptoms of it. Since some individuals don’t have any symptoms at all and those that do get symptoms don’t have them for up to five days after being infected, this has been having a significant impact on how fast the virus is spreading, which is why there is a sizable portion of the population at risk of catching it. Certain populations, like pregnant women, people older than 60 and those who have underlying health conditions, are the most at risk. So far, in looking at the data of those who have died, the majority of the people have been in their 70s, 80s or 90s. Due to this, COVID-19 isn’t having a significant impact on the life expectancy rate. As far as the fatality rate, the definite number isn’t known yet, but for here in the US, it’s been hovering between 1-2%. Unfortunately, since the virus is so new, there is still a great deal of uncertainty around it, which means the information we have could change significantly. This strain is already showing some unexpected traits. Some viruses, like the flu and common cold, become less transmissible as temperatures and humidity rise in the summer months because the viruses don’t live as long on surfaces in these conditions and human behavior changes since we spend less time in confined spaces. A few studies suggest that this isn’t the case with COVID-19. This is true in parts of the world, like Australia, where they’re currently in the middle of their summer and are having outbreaks of cases. As a result of this information, there is some fear that COVID-19 will become an endemic, which means that it’ll regularly infecting humans. Most likely, this indicates that to put an end to this outbreak, there will need antiviral treatments or a vaccine. While those are currently being worked on at record speeds, it will probably be a year or more before these products are available to the public.
How many people might die? How many would be infected and need hospitalization?
Recently, officials at the CDC and pandemic experts from universities around the world discussed what could happen if COVID-19 gains a foothold in the US. The four scenarios have different parameters, so the projections range widely. The assumptions are based on what is known so far about how the virus has behaved in other contexts. The scenarios were depicted in terms of percentages of the population and when translated into absolute numbers by independent experts the worst-case figures are staggering (if no actions are taken to slow transmission). The scenarios indicate that somewhere between 160 million and 214 million people could be infected with 2.4 million to 21 million people requiring hospitalization and as many as 200,000 to 1.7 million people could die. The influx of patients has the potential to crush our healthcare system since it only has 925,000 staffed hospital beds. The CDC is looking at how interventions might decrease the worst-case numbers, but these projections have not been made public yet.
An infectious diseases specialist and public health expert, Dr. James Lawler, at the University of Nebraska Medical Center, which was where US Ebola patients were treated, recently presented his own projections in a webinar to the hospital and health system executives of the American Hospital Association. For the US, his estimates show that around 96 million people would be infected with about 5 million hospital admissions. He further breaks it down by saying that nearly 2 million of those patients would require intensive care and half of these patients would need the support of ventilators. As far as the number of deaths, he estimates that a conservative number would be near 480,000.
Are our hospitals prepared? What’s the worst-case scenario?
The good news is that most of our hospitals have disaster preparedness plans for a multitude of situations, such as mass casualties and novel infectious diseases. Typically, these contingency plans are designed to accommodate a surge in capacity of up to 20% and address the protection of healthcare workers, how to deal with staffing shortages, triage issues and management of scarce resources. Thanks to the 2009 H1N1 pandemic, many healthcare institutions have recent experience with being prepared. The concern is that COVID-19 could easily surpass the allotted amounts. This has led the American Hospital Association to ask for flexibility to increase capacity by allowing physicians to practice in states where they are not licensed and waiving requirements that Medicare enrollees stay at a hospital for three days before moving to a long-term care facility. Other measures hospitals can take are canceling elective procedures or repurposing facilities meant to care for psychiatric patients. One major concern is that staffing shortages could result if doctors and nurses become infected and can’t be there to take care of others. In Wuhan 1,000 healthcare providers got sick with at least 15% so severely ill that they had to be in intensive care. Since personal protective equipment (PPE) is supposed to help protect healthcare personnel, shortages are very concerning. An additional worry is that there might not be enough ventilators if there is a huge spike of seriously ill patients.
