How Should the US Handle a Pandemic?
This is Part 3 in a series of articles on the United States COVID-19 public health response. Click here to see the other parts.
This article can also be found in my “Policy Opinions” section.
It’s pretty evident that the US has taken a major hit from COVID-19. We have over two million cases with a high daily case rate, and our economy is going through a recession at a 13.3% unemployment rate.
Now with the news of another Ebola outbreak in the Democratic Republic of the Congo, it’s more important than ever to understand how we contain an outbreak. Therefore, we should really talk about how to fight a pandemic. This problem isn’t going away in the future, and future outbreaks have the potential to screw us over if the government responds poorly. Let’s get into it.
Utilize our Existing Infrastructure
The US government has plans and agencies in place to handle a biological threat such as an epidemic. Let’s look at the 2016 Pandemic Playbook released by the Obama administration. This Playbook explained what each government department should do — basically, the government should divide and conquer to address all the problems a pandemic causes. Let’s go down the list of things that the US should consider, according to the Playbook:
Working with Other Countries
The State Department should communicate with foreign governments and NGOs. If the US has conflicts with other countries who could provide valuable assistance (or need assistance), then the State Department should resolve (or at least put “on hold”) these conflicts to enable cooperation. They should also update foreign countries periodically on the status of the US.
The US Agency for International Development (USAID) is in charge of actually providing humanitarian aid to countries that need it. The USAID can deploy Disaster Assistance Response Teams (DARTs) to help manage the spread of disease. For example, during the 2014 Ebola outbreak, Obama sent health officials to Liberia, Sierra Leone, and Guinea to establish treatment centers (15, to be exact) and deliver personal protective equipment.
Alongside the USAID, the Centers for Disease Control and Prevention (CDC) can deploy “Global Rapid Response Teams (Global RRTs).” RRTs deploy medical workers and experts to help with emergencies in other countries. RRTs can also maintain communications with the domestic CDC so that the White House is updated on what’s happening abroad. Using the CDC and USAID together can double the number of responders abroad.
These groups have specific roles on which they should focus — splitting up “international cooperation” this way is meant to avoid overburdening any one organization so that the US can cooperate with other countries efficiently.
Public Health: Department of Human Health Services (HHS)
Obviously, the HHS should lead a pandemic response. The HHS will focus on developing and stockpiling tests and vaccines along with stockpiling supplies. The HHS also communicates with local authorities and researchers on the status of cases, testing, and vaccine development. Finally, the HHS provides expertise and recommendations to the White House on whether to declare an emergency, how to address and end the emergency, and how to prepare for future emergencies.
Because the HHS is the most involved department, its work is divided among several of its smaller agencies. So now it’s time for a list within a list:
Centers for Disease Control and Prevention (CDC)
The CDC is meant to be the primary public health adviser to the White House. It can make various recommendations, such as guidelines for keeping medical workers safe. An example of that would be to establish separate facilities for COVID-19 patients from regular hospitals to split up healthcare workers. The CDC can also make recommendations on executing health screenings at airports, distributing tests and releasing guidelines for testing, etc.
The CDC should also maintain communications between the White House and researchers across the country. The Playbook recommended that the CDC establish a network of laboratories to communicate testing methods and regulations (e.g. who should be tested?). The CDC should also manage the Strategic National Stockpile (the stockpile of supplies like masks, ventilators, etc.) and manage requests for supplies from the state governments.
The CDC is on the front line — they’re advising the White House how to proceed, they’re advising researchers how to proceed, and they’re helping deliver supplies and drugs to states as needed. Arguably, the CDC is the most important agency on the list — but not the only one.
National Institute of Health (NIH)
The NIH is designated as the leader in R&D. This includes conducting preclinical studies and clinical trials, developing diagnostics (to diagnose people), and creating a vaccine. The NIH should use its research capabilities and its expertise to help (1) identify that an emergency is imminent, (2) reduce deaths and end the emergency (e.g. with a vaccine), and (3) prepare for future emergencies. That last part can be accomplished by making recommendations to the HHS secretary and the White House.
Side note: A smaller institute within the NIH is the National Institute of Allergy and Infectious Disease (NIAID). Dr. Anthony Fauci is the director of this institute.
