The U.S. Didn’t Need 50 Different Covid-19 Strategies

(Bloomberg Opinion) -- President Donald Trump says his constitutional principles don’t allow him to issue national rules on social distancing to curtail the coronavirus pandemic. “Legally, I can,” he tried to explain earlier this month, “but morally, I — you know, I believe in our Constitution, much more so than most people.”

 “Guidelines” have been all he’s willing to offer. That’s a problem because, in the absence of strong national leadership, the individual states have come up with a variety of strategies — many of them filtered through a political lens. This has put more people than necessary at risk of contracting Covid-19, and better enabled the virus to spread from state to state.

Add in weak testing capacity, a fragmented health care system and a thin social safety net, and it’s easy to see why the U.S. has suffered the world’s worst coronavirus outbreak. The final toll will depend on whether the reopening of the country is as disjointed. A group of East Coast states led by New York announced Monday that they will work together on a cautious return to economic normalcy. California, Washington and Oregon declared a similar alliance shortly afterward. Such cooperation could make Americans safer going forward than they have been so far, as individual states have gone their own way.

“Y’all we are not Louisiana, we are not New York State, we are not California,” Alabama Governor Kay Ivey said late last month, defending her initial decision not to impose a stay-at-home order. As her state’s case count grew, she was forced to change course. Similar rhetoric has been used by governors in other states, including Missouri and Florida, that have been slow to enact strong statewide rules or still haven’t done so.  

Georgia Governor Brian Kemp needed to be informed, weeks after the rest of the world well knew, that some people without symptoms of Covid-19 carry and spread the virus — a key reason that social distancing is crucial.

Multiple late-acting states now have fast-growing outbreaks and more cases per 100,000 residents than there are in California, whose governor acted quickly to stem one of the country’s earliest-detected epidemics. Obviously, stay-home orders work best when they’re put in place before there’s significant community spread. 

South Dakota Governor Kristi Noem has argued that it would be pointless to enact a significant stay-at-home order, because it would need to be maintained until October. Her implication is that it would be preferable to weather a shorter, more severe outbreak. Now she may be getting one: A Sioux Falls pork processing plant, one of the largest in the country, was forced to close over the weekend after 293 workers tested positive for Covid-19. 

Governors also have variously defined which businesses are “essential” enough to remain open. Arizona Governor Doug Ducey included nail salons, until statewide criticism persuaded him that wasn’t a good decision. Golf courses in Arizona, and in other states as well, remain open. And in some states, including Missouri and Virginia, some non-essential businesses can continue operating if they abide by loosely enforced distancing guidelines.

Texas, Florida, New York and Louisiana consider religious gatherings essential, despite evidence that services are places where the virus spreads. This is one of several ways in which Florida Governor Ron DeSantis’s statewide order overruled stricter local regulations. 

Some states demand distancing measures for services or limit size. But such rules are difficult to enforce, especially on a major holiday. Ahead of Easter Sunday, Kansas legislators revoked Governor Laura Kelly’s mandate to limit religious services to 10 people, a move she rightly called “shockingly irresponsible.” The state's Supreme Court went on to back her restrictions.

Kentucky Governor Andy Beshear came up with a much more effective approach: He had police record the license plate numbers of people attending services that didn’t follow his state’s crowd limits — so that they can be given orders to quarantine for the next 14 days.

The variation in local strategies may well contribute to a worse outbreak nationwide. The virus doesn’t stop at borders, and weaker rules in some states only encourage travel — enabling Covid-19 to keep spreading. 

Ideally, the federal government would broadly enforce a national shutdown, make sure all hospitals have the supplies they need, and help broadcast essential public health messages. Some states are responsibly working to fill the gap. The governors of Kentucky and Ohio have turned their daily briefings into must-watch television, and Alaska has enacted strict travel restrictions to protect small communities with limited health care access. California will send thousands of needed professionals into the field to provide health care and testing. New York has vastly expanded hospital capacity. And Connecticut’s ban on surprise medical billing will provide essential financial protection for its residents. 

As attention turns toward opening the economy, the White House has an opportunity to better follow the dictates of public health. Unfortunately, the planning has already been politicized. Picking up on Trump’s obvious preference for an early and fast economic restart, Texas Governor Greg Abbott is already calling for quickly relaxing restrictions. At the same time, New York, Connecticut, Rhode Island, Pennsylvania and New Jersey collectively pledged to take a close look at incoming data and wait for recovery before loosening distancing.

If Trump can now listen to experts and help orchestrate a careful reopening — keeping impatient governors in line and supporting regional groups with federal resources — he could avert further damage and at last show how a federal system can function well in a crisis. If he instead tries to force states to return to work early, or lets some open