When you look at the numbers, it’s easy to see why health officials are so worried. The US has 2.8 hospital beds per 1,000 people, which is fewer than Italy’s 3.2 beds per 1,000, China’s 4.3 and South Korea’s 12.3. So, we have far less hospital beds available to deal with the pandemic than other countries. A study published in 2010 estimated that our hospitals had stockpiled 160,000 ventilators. Based off of the current projections, if COVID-19 follows the pattern of the 1918 Spanish flu, we would need more than 740,000. The worst-case scenario for the US is if there are sudden spikes in infections in communities across the country. This will overwhelm our healthcare system. The goal right now is to slow the spread enough that the infections happen over 10 or 12 months instead of one or two months. This will greatly impact how many people are seriously infected, how many people end up hospitalized and how many ends up dying. When you hear on the news about “flattening the curve,” this is what they’re referring to. Basically, it’s to not have a big, sudden peak in cases, but it’s a more moderate plateau over time. While this lengthens the time period of the outbreak, it allows the healthcare system to not be overwhelmed. In addition to reducing cases and deaths, it helps buy scientists time to work on treatments, such as medications and vaccines. If we don’t follow the recommended measures to flatten the curve, we’ll become like Italy and force doctors to decide who lives and who dies.
How does COVID-19 compare to the Seasonal Flu and Spanish Flu of 1918?
Many people are comparing COVID-19 to the seasonal flu. On average, the seasonal flu kills 30,000 to 60,000 Americans every year. According to the CDC, for this flu season, there have been at least 34 million infected with 350,000 hospitalizations and 20,000 deaths. This means the fatality rate is 0.05%. When there is severe flu season, it stresses our hospitals to the point of setting up tents in parking lots and keeping people in emergency rooms for days. One of the major concerns with COVID-19, is that unlike the flu, the entire population is thought to be susceptible. So, this means that it has the potential to cause 5-10 times the burden of the seasonal flu on our healthcare system.
Another comparison that is being made is between COVID-19 and the Spanish flu of 1918. The 1918 flu pandemic is thought to be the deadliest in human history and killed at least 50 million people worldwide, which would be the equivalent of 200 million today, and 675,000 of those were in the US, according to the CDC. One of the things that was alarming at the time was that it primarily killed those that were in the prime of their life, which were individuals in their 20s, 30s and 40s. It’s important to keep in mind that world was a very different place in 1918. While doctors knew viruses existed, they had never seen one. Whereas, nowadays, researchers are not only able to isolate a virus, but can find its genetic sequence, test antiviral drugs and develop a vaccine. In 1918, you couldn’t test people with mild symptoms, so they could self-quarantine, and it was nearly impossible to do contact tracing. Other things that weren’t readily available was protective equipment for healthcare workers and supportive care with ventilators. The fatality rate of the 1918 Spanish flu was at least 2.5% making it far more deadly than the seasonal flu. It was so infectious that it spread widely and quickly. This lead the US surgeon general to issue a statement in the beginning of October 1918 to local authorities to close all public gathering places, like schools, churches and theaters, if their community was threatened with the epidemic. He did this because there is no way to put a nationwide closing order into effect. The mayor of St. Louis followed the recommendation and closed for several weeks the town’s theaters, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions. While the death rate rose, it stayed relatively flat. However, Philadelphia didn’t take any of those measures because the epidemic there had started before the warning was issued and its death rate skyrocketed. According to the Institute for Disease Modeling, COVID-19 is about as equally transmissible as the 1918 flu. The good news is that it’s just slightly less clinically severe. Other than the Spanish flu of 1918, it has a higher rate of transmissibility and severity when compared to all other flu viruses in the past century. One major concern is that the world population has almost triple in size of what it was the year before the 1918 flu and there are 10 times as many people over 65 and 30 times as many over 85. Since these groups have proven to be especially susceptible to become critically ill and die in the current pandemic, this is very concerning. Also, the world of the 1918 flu wasn’t as highly connected as our world today. We can easily get on a plane and within several hours be halfway around the world. This means that COVID-19 will spread much more quickly than the 1918 Spanish flu.
How have public health issues been dealt with more recently?