Assistant Secretary for Preparedness and Response (ASPR)
The ASPR doesn’t have a unique responsibility — rather, it partners with other agencies to help them. The ASPR was actually created after Hurricane Katrina to help lead emergency responses.
The ASPR has an institution called the Biomedical Advanced R&D Authority (BARDA), which can help the NIH with R&D.
The ASPR can deploy medical personnel — such as first responders, paramedics, or doctors to hospitals. It can also help manage the Strategic National Stockpile.
The ASPR can pretty much do whatever the White House needs it to do in an emergency. Personally, I think this is somewhat problematic. For example, if the ASPR is managing the Stockpile alongside the CDC, then states may be unsure whether to ask the CDC or the ASPR for supplies, creating confusion. The point is that if there are agencies with duplicate roles like this, it needs to be clear what the division of labor is for each specific protocol.
Food and Drug Administration (FDA)
Like the ASPR, the FDA doesn’t have a unique role but rather supplements other agencies. For example, the FDA can help manufacture and distribute drugs (e.g. vaccines or antiviral medicine) along with tests. This can be done by working with private manufacturers.
Keeping People (Including Medical Workers and Patients) Safe
We must ensure that the virus can’t spread among the population. In particular, we don’t want to put front-line workers (e.g. medical workers) at risk, as they’re the foundation for a pandemic response.
This pertains to the Department of Defense (DOD) and the Department of Homeland Security (DHS) — both of which are more applicable during a bioterrorism event but can still help out in a pandemic.
The DHS should secure borders and ports of entry as needed to stop unnecessary travel that could bring in a pathogen. They should also organize a lab network with which the federal government can communicate — this helps with sharing tests, statistics on cases and testing, and progress reports for vaccine development. A more advanced function of the DHS is the use of the Federal Emergency Management System (FEMA). This agency can deploy medical experts who can advise R&D efforts along with doctors and paramedics to help at hospitals.
Like the DHS, the DOD can help in R&D — the DOD can conduct research itself into developing a vaccine. The DOD can also deploy military personnel to transfer patients to safer facilities for example.
On the note of transferring people, the Department of Transportation can help transport patients, at-risk individuals, or other people who should be quarantined. They can be transported to isolated areas or secure facilities. The Department can also transport goods or supplies if needed.
On the note of deploying first-responders, the US Public Health Service (USPHS) can help. Although the USPHS is an agency of the HHS, it can help the military by delivering supplies to local authorities or deploying medical workers to healthcare facilities to help process all the patients coming in.
My point is that there should be cross-department collaboration — agencies of different departments should work together if they have the same functions. That way, we maximize the number of people helping with the crisis.
Regulations for Medical Workers — The Department of Labor
Not only should the government provide labor and capital to help hospitals, but it should also issue regulations to protect workers so that they can do their jobs properly. The Department of Labor handles this. It can require hospitals to create safeguards for workers against a virus — this can be done in an emergency. This is accomplished through its smaller agencies.
The main agency for this pursuit is the Occupational Safety and Health Administration (OSHA). OSHA can deploy safety inspectors to hospitals and nursing homes to ensure that workers and patients have safe conditions. These inspectors can also determine if managers train nurses and other workers for handling high-risk patients.
As an example, in 2010 (after the swine flu outbreak) OSHA drafted safety standards that hospitals were required to adopt. These standards included building isolation rooms to quarantine patients and having employees wear gowns, gloves, and respirators around high-risk patients.
Congress can also dictate how the Department of Labor acts by passing laws requiring them to enforce specific labor and safety standards.
Monitoring our Food Supply and Environment
In a pandemic, we need to make sure that our food supply and livestock aren’t infected with a disease. Because eating infected food is… not pleasant.
For that reason, the Department of Agriculture (USDA) monitors the food supply. This includes monitoring imports, testing livestock, researching how a virus impacts agricultural products and preventing the disease from spreading among agricultural products. The USDA can also distribute food through disaster food stamp programs (D-SNAP) if the situation becomes dire.
Similarly, the Department of the Interior (they’re in charge of national parks and natural resource reserves) can investigate if the virus is spreading through wildlife. They can potentially make recommendations to the President on whether to move people away from a wildlife disease hotspot, for example. On the note of nature, the Environmental Protection Agency can take environmental samples to find hotspots for the disease. They can also engage in decontamination efforts if needed, but that’s probably more applicable in a bioterrorism event.
