Few challenges has the United States been less prepared for than COVID-19. Looking back on the end of 2019 and the beginning of 2020, it is obvious that the US could have done much more to prepare for the challenges posed by this pandemic to limit the impact on the wellness and survival of the US population and people around the world. The US’s response was characterized by lack of early action by the federal government, misinformation, and unpreparedness. As the next head of the Public Health Emergency Management Team, what I would have done differently can be summed up as the following: 1. increased PPE and ventilation preparedness, 2. earlier mask requirements and consistent prosecution/fining of PPE/social distancing violators in high-risk areas, 3. increased health education effort in schools (MRNA vaccines, smoking, obesity), and 4. created a specific safety net for marginalized communities/low income neighborhoods. These actions would have stood the chance to create significant change in the health and wellness of the US and globally during the pandemic.
Perhaps the most obvious change that most critics of the management of this pandemic would recommend would be an increase in PPE and ventilation preparedness in the US. The first cases of COVID-19 were widely recognized in the end of December 2019 or the beginning of January 2020. After the news of the pandemic, people across the world began to stockpile PPE (face masks, gloves, etc.), which led to global shortages, backlogs, and price increases (Park, et al.). I would have advised corporations to start making PPE and ventilators to meet the potential demand of the pandemic and keep more people safe. If the US had been more acutely focused on the potential risks of COVID-19, then proper action could have taken place. I would have advised the executive branch to invoke the Defense Production Act (DPA) much earlier. The DPA includes “a broad set of authorities to ensure domestic industry can meet national defense requirements… to acquire spare parts, protective equipment and supplies to ensure readiness, especially in times of natural disasters” (“COVID-19 – Defense Production Act). The President only invoked the DPA in the middle of March 2020 to reallocate private and public resources to more production related to combatting COVID-19, especially in the form of PPE. I would have used this executive power around January 2020 to ensure that COVID-19 was given less opportunity to spread due to an increase in availability of life-saving interventions like PPE and hospital ventilators, but also sanitation products like antibacterial soap, hand sanitizer, and disinfectant products (and maybe even toilet paper).
I would have recommended a mandate requiring face masks for the general public much earlier in the pandemic timeline. It was not until the beginning of April 2020 that the CDC began recommending that Americans wear face coverings to help stop the spread of COVID-19. This was after over a month of directing folks that masks were not required nor were they helpful in stopping the spread of the virus (Megerian). As we now understand to be true, masks prevent the spread of droplets of the dangerously transmissible COVID-19 virus. Related to masking, is the enforcement of similar requirements. As a national health expert, I would have recommended to Congress and the executive branch that there should be consistent and unequivocal implications from being observed not wearing a mask in a public, high-risk place where social distancing cannot be maintained. To their credit, some local governments, including some across California in August of 2020, required people to pay fines in mid-2020 for the failure to wear face masks for individuals and businesses (Martichoux). New York City followed suit around a month later (“NYC to fine…”). Congress should have implemented fines to increase compliance with mask mandates and social distancing across all 50 states and territories – yes, even Florida. Swifter action on those who failed to follow health guidelines would have aided in stopping the spread. Of course, there would have been significant opposition from conservatives in Congress and those claiming violation of personal freedoms; however, in an ideal world, this fining system would have been enforced. Additionally, I would have pleaded with Congress to initiate the process of fining in April 2020 once masks became recommended by the CDC. In Introduction to Public Health, the 3 E’s of injury prevention include enforcement (Schneider). In response to opponents of a mask enforcement, I would reference this and make an example of seatbelt use, although injury and COVID-19 infection may not be considered synonymous. With the exception of New Hampshire, front passenger seat belts are now required by all states, and the CDC notes that seat belts significantly reduce the risk of death and serious injury (Policy Impact: Seat Belts). Is wearing a seat belt also an infringement on anti-maskers’ freedom?
I would have also responded differently to COVID-19 by increasing health science education requirements in US schools. This would be a multifaceted approach. As a leader in public health management, I would work with the Department of Education to create foundational change in the way we educate our students as it relates to mRNA vaccines and other topics related to managing health crises. The other piece of this would be meaningfully engaging with students, even more than they are now, to deter them from picking up bad habits like smoking that impact respiratory health and lead to preexisting conditions. Taking more aggressive efforts to tackle a few of public health’s major enemies, poor diet and physical inactivity, would have created a culture of health-first may have helped the impact it had on folks with preexisting conditions such as COPD, obesity, cancer, and more (Scheider) (“Obesity, Race/Ethnicity, and COVID-19”). This education platform would also promote students to trust science as it relates to vaccine technology rather than being impacted by “fake news” ideology about the science behind vaccines. For example, the science behind mRNA vaccines, although perceived by some as “new” and “rushed” into creation, has existed for decades under the close and organized scrutiny of research (Kolata). Consequently, this education would also endorse vaccines as legitimate and life-saving technology, which would create a ripple effect for generations to come.
Lastly, but absolutely not least, I would have created a larger and stronger safety net for communities of color and folks living in poverty during the pandemic. Besides the fact that studies show black and brown folks in the US have higher rates of preexisting conditions, such as obesity, in the US, which makes them at higher risk for complications associated with COVID-19 (“Obesity, Race/Ethnicity, and COVID-19”), communities of color disproportionately experience the impact of serious illness from COVID-19 “due to underlying health and economic challenges” that are compounded by their socioeconomic status (Koma). This is also addressed by Scheider in Introduction to Public Health, and this pandemic has only further highlighted the racial health disparities in this country. That said, I would have lobbied Congress to divert funds to those communities specifically as they are most at risk to have physical, mental, and economic harm from the pandemic. The circumstances were described succinctly by Dr. William Marshall:
While there’s no evidence that people of color have genetic or other biological factors that make them more likely to be affected by COVID-19, they are more likely to have underlying health conditions… experts also know that where people live and work affects their health. Over time, these factors lead to different health risks among racial and ethnic minority groups. Where you live and who you live with can make it challenging to avoid getting sick with COVID-19 and get treatment. For example, racial and ethnic minority members might be more likely to live in multi-generational homes, crowded conditions and densely populated areas, such as New York City. (Marshall)
One of many solutions comes to mind here: route the money collected from fines for folks not complying with masks and social distancing directly to nonprofit organizations or individuals fighting for equity in the time of COVID-19. This also relates back to COVID-19 vaccines because folks in marginalized communities should be the most prioritized for vaccination in the US and globally as they face the most health challenges. That is a focus that would be realized from the steps I would have taken if I were given the opportunity.
They say “hindsight is 20/20”, and this assignment demonstrates all the ways I would have used what I know now if I could go back to 2020 as the head of the Public Health Emergency Management Team. The interventions I discussed, when combined, would have changed the course of COVID-19 in the US and globally. Ultimately, I hope I never have the opportunity to test out my theories in a future pandemic.
References
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