When it comes to protecting us from infectious diseases, public health officials have a range of options for slowing or stopping the spread. When a virus appears outside US borders, the first step is to screen people as they arrive at airports and other entry points. The only issue is that it provides limited value when it takes a day or more for an infected person to show signs of the illness, which is the case with COVID-19. After a disease reaches the US, health officials have to figure out and isolate those who have been exposed. Once these people are identified, to avoid spreading the virus, they’re asked to isolate themselves for days or weeks depending on the length of time it takes for a person to start showing signs of the infection. This is also called quarantine. The thought is that if they’re separated from the general public for the designated period of time, they’re less likely to spread the disease if they have it. The good news is that if they do become sick while in quarantine, they can be moved to isolation and treated quickly. Isolation is when a person is separated from others because they’re confirmed to be infected and has developed symptoms. There are some issues with asking people to voluntarily quarantine because not everyone stays home when asked. Another issue is that people might not remember each person they’ve been in contact with. This is how a virus spreads within a community and COVID-19 has crossed that threshold. The virus first appeared in Washington state and genetic detective work suggests the virus had been circulating there for at least six weeks before it was found. It’s key to remember that by the time there is a death in a community, there already are a lot of cases in the area. Basically, it’s giving insight into where the epidemic was, not where it is currently.
When looking to past infectious disease events to see what was done, we don’t have to look very far. In 2009, the swine flu (H1N1) epidemic broke out across the globe. On April 14th, the CDC identified the first case in the US. By April 26th, the Obama administration declared it a public health emergency and two days later the Food and Drug Administration (FDA) approved a rapid test. At the time, the CDC had reported the number of cases was 64 and there were 0 deaths. The test kits began shipping to public health laboratories on May 1st when there was 141 cases and 1 death in the country. A second test was approved in July. More than 1,000 test kits were shipped from May to September with each one able to test 1,000 specimens. While there were flaws and limitations in the tests, testing was still able to be conducted. A vaccine was available by early October; however, since there were reported shortages, a national emergency was declared later that month. Overall, from April 2009 to April 2010, the estimated death toll in the US from H1N1 was 12,469. This number would have been much higher if the government hadn’t taken the swift action that it did.
As a result of the H1N1 epidemic, the 2010 Public Health Service Act was passed and it allows the federal government to prevent the entry and spread of communicable diseases from foreign countries into our country and between states. The legislation gives the CDC the power to stop travelers, whether foreigners or American citizens, from arriving on ships, airplanes and over land. If they deem it necessary, then the travelers can be quarantined. An executive order was updated in 2014 that listed the infectious diseases that could prompt the CDC to do this, including cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes and new types of flu that could cause a pandemic. So, COVID-19 is covered under that list because it causes a severe acute respiratory syndrome. The provisions don’t allow the CDC to enforce these rules, which means they typically rely on state or local officials to carry out the orders. As far as closing schools or workplaces, that is up to state and local authorities (although they often follow the guidance of the CDC). Most governors or county executives have the power to impose quarantines or other measures to block the spread of a disease. When it comes to using those powers, they tended to be more aggressive than the CDC. While the federal government can impose quarantine and isolation orders, it doesn’t usually test that power. The most recent use of this power was in the 1960s. However, that all changed on January 31st when the CDC initiated a 14-day quarantine of 195 Americans who were transported from Wuhan, China, to March Reserve Airbase in Ontario.
The federal government also has the ability to push for mandatory vaccinations and can determine who should get it or drugs that are in short supply. However, states can make their own rules on the same matters. In addition, the federal government could place limits on interstate travel or commerce if they felt there was a good chance of a disease spreading between states. So far, this has never happened. The federal government keeps stockpiles of medicines and supplies that it deems essential, like ventilators, vaccines and anti-viral drugs, and distributes them as it sees fit. These emergency supplies are provided to hospitals when patient volumes surge. Washington State has already had one request for additional N95 respirator masks, which healthcare providers need to protect themselves, fulfilled by the federal government.
What was the initial federal government response? Why was it wrong?
