Virus fight marked by public health failures
The American response to the current COVID-19 pandemic has exposed policy failures: the failure to heed decades of warnings by epidemiologists, the failure to implement a coherent response to the crisis, and most of all the failure of our nation’s public health system.
The lack of preparedness of our public health system has taken our citizenry by surprise. As a country, we have assumed that our public health apparatus was a well regarded, world leader in the field. Instead we have awakened to find that our public health system is a Potemkin village, hollowed out by underfunding, years of neglect and complacency. America is about to receive an abject lesson in the old adage that: “… an ounce of prevention is worth a pound of cure.”
To understand where we are with regard to our public health system, it would help to understand how this system developed. Guided by the belief that a healthy populace was necessary for the young nation’s economic prosperity and national defense, President John Adams signed into law on July 16, 1798, the Act for the Relief of Sick and Disabled Seamen, which established what has now become the Public Health Service. This act provided for a series of marine hospitals in ports. These hospitals established protocols requiring ships entering port to declare themselves free from communicable disease. Failing that, authorities diverted ships to a quarantine anchorage until satisfactorily inspected.
The prevalence of major epidemic diseases such as smallpox, yellow fever and cholera spurred Congress to enact a national law in 1878 to prevent the introduction of contagious and infectious diseases into the United States. The task of controlling epidemic diseases through quarantine and disinfection measures as well as immunization programs fell to the U.S. Public Health Service (USPHS) which served the whole nation. The USPHS developed a world-class reputation in the field of epidemiology, as well as others.
While the American public rested easy, confident in its medical system’s ability to handle any crisis, others, especially epidemiologists, were not so sure. Scientists estimate that between 1940 and 2004, 335 new infectious diseases appeared in humans. The majority of these diseases, about 60%, were zoonotic (transmitted to humans from animals.) It is believed that the COVID-19 virus is one such pathogen.
The Obama administration made the Global Health Security Agenda a priority. Meanwhile, the Trump administration has been pulling back on supporting the USPHS on multiple fronts. The administration’s proposed 2021 budget for the Department of Health and Human Services cuts $25 million from the Office of Public Health Preparedness and Response and $18 million from the Hospital Preparedness Program. The administration also asked for over $85 million in cuts to the Emerging and Zoonotic Infectious Diseases program.
What is most puzzling is how we find ourselves so poorly prepared for a pandemic that scientists have been telling us for decades was going to happen? Where are the contingency plans? Why aren’t field hospitals being set up in the most affected areas? Why haven’t the National Guard and Civil Emergency Response workers been mobilized?
How can it be, in a country that prides itself on material wealth, that our health care workers and first responders do not have the most basic equipment: N95 respirators, nitrile examination gloves, sanitizers, disinfectants, etc.? Where are the ventilators? Wouldn’t maintaining a reserve, in strategic locations, of such critical items be considered prudent?
Over the last 200 years, through the assiduous study and application of public health science, our nation managed to nearly double the life expectancy of the average American. Now due to a smug, self-satisfied, complacency we find ourselves sequestered in our homes waiting to see when the butcher’s bill will come due and what will it be: 100,000 dead? 250,000? More? We have done better as a nation and must strive to do so again.
Capt. Patrick M. Wright