EDITOR NOTE: Without a unified national strategy to stop the spread of COVID-19 in its tracks, states are left to make their own decisions, devise their own strategies, and determine their own implementation at their own pace. As several states have begun to see a massive surge in coronavirus cases, we know now that this strategy (or lack of) was a complete and utter catastrophe. Now, states are left to fend for themselves, and most are desperate for Federal support. This describes only the healthcare aspect of the crisis. The economic impact will be just as bad if not worse.
Leaving the nation's coronavirus fight to individual states has created gaping holes in the public health response that have allowed the infection rate to soar and death rates to rise once again.
While countries like New Zealand and Germany have taken a unified national approach to fighting the virus — and are enjoying the fruits of a successful mitigation strategy — the Trump administration’s federalist philosophy has helped create chaos across the South and West.
Cash-strapped cities and states trying to create their own testing, tracing and public awareness campaigns from scratch are desperate for federal support as they grapple with questions about whether it’s safe for people to return to school and work, along with bars and beaches.
“Every governor is out there on his or her own working to build the same programs that are being built next door,” said Reed Schuler, a senior advisor to Democratic Washington Gov. Jay Inslee. “The federal government’s efforts range from a little bit of backup to not even being present.”
This dangerous new chapter of the coronavirus outbreak is intensifying calls from politicians and public health experts across the country for a set of national strategies to combat the virus.
Arkansas’ entire congressional delegation — all Republicans — wrote Vice President Mike Pence this week asking the federal government to address shortages of chemical reagents needed to analyze coronavirus tests.
And New York Gov. Andrew Cuomo, a Democrat, expressed his frustration with the federal government's pandemic response on Tuesday. “The White House doesn’t get it,” he tweeted. “Until we control this virus as a nation, the economy can’t fully recover. Where is the national plan?”
Rep. Greg Stanton (D-Ariz.), who represents hard-hit Maricopa County, expressed similar frustration. “How can you have national success without having a national plan?” he said. “How do you fight the worst pandemic in 100 years without a coordinated strategy?”
A White House official rejected such criticism. “We’re in a much better position now than we were at the beginning of the pandemic in terms of [personal protective equipment], ventilators, testing capacity, and vaccine and therapeutics development,” the official said.
The situation today is not as dire as it was in March and April in some ways. There are no shortages of ventilators, and doctors have more experience treating the virus. The country’s testing capacity has grown exponentially, and the death rate is lower thanks to concerted efforts to protect seniors and other vulnerable groups.
But with cases still rising, public health experts say much more federal support and leadership are needed to bring the outbreak under control — and keep it that way.
“We shut down the country for three months and we could have used that time for all kinds of planning and preparing, and we did not use it at all,” said David Eisenman, the director of the UCLA Center for Public Health and Disasters.
Once-isolated outbreaks have grown into a national calamity concentrated in the South and Sunbelt where governors took early victory laps. Now the virus is spreading northward into the heartland and industrial Midwest, erasing the progress made in March, April and May while the country was locked down.
Organizers cover the boxed cremated remains of Mexicans who died from COVID-19 in New York | Eduardo Munoz Alvarez/AP Photo
With the death toll rising, several governors have reimposed restrictions on businesses and public life -- a move they once described as a last resort. School districts in Arizona, California and North Carolina are delaying their return to in-person learning, despite the president’s threats to cut federal funding for districts that don’t fully reopen.
In many ways, the White House has positioned itself as a consultant to states as they battle the virus. Federal officials, including Vice President Mike Pence, have warned that the government’s Strategic National Stockpile is only a stopgap — and that states themselves are primarily responsible for securing masks, gowns, gloves and chemicals for testing on the open market.
Pence, White House coronavirus coordinator Deborah Birx and others have also gone on listening tours in states where cases are climbing the fastest. Federal officials have also worked to increase the country’s testing capacity from hundreds of thousands to millions of samples per week.
But the lack of stronger federal oversight has made it hard to maintain some of those gains.
Commercial labs like Quest Diagnostics, which are handling about half of all tests, have not been able to keep up with the spike in demand. It now takes a week for people to get their results in some places, and labs say they are having trouble getting basic supplies.