Containment is when a virus is prevented from spreading through identifying and isolating the sick. Usually, this is used as an initial response. It was used in the 2003 SARS (another member of the coronavirus family) outbreak and helped to end it. The issue with COVID-19 is that by the time the federal government tried to put these measures in place, we were past the point of being able to contain it. There are several reasons for this. The first is that the virus has features that are different from previous viruses that resulted in global outbreaks. While it’s still being studied, we do know that people who don’t have to have symptoms can spread it and the fact that it can exist so long in the air and on surfaces. This means that it is incredibly hard to contain. A large component of containment is travel restrictions. Unfortunately, all of the travel restrictions put in place by the federal government came way too late. By the time the majority of them were enacted, the virus was already here. Trump has boasted constantly about his early decision to restrict Chinese travelers from entering the US. Since then, the list of countries that travel is restricted from has steadily grown. The first known cases in China were reported to the WHO on December 31, 2019. The first case in the US was announced on January 21st, but travel restrictions of foreign nationals who were in China at some point in the last 14 days didn’t go into place until 10 days later on January 31st. Further travel restrictions of other countries that were impacted didn’t go into effect until over a month later on March 11th. By that time, the number of cases in the US was over 500 with deaths in several states. Since then, new cases have poured in, first by the dozens, then the hundreds and now the thousands. Epidemiologists and other experts say that any type of travel restriction might help slow the spread of disease, but by only a few days or weeks, and in order for them to be effective, they need to be implemented early in the process. This was not the case when it comes to COVID-19. Most US patients are being diagnosed without having any history of overseas travel or coming into contact with any one that had. This means that the illness has been circulating widely throughout the country and that people are being exposed in public places. Many experts have said that there should have been more planning for a pandemic once it was established this virus was easily spreading between people back in early January. This would’ve included increasing the availability of diagnostic testing, preparing hospitals and crafting public health messages well in advance of actually needing to use these things.
The biggest reason why COVID-19 has spread so quickly and is so widespread is that the federal government was incredibly slow in rolling out diagnostic tests, which was in part due to a production error at the CDC. Also, at first, the CDC was the only place in the country that could test for the virus, creating an enormous backlog. Another issue is that the CDC had strict criteria for who could be tested, so mild cases and those not somehow linked to travel to an affected region, were not tested despite the fact that these people could still infect others. This has led many epidemiologists to fear the actual number of cases is much higher than what is being reported. In addition to the original CDC test, New York state developed their own test, which was approved by the FDA. However, there is still a backlog because public health labs can test only about 15,000 people daily. Initially, the FDA hadn’t given independent laboratories the authority to develop, validate and use their own tests. Even with the CDC shipping hundreds of test kits and having some public health labs and private lab companies, like LabCorp and Quest Diagnostics, have their own test kits. There aren’t enough tests, especially after the CDC broadened the criteria for testing to include anyone who has symptoms, had traveled to a country with an outbreak or come into contact with a confirmed case. A big complaint about any of the tests was that it takes somewhere between 3-7 days for an individual to receive results. To address this matter, a new test was developed and approved by the FDA in the past few days that can provide results in 45 minutes. The issue now is that it doesn’t matter which test you’re trying to get because there aren’t enough supplies to make them. While the CDC did fix the malfunctioning component and the FDA corrected its authorization process, these measures came too late. The lack of availability of testing is a major disaster. It’s key to realize that it didn’t have to be that way. There was a law created in 2004 that put into place the process and requirements for the use of unapproved products in public health emergencies. In 2014, the FDA issued a “draft guidance” in which it sought to increase its authority to regulate laboratory-developed tests. Under a law and guidance set by the Trump administration, creators of laboratory-developed tests need to submit information and to comply with certain procedures under the guidance of the FDA. In response to COVID-19, the agency issued a statement in early March that for 15 days, unapproved tests could be used while developers are preparing their emergency authorization request. Despite having the power to fast track the formation of test kits, the Trump administration didn’t do that.
Another enormous issue is all of the mixed messages and misinformation that has been coming from the Trump administration since this virus was discovered. While this type of governing isn’t out of the ordinary for the Trump administration, when it comes to something involving public health, it isn’t just confusing, but downright dangerous. Many of the statements that have been issued from the White House range from false to unproven, such as the US containment of the virus was “close to airtight” and that the virus is only as deadly as the seasonal flu. Trump said in an interview on Fox News that the World Health Organization’s (WHO) figure of a 3.4% death rate was “really a false number” and that his “hunch” was that the level is “way under 1%.” After saying this, he offered no evidence for his contradiction. These types of statements underestimate the gravity of the situation and undermine the challenges that healthcare officials and workers face in responding to the virus. This has placed our country at a disadvantage in the combat against the virus. Several public health leaders, including the CDC, have said from the beginning that if we don’t put in place drastic measures, the virus will begin spreading at a community level and the disruptions to daily life would be “severe.” During a time when the health of every citizen of the country is at risk, it’s essential that the federal government speaks with one common voice. This has definitely not been done.