Using our Infrastructure Efficiently
The US government has a massive bureaucracy — whether or not you like that, it’s what we have, and in a pandemic, the government should utilize all the departments and agencies at its disposal. To summarize:
- The State Department, USAID, and CDC should focus on international aid and communication.
- The HHS should use all its agencies for research and development of drugs, for stockpiling and distributing supplies, and for recommending counter-measures against an outbreak to the White House. The DHS and DOD can help with research if necessary.
- The Departments of Homeland Security, Defense, and Transportation should work together to transport supplies and patients as needed while deploying personnel to help at hospitals.
- The Department of Labor should ensure that medical workers have safe conditions so that workers and patients aren’t at risk of getting infected.
- The USDA, the EPA, and the Department of the Interior should monitor the food and agriculture supplies along with the environment and wildlife to determine if the virus is spreading through animals or plants.
If all these pieces run smoothly, then the government can efficiently cover every major problem that arises with a pandemic. Of course, there’s also the economic risks with a pandemic, but I’ll talk about that separately.
It’s important that agencies work together to maximize the effectiveness of the government response, but it’s also important that agencies know what their responsibilities are (and what they shouldn’t do) so that there’s no confusion about who does what — the last thing you need in a pandemic is for the government to eat up time figuring out each agency’s roles.
How to Prepare for a Pandemic
This is the simpler (but arguably more important) part. Essentially, the government needs to stockpile supplies ahead of time, it needs to have a system to communicate with local authorities and distribute supplies, and there needs to be proper funding of emergency response teams and research.
Gathering the Necessary Supplies (In a Timely Fashion)
A key aspect of preparing for a pandemic is stockpiling essential supplies before the virus hits the country. That includes personal protective equipment (PPE) — masks, gloves, etc. — syringes, needles, swabs, and ventilators.
Gathering supplies before the outbreak occurs is critical. If the government waits to stockpile resources until the pandemic hits the US, then they’ll be playing catch up while people are dying and hospitals are being overwhelmed. Those reserves have to be ready ahead of time.
Those supplies can be ordered, but that’s tricky in a pandemic — other countries are stockpiling resources as well and likely won’t want to share (i.e. foreign governments temporarily ban exports). The safest route is domestic manufacturing. So to ensure that the country produces these supplies quickly enough, the President can invoke the Defense Production Act (I’ll call it the “DPA” here). This allows the President to — for national defense — require companies of his choosing to manufacture specific products and supplies for the state, regardless of whether those corporations incur losses as a result.
While the DPA is traditionally meant for wartime, it’s definitely applicable in a pandemic. Through the DPA, the President can take several actions to increase production and make supplies readily available. For example, he can settle labor disputes so that companies are producing at maximum capacity or impose price controls to make the supplies more affordable.
If the DPA is going to be invoked, it should ideally be invoked before the emergency hits its peak (or even before there’s a significant number of cases). By invoking the DPA early, companies have more time to meet the government’s supply needs, and they don’t have to produce so many units in a short time-crunch. That way, manufacturers don’t have to experience as much in fiscal losses.
Establishing Protocols and Communication
I already talked about what the White House and each of its departments should do. However, all of that is worthless if the federal government isn’t communicating with states, local authorities, hospitals, and researchers properly.
State governors need to know who to ask for supplies. Hospitals need to know how much medical personnel they should expect to receive. Laboratories need to know the protocols for conducting tests, and they need to be able to tell the federal government about their progress in making vaccines.
The point is that the federal government needs to establish efficient communication with local authorities — maybe that means establishing public databases that are constantly updated, for example. Maybe it means updating people on disease hotspots (e.g. notify people where the most infected areas are).
Conclusion
There’s no time to sit around and sort things out during a pandemic. Everything should run like clockwork: each department should know what they’re doing, manufacturers should be pumping out supplies at maximum capacity, and the federal government should be communicating with states and with the public.
If someone tells you that “there’s nothing we can do” to in a time of emergency, they’re probably wrong. Remember to Stay Cynical.