Oregon Gov. Kate Brown says her state's testing capacity has been overwhelmed by the recent surge in infections. The state is now averaging more than 270 new coronavirus cases a day — a three-fold increase compared with a month ago.
“We could certainly use an assist from our federal partners,” Brown said. But her administration has been frustrated by the lukewarm responses it has received from the Trump administration.
Her next-door neighbor, Inslee, is one of several governors to call for a national testing strategy. In recent weeks, Washington state has struggled to buy enough swabs to collect patient samples and chemical reagents to test them.
And the federal government’s failure to fully use the Defense Production Act to increase available supplies and coordinate their distribution has put states like Washington in the “horrible position” of competing against one another, Schuler said.
“We have an obligation to the residents of Washington to ensure our labs are fully supplied, but we don’t want it to come at the expense of a less successful state,” he said.
In its letter this week to Pence, the Arkansas congressional delegation said that the ongoing shortages of testing reagents have prompted the state to consider abandoning its requirement for people to be tested for Covid-19 before undergoing elective surgery.
The testing problems are also hampering the country’s scattered and overwhelmed contact tracing efforts. Nationwide, there are fewer than a third of the 100,000 contact tracers that the Association of State and Territorial Health Officials estimates are necessary to contain the outbreak.
Nearly six months into the pandemic, some states are still struggling to get their programs off the ground. Others have abandoned location-tracking apps that were supposed to help scale contact tracing to unprecedented levels.
“You need federal leadership, and that’s been lacking,” said former CDC Director Tom Frieden, who, for months has been calling for the federal government to expand testing and provide support for people asked to quarantine at home.
Eisenman said the federal government should have used the spring lockdown to appoint expert commissions to address issues such as setting up contact tracing, distributing testing supplies and returning children to school safely.
Testing and contact tracing are the cornerstones of the test-trace-isolate strategy that governments have used to thwart infectious disease outbreaks since the 19th century. But many understaffed and underfunded local health departments have not been able to adequately expand the small workforces they usually use to track outbreaks of measles and sexually transmitted infections to combat the coronavirus pandemic.
Alabama only has about 200 contact tracers to investigate the more than 1,000 coronavirus cases diagnosed there each day. Most of those workers have been reassigned from other public health duties, such as restaurant inspections and immunizations. They are currently trading off in 10-day rotations between tracking coronavirus cases and their other work — meaning both are suffering. And with schools in the state set to reopen next month, the burden will only increase.
Ricardo Franco, an assistant professor of medicine at the University of Alabama at Birmingham, says the shortage of tracers is allowing the state’s outbreak to spiral out of control.
“If you asked me what we need, I would say we should have 5,000 contact tracers,” he said. “That would be the responsible thing to do.”
Washington state, which was among the first states hit by the virus, says that only 7 percent of the gowns, gloves and face shields it has handed out came from the federal government. The state has had to compete with other states and countries to purchase the rest itself.
“It’s jaw dropping that after what we’ve been through, we didn’t have hundreds of millions of face masks and other PPE stockpiled around the country,” said Irwin Redlener, founding director for the National Center for Disaster Preparedness at Columbia University.
Even as governors who once scoffed at fears they reopened their economies too quickly begin to reimpose restrictions, the White House is still struggling to put out a consistent message about the threat posed by the virus and how best to combat it.
Trump on Monday attacked his own administration’s public health officials, retweeting messages that suggested the CDC is lying about the virus and concern about the pandemic is overblown for political reasons, prompting top officials to defend themselves on national television.
John Henderson, president and CEO of The Texas Organization of Rural & Community Hospitals, said the lack of coordinated national coronavirus messaging has been compounded in states like Texas where governors, following Trump’s lead, took a laissez faire approach until cases skyrocketed.
“There’s just been a leadership void at the federal level,” he said. “We have pushed everything down to the states and then conservative states, like Texas, have just pushed all that decision-making down to the local level. … Every day that we go with a crisis and without a plan is another day lost.”
Originally posted on Politico