An additional issue with how the White House has responded to COVID-19, is that there has been an underlying tone that this is political issue. In his responses to questions the first few weeks, President Trump not only downplayed the problem, but blamed the media for making it into something more than it was. Obviously, this isn’t the case. He also has referred to the virus as the “China virus,” which doesn’t help the situation in any way. Yes, the virus originated in China, but that has nothing to do with our response here in the US. President Trump’s idea of America First where the main focus is internal safety at the expense of international cooperative organizations has left us vulnerable to a global disease. Throughout his presidency, Trump has questioned the mission of global organizations and since the coronavirus outbreak began, Trump has limited extra US investment globally to $37 million for the WHO. It’s important to note that the US does already fund 22% of the WHO budget. However, the agency is asking donors for $675 million to help fight the virus because it’s struggling to support countries abilities to test and isolate potential victims. Even after getting $125 million from the European Union (EU), they still need help. In past global health issues, when the WHO is unable to be the first responder, the CDC steps in to help. However, that could now fall to European authorities. By behaving this way, President Trump is taking an already polarized country and dividing it even further internally and externally, which isn’t what we need in a time of crisis. There has been some concern by public health experts that if COVID-19 becomes a political issue, people may not follow useful information because they’ll say it’s coming from a partisan point of view. This could have deadly consequences.
The concern about how this pandemic has been handled doesn’t just apply to everything that has gone on in the past few weeks. In the past three years, the Trump administration has focused on the remodeling of scientific panels to favor industry interests and a president who regularly dismisses or distorts scientific facts. As a result, the federal government isn’t up to the task of protecting the American people the way it should be. There has been significant downsizing of scientific expertise within the US government. For example, the Environmental Protection Agency’s (EPA) staff numbers are a third smaller than they were before Trump took office and according to the Office of Personnel Management’s employment data, more than 1,600 federal scientists left various government agencies in the first two years of the Trump administration. Also, Trump’s 2021 budget proposal includes a 16% reduction in funding for the CDC. It’s important to note that this proposal was submitted just days after international alarm was raised over COVID-19. Trump’s rationale is that he CDC and other agencies could rapidly restaff if needed, but this concept goes against the standard practices of government-run research. Even though Trump said he was not responsible for disbanding the White House’s pandemic team, according to The Washington Post, the top White House official charged with leading the country’s response to a pandemic left the administration in May 2018 and the rest of team was dispersed by the national security adviser at the time, John Bolton. While there isn’t direct evidence that Trump was personally involved, he hasn’t replaced any of these individuals in the two years since, even with repeated bipartisan urgings from lawmakers and experts to do so. Every single one of these actions has left the US badly positioned to deal with something like COVID-19.
A significant issue under the Trump administration has been immigration policies. When there are more aggressive immigration policies are in place, during outbreak of disease, immigrants are less likely to go to the hospital for testing and evaluation, which means the disease can easily spread throughout a community. Also, there has been some reports of people being stigmatized because of their ethnicity, which only makes them more hesitant to speak out and seek care. Internationally, there is some concern about refugee populations being at high risk for rapid outbreaks. With COVID-19, it’s infecting men more than women and since the majority of refugees are typically men (because they will go somewhere new and then send for their families after they’ve got established in the new area), this is concerning. Also, refugees don’t have access to proper hygiene and healthcare systems. In addition, refugees are highly mobile. This is why the EU is concerned with the group of 1 million newly displaced people on the move in Syria and the 3.5 million refugees already in Turkey because the Turkish government said it would no longer keep refugees from traveling through Turkey to enter the EU via Greece and Bulgaria. Here at home, Republican lawmakers have expressed concerns about people attempting to come to America if there are significant outbreaks in Mexico or Central America. While this isn’t completely impossible, there are measures that have been put into place to decrease the chances of that happening.
What can we learn from other countries’ responses?
The difference in response from countries across the globe has shown that when effectively dealt with the number of cases and loss of life can be reduced. China’s rapid and aggressive quarantine and social distancing measures of implementing school closures, eliminating mass gatherings, requiring work from home and rigorously decontaminating their public transportation and infrastructure in cities, like Singapore and Hong Kong, which are outside of the outbreak’s epicenter, have achieved significant success. In addition, they conducted widespread testing. All of these measures helped them to reduce a volatile epidemic to a steady state. On a federal level, the US wouldn’t be able to wall off cities, like China did with Wuhan and Hubei province due to the differences in style of government. Not only would it cause a public outcry around civil liberties being impeded, the courts wouldn’t allow it because it would they would claim that it is a disproportionate action since it would affect many, many people who are not infected or exposed to the pathogen. In addition, we don’t have a single national health service that provides instruction the way many other countries do. So, part of the issues is trying to coordinate the effort among multiple factors, like state government, local governments and hospitals.
