Health experts say the federal government is still not adequately responding to the coronavirus threat and is failing to inform the public, medical community, and local governments fully about the massive scale of domestic preparations necessary.
President Trump attempted to reassure the public Wednesday evening that the 15 cases found in the United States, as opposed to cases involving those who were repatriated to the U.S. after getting sick abroad, will drop to zero in a “few days.” And he said his administration was taking an aggressive approach to kill the threat before it wreaks havoc, as health experts predicted it would earlier this month.
“He has done a terrific job so far,” Dr. William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine’s Department of Health Policy, said about the government quickly identifying, tracing, monitoring, and quarantining those who are sick.
However, Dr. Arthur L. Caplan, founding head of the Division of Medical Ethics at NYU School of Medicine in New York City, gave a resounding “overall, no” when asked if the Trump administration was prepared.
“The problem is [Trump] has been sending mixed messages like, ‘We’re under control — there’s no problem here,’ when his own CDC knows we don’t have a problem here because it hasn’t gotten here yet. It’s like saying, ‘We don’t have a problem with anybody attacking us tomorrow in Afghanistan or something because they just haven’t started their attack,” said Caplan. “It makes no sense to give false assurance to the American people.”
Three distinguished public health experts, Georgetown University professor of health systems administration and population health, Dr. Michael A. Stoto, Caplan, and Schaffner, identified five critical things that the federal, state, and local governments should be doing, and they agreed the Trump administration must call the shots and brace the public for the worst — not to scare people but so they understand what may be expected of them.
1. Describe how it actually spreads
Coronavirus is a respiratory virus spread through close contact with people gathering face to face or in enclosed spaces. As of this week, health experts know the virus is contagious several days before symptoms arrive. A kiss on the cheek from a friend who is seemingly healthy today is risky because they may not show symptoms of the virus until early next week.
2. Make clear that face masks may not save you
Trump told reporters Wednesday that the government “ordered a lot” of face masks, but Schaffner said these types of coverings do not protect someone healthy from getting the virus and give people a “false sense of comfort.”
“There’s really scant scientific data that would support their use to protect us from getting an infection. Those masks are not designed to prevent us from getting a viral infection,” said Schaffner, adding they are also not effective at containing germs when worn by someone who is sick.
The best tool for avoiding the virus, which the government has not shared, is “social distancing,” or staying away from people and public spaces.
3. Localities must decide when to separate people and enforce quarantines
When, not if, small communities and large cities see new cases pop up, local governments must be ready to put into place voluntary or mandatory social distancing policies to keep people away from one another. Local governments will have to decide whether to mandate work from home policies and even teleschool for children.
“We would see recommendations for all of us to become semi-hermits for as long as possible during transmission if the virus came to your community or mine. It would be very localized depending on where the introductions are,” said Schaffner.
Stoto said state and local governments will have to make these types of calls on how to handle people who are in quarantine and who do test positive.
“When cases show up, it’s going to be state and local health departments that do the contact tracing — that do quarantine if that becomes necessary, decisions on social distancing measures … communicating to the people who live in their jurisdictions on what the actual risks are,” said Stoto. “With Ebola, for instance, when people came into the country, and they were identified at the airports as to potentially being exposed, it was the state and health department that had to follow up with these people every day.”
4. Make testing more widely available
Testing those who are sick to see if they have the virus is also a challenge for the medical community and local officials in rural areas, Schaffner said.
“If there were one thing that we could ask for now is a greater ability to test more broadly. We don’t want to test every patient that comes in with a cough,” said Schaffner. “We would like to open up testing more broadly than it is available.” Health facilities need ways to get those tests to state health departments faster. Tests developed by commercial laboratories should be put on a fast-track approval basis by the Food and Drug Administration so that more tests can be manufactured and made available to avoid a potential shortage.
5. Decide now who will get a vaccine when it is ready
A vaccine is 12 to 18 months away, National Institute of Allergy and Infectious Diseases Director Dr. Tony Fauci told reporters at the White House Wednesday. But there may not be enough vaccine for everyone who needs it, Caplan said, and the country needs to decide now who will be at the top of that list, should it come down to it.
“Who’s going to decide that and on what basis? I’m OK with people in factories making the pills, even doctors and nurses getting early access, but let’s talk about it, so people understand we have to ration initially until we get enough for everybody,” said Caplan. “None of this is what we’re hearing about. We’re hearing about the impact on the stock market — supply chain. We’re not getting the rest of the story.”
The Centers for Disease Control and Prevention did not respond to requests for comment.
