4. Government’s response to public health threats must be informed and guided by data.
During the COVID crisis, New York has collected and publicized more data than most other states, and the state’s usage and reliance on data and metrics are something we have done extraordinarily well. Data allowed us to better manage the crisis, understand where to target resources and efforts, and identify and mitigate emerging areas of concern. From the earliest days in the crisis, New York required hospitals and other health-care providers to submit detailed information daily on how many hospital beds were available, the number of ICU beds occupied, how many ventilators were in use and on hand, the amount of PPE available, the number of tests performed, and much more. We tracked how many patients were in hospitals, what communities they were from, and extensive socioeconomic information. In New York, we also collected individual data so we knew what was happening in each community down to the zip code level. This approach to data collection and attention to detail has supported our nation-leading contact tracing program.
The federal government should use New York’s model and build a similar system, and it must be completed quickly. It should share the data that is collected with states, especially states that lack resources or technical capacity to develop their own robust systems. During the COVID-19 crisis, the federal government did not mandate data be collected or reported in any uniform way. Most states did not collect or publicize as detailed information as New York State. As a result, as of this writing, it remains impossible to do a true state-by-state analysis of what happened.
Data must be reliable and transparent to the public. As a starting point, it has to be free from political influence so that the people can have faith in the information they are receiving. Recent media reports have stated the White House is interfering with hospital data, asking hospitals to bypass the CDC and instead report information to HHS. Why would they make this change seven months into the pandemic? It raises serious questions about the accuracy of information being collected, controlled, and released by the federal government.
5. The federal government must build a public health emergency operation team and program with the capacity to coordinate and respond to major health crises.
The Federal Emergency Management Agency was designed to assist in natural disasters such as hurricanes, floods, and fires, but it was wholly ill-suited to be helpful and responsive during the COVID crisis. Public health experts must be central to the response for their epidemiological expertise, but health agencies are largely regulatory bodies and are not equipped with managing a crisis of the magnitude of COVID-19. In essence, public health experts in the federal government need the experience and expertise of emergency operational officials who can execute tasks like building large-scale testing capacity quickly.
A robust public health emergency operations team will be well suited to implement a national public health program that is responsible for building up the nation’s health-care capacity to deal with future crises—an urgent need. It is obvious that the nation was unprepared to handle a viral outbreak on the scale of COVID-19. For instance, the federal government’s own forecast in March estimated that the COVID virus would require between 2.4 million and 21 million hospital beds nationwide, yet the entire country has only 925,000 staffed hospital beds. One can argue that we should have been better prepared after H1N1 swine flu, SARS, Ebola, and other past public health challenges. Whatever the reason, it is clear we were not.
A public health capacity program must start with an early warning detection system as outlined above, but first and foremost it must focus on building a nationwide testing system. The United States has no capacity to quickly ramp up large-scale testing of our population. Other countries such as China and South Korea were much more successful in quickly determining the number of individuals infected with a virus and isolating them to stop the spread. In the United States, testing is a fragmented network of private labs with major national manufacturers selling different equipment and proprietary test kits and approximately seven thousand private laboratories and hospitals capable of conducting tests. It is imperative that the federal government design the necessary requirements to provide mass-scale, nationwide rapid testing—including for new and emerging viruses.
Likewise, the nation needs a contact tracing operation to follow up on those who test positive and help limit viral spread. Like the testing operation, it can be either federally operated or federally designed and delegated to the states. In New York, we set a tracing formula based on the infection rate of regions within the state, and as of this writing we currently have about seven thousand contact tracers. The program has helped the state find and isolate COVID clusters before the virus spreads more broadly in the community.
Staffing was also a challenge nationwide. On the front lines of the crisis in hospitals and other health-care facilities, nurses and physicians would contract the virus or need a break because of the severe fatigue of working long hours. Given that COVID-19 is a national crisis and that future viruses will likely be as well, the federal government should create a nationwide volunteer portal where health-care professionals across America can offer their services and states and local health-care facilities can access as needed. Such a system will avoid competition of scarce human capital during an emergency.
The federal government must invest in isolation and quarantine facilities, which must be readily available to hold infected people who do not have the ability to self-isolate. In dense and crowded communities, like New York City, a person who tested positive often did not have the ability to self-isolate. We need a public health system that can care for highly infectious individuals
