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2020-03-21

Infectious Pandemics Are Our Achilles Heel

Infectious diseases claim most of our attention. Whether it is the Black Death, the 1918 Influenza Pandemic, or the more recent outbreaks of SARS and Ebola, they scare us--as they should. The reason we generally do not contain them is partly a lack of scientific knowledge, but actually more about the public health system.

Liberia Emergency Operations Center
More people die from infectious disease when public health systems are weak and fragmented. Ebola ravaged West Africa because the public health systems there were quickly overwhelmed when frontline health workers were unable to receive direction from experts. Ebola in Liberia persisted because the public were not reliably informed about contagion and continued normal interactions, accelerating the spread of the virus. Health workers did not have personal protection equipment and a large proportion died in a country that had far too few to begin with. 

I saw that myself when I made my first trip there in 2015. Even then, the outbreak had passed its peak, but it had ravaged the country and decimated the healthcare system. In a society that treasured physical touch, not just of the living but with funeral rites that included touching the dead, their society had been radically changed. (Even a dead Ebola victim is still highly contagious.) People did not give hugs or shake hands. Every building open to the public required people to wash their hands in a bleach solution before entering. Here's a picture I took in front of the Emergency Operations Center where you can see one man washing his hands. On the far left is a guard who made sure everyone did so. 

Lest we think that it cannot happen here, we should know that funding for personnel in public health from the federal to the state to the local level has decayed over the past generation. Moreover, our system of public health is fragmented across thousands of agencies. Thousands, you say? Yes, every county and major city has its own public health department. So does every state. And at the federal level responsibility for public health is split across Health and Human Services, Homeland Security, Defense, CDC, the US Public Health Service, the Indian Health Service (that's on the reservations), Medicare, Medicaid, the VA, etc. Some may argue with including healthcare services, but they are the front lines in immunizations as well as reporting infectious disease cases. If we tried to design a more confusing network of agencies and workers, we would not do worse that what we have. 

Now we have our own major crisis. It is exposing the inherent weaknesses in our system of protecting the health of the public. But that could be addressed by strong, consistent leadership from the top. Too bad. We don't have it. We have confusion and partisan bickering. 

We get conflicting signals from the bully pulpit of the White House. Health workers lack appropriate personal protection equipment. As of this week, the president has refrained from using available powers to mandate the production of that equipment. Turning to immunization, we have no coordination in the development, much less the hoped for manufacturing of a vaccine. 

Perhaps most alarming, a strong majority of Republicans think that the danger of COVID-19 is exaggerated—twice the proportion of Democrats. Main Street Republicans give Trump stellar poll numbers that they approve his handling of the crisis, as high as 87% in polls conducted this month.

Let's hope that the federal government succeeds in bandaging this public health wound but remember, the underlying health of our fragmented, underfunded, and overwhelmed public health system remains in dire straits. It's a victim of longstanding neglect and now partisan division.

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