As President Trump says there are plenty of coronavirus tests available, many governors argue they are running short. In recent weeks, the Trump administration has come under growing pressure to do more to assist states in ramping up testing nationwide.
The coronavirus pandemic has exposed major weaknesses in the federalist system of public health governance, which divides powers among the federal, state, and local governments, according to Michelle Mello, in this New England Journal of Medicine commentary. Mello, a professor of medicine and a professor of law, and Rebecca L. Haffajee, a health policy researcher at the RAND corporation, argue “strong, decisive national action is therefore imperative.”
The Center for Ethics in Society asked Mello, an advisory board member, about the U.S. response to COVID-19. Here is an edited version of the conversation.
Is there anything the federal government could or should have done to slow the spread of the virus?
There are many things that the federal government could have done differently—starting with its entire approach to whether the virus represented a threat. Weeks beyond a point at which any reasonable person would have acknowledged this is a serious situation, we still had people in Washington dismissing it as a threat with the aid of media outlets fanning the idea that it is no worse than the common cold. That set the stage for public attitudes about the public health measures that were to come because a broad swath of the country quickly became convinced that there was no need for these measures.
The second big failure was on the testing front. Our usual way of developing tests for novel pathogens failed utterly. Even when the rest of the world had a test, the CDC labs wanted to develop their own. I have never been able to get a clear understanding of why that is other than the general feeling that their scientists are the best in the world, so why would we take a chance on anybody else's test? In this case, what that meant is that only their tests were allowed to be used initially, and it was a failure because we now know of pretty egregious violations of standard laboratory hygiene and manufacturing processes. It took far too long for that to be corrected.
You write that the public messaging about the seriousness of the problem has been misleading. Do you worry this may have led Americans to take fewer steps to prevent community transmission?
What I mean by misleading is saying, first of all, that this is no more serious than the common cold, or seasonal influenza, and secondly, that things were completely under control. And then those falsehoods continued to be repeated on Fox News. You have a broad swath of people who remain under this impression, as evidence by interviews with protestors who are repeating these same falsehoods. It's very hard to unring the bell that way, and no one is trying. And there is no prospect that these folks are going to get their information from any other source because of the state of where we are as a nation. We have a serious problem.
At the state level, I don't think Gov. Newsom’s messaging has been a model of clarity. For example, when the state first imposed stay-at-home orders, the web page that described "more information" about it was pitifully inadequate and surprising in light of the much more complete set of FAQs Santa Clara County, and others had already posted. It led to a lot of confusion and probably some delay in getting total compliance with those orders.
In multiple states, protesters are pushing back against governors' stay-at-home orders, and in some states, governors are planning to reopen certain businesses. What can the federal government do to promote a more unified response?
The federal government can serve an important coordinating role. I think it was very helpful that there were guidelines issued on what a reopening plan might look like. It seemed to me like they were written with somebody who has public health knowledge and has actual expertise. It was a step in the right direction to give state and local governments some evidence-based plan for how to think about reopening. The other thing that can be done is more convening of governors. It is really heartening to see these two working groups of governors in the Northeast and on the West Coast coming together, but how about the other 38 governors? Why aren't they part of this conversation being led by people who really care about evidence?
Under the Defense Production Act, President Trump has authority to order private companies to produce and expedite production of certain essential items and allocate them. Has the federal government fully embraced the statute during this public health emergency?
They certainly are at liberty to make greater use of that statute. Part of the problem, I think, is that there has been an unwillingness to acknowledge, at least publicly, that there are shortages of these supplies. Let's first acknowledge where the shortages are, and then let's see how much compulsion is necessary or whether there are voluntary measures that could be implemented to get a better supply chain running again. For example, some areas have a more than ample supply of things, and there is not a great framework in place for reallocating.
The CDC recently said there could be a second, possibly worse coronavirus outbreak this winter. What sort of policies and guidelines should be put into place to prevent the United States from becoming the epicenter of COVID-19 if it comes around again?
There are two things that are critical. One, we have to have the ability to do widespread testing quickly. We cannot again have a policy that you have to be unable to breathe in order to get a coronavirus test. The second thing is we need to make sure people get a flu shot. Not because it prevents coronavirus but because it will prevent hospitals from becoming overwhelmed if we can keep vulnerable people out of the hospitals from seasonal influenza, and other respiratory illnesses.
What else is important for people to know?
I think one of the most interesting things about this from an ethical perspective is the question of social solidarity. Is it happening or not? In other times, when countries have faced profound national experiences of privation, they have really come together. They have instituted social safety net measures to protect people going forward. The prime example of this is Western Europe after World War II. They went from a Victorian system in which they had no social welfare policy of any kind to a very complete personal safety net. Historians attribute that to the experience of having gone through something terrible together and feeling some solidarity.
There seems to be some of that going on, but there is also incredible reinforcement of partisan division. I think one of the most interesting questions is: what is going to happen to our health and social policy going forward coming out of this? Will we learn anything?