On the other end of the spectrum, you have Italy, which shows what can happen if a country can’t slow the spread. While Italy has put into place social distancing measures, like restricting movement and closing all stores except for pharmacies, groceries and other essential services, it didn’t take place in time to prevent a surge of cases. This surge has completely overwhelmed one the well-regarded healthcare system in the world. In response to this surge, Italy’s civil protection agency is trying to find ways to accommodate more patients, such as using an exhibition space abandoned by canceled conventions as a 500-bed intensive care ward and hiring of thousands of doctors and health workers, including medical residents in their last years of medical school. While a great notion, it takes time to train new doctors. The lack of resources and mammoth influx of patients has forced doctors to decide not to intubate some patients, particularly those who are very old or are less likely to survive, essentially leaving them to die. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care issued guidelines that when it comes to serious shortages of health resources, then priority should be given to patients with the best chance of survival. Public health experts from around the world have warned that Italy is about 10 days ahead of other European countries in the development of its outbreak, which means that these countries need to act decisively, quickly and early.
What can you do to help?
There are two essential things that everyone of us can do to help slow the spread of the virus. Hand hygiene is critical. When washing your hands, make sure you use enough soap that you’re able to cover not only your palms, but the backs of your hands, your thumbs, in between your fingers and your fingernails. You should lather at least 20 seconds before rinsing. A good way to make sure it’s been long enough is to sing “Happy Birthday” twice. Once you’re done washing, turn off the faucet with a paper towel and use it to grab the handle to open the door. You should wash your hands after going to the bathroom, before and after preparing food and after you sneeze or cough. If you don’t have access to soap and water, then use alcohol-based hand sanitizer that is at least 70% alcohol. The other major thing that you can do is social distancing, which means that you stay at home so you don’t get infected or, if you’re infected, you don’t spread the disease to others. You should only be leaving your house to get essentials, like food from a grocery store or pick up food to go from restaurants. When you are out in public, take care to be separated from others by staying at least 6 feet away. If you have to leave your house for work, take all necessary precautions to protect yourself and others. These measures are crucial because even though you may not be a risk of being seriously impacted by COVID-19, you could spread to someone that is, such as a parent, grandparent or elderly neighbor. One thing for certain is that previous studies of pandemics have shown that the longer people wait to distance and protect themselves, the less useful those measures are.
Unfortunately, we’ve reached the point where widespread person-to-person transmission has passed the ability of public health officials to track every exposed person and all of their contacts. As a result, voluntary social distancing, such as avoiding large gatherings, has been encouraged in communities across the country. As more and more cases have been identified, it has led to schools and businesses closing and mandatory stay at home orders from several states. Obviously, this has a huge impact on the day-to-day lives of the majority of Americans. Political and public health leaders understand the profound implications these drastic social distancing measures can have, such as some children not getting to eat because they depend on school meals to eat every day and many adults across the country are losing their jobs, which impacts their ability to pay for everyday living expenses. However, these are necessary steps at this point in order to limit the severity of the spread.
In our country, often individual rights supersede considerations of communal welfare, which is why a voluntary order suggesting that people “do the right thing” may not be enough. There is concern among health officials that it’s unclear how far Americans will go in adopting socially disruptive steps that could prevent deaths and how quickly they’ll act. The best way to encourage participation is to educate people on why it’s so important and what the benefits are. In 2007 survey, nearly 90% of respondents said that if asked, they would abide by a voluntary quarantine and stay home during a flu pandemic. Among those who said they wouldn’t, 64% were concern over losing needed income and 39% thought they might lose their jobs entirely. This isn’t surprising since many people live paycheck to paycheck. Outbreaks do economically impact people who have to take off as a result of a quarantine. In addition, it’s often these individuals who can’t afford medical care. With COVID-19, businesses that rely on the global supply chain are worried about falling revenues and insurers and hospitals are nervous about having to foot the bill for thousands of sick people. Due to the reduction in travel, airlines, shipping firms and conference planners have seen a major decline in business. As a result of all of these apprehensions, the stock market has plummeted to recession levels and there is talk that the unemployment rate could reach 20% or higher. There hasn’t been an unemployment rate that high since the Great Depression. So, no longer is COVID-19 just a health pandemic, but it’s rapidly becoming an economic issue as well.
What is the government doing now to help?
In response to the crisis surrounding COVID-19, on January 31st, the secretary of Health and Human Services, determined that an emergency existed under the Public Health Service Act. By stating this, it made it easier for state and local health departments to temporarily reassign personnel freeing them from regular duties to help respond to the pandemic. In public health, emergency power laws are included in provisions of the Public Health Service Act, the Stafford Act, the Social Security Act and other statutes. The Stafford Act is the government’s main mechanism for responding to major disasters and emergencies because it permits tapping into an account, currently with over $40 billion, that could be used to do things, such as buy medical supplies and equipment. While the Stafford Act is usually activated in cases of major disasters that cause property damage, it has been used in public health emergencies, such as the 2000 West Nile virus outbreak in New Jersey and New York. If an administration uses Section 1135 of the Social Security Act, not only does it make it easier to get medical supplies, doctors and nurses where they are needed most, it waives the requirements in Medicare, Medicaid and the Children’s Health Insurance Program that normally apply. These waivers include payment limitations on using out-of-network providers, certain certification requirements and a federal mandate that doctors be licensed in the state in which they are practicing. It’s key to note that the waiver power under the Social Security Act requires both a determination under the Public Health Service Act and a presidential declaration under either the Stafford Act or the National Emergencies Act (which allows emergency funds to be freed up, lowers legal barriers to getting supplies and resources and allows the Federal Emergency Management Agency, or FEMA, to coordinate a response). In 2009, the National Emergencies Act was used to unlock Section 1135 powers as part of the government’s response to the H1N1 epidemic. Despite having all these tools to help combat COVID-19, the US didn’t declare a national emergency until March 13th, which was two days after the WHO stated the virus is a pandemic and over a month after the determination made by the secretary of Health and Human Services.
The good news is that prior to the declaration, on March 5th, Congress passed an $8.5 billion measure in an effort to help the government develop a vaccine and provide money for states to expand their lab-testing capacity without needing to seek regulatory approval first. A second relief bill was passed by the House of Representatives on March 13th that was aimed at making COVID-19 testing free and allow for two weeks of paid sick leave and up to three months of paid family and medical leave sick leave to many of those affected. The bill would also provide more funding for state Medicaid programs and extend unemployment benefits to those temporarily unemployed. It did allow for businesses with fewer than 50 employees an exemption from paying emergency sick leave by proving dire hardship. In addition, it secured money for those who rely on food assistance programs, such as children who receive free meals at school, and would waive work requirements for food assistance. The bill also gives $500 to low-income pregnant women and mothers of young children who lose their jobs because of the pandemic and $400 million to assist food banks to handle expected demand. The US Chamber of Commerce said the bill would provide immediate relief to many Americans. Given that there are no federal legal requirements for paid sick leave in the US this bill is significant.
In addition to the relief efforts that have already been passed, the White House is asking Congress to pass an emergency rescue package that totals over $2 trillion to help businesses as well as taxpayers cope with the economic crisis. The proposal aims to provide a massive tax cut for wage-earners and bailout money for the airline industry and small businesses. Also, it’s been proposed to provide a set amount of money as a one-time payment to every American to help them bridge the gap in income. Currently, the amount hasn’t been decided and there is talk about putting a limit on who can receive the payment based of yearly income. If this bill is passed, it’ll be the most extensive economic rescue package since the Great Recession of 2008. Unfortunately, it’s currently being held up due to disagreements between the House of Representatives and the Senate regarding certain factors in the bill.
The Bottom Line
According to public health experts, we shouldn’t give up on trying to slow the spread. We know that a single step can’t stop it, but if we layer several steps together it can be very effective. By doing all that we can to spread out the inevitable infections, we’ll prevent our healthcare system from becoming overwhelmed, which is vital to preventing deaths. There’s no question that everyday life across the country is continuing to change and it’s having immediate impacts on people’s health and their wallets. How we respond, or don’t respond, in the next few days and weeks will determine if we’re able to follow the path of China and mitigate the spread or Italy and see a surge in cases. If each one of us, does our small part of staying home, it will make a difference. In the meantime, the federal government needs to step up and provide the assistance that the states and hospitals need to combat the virus and the economic relief that every individual American needs to make it through this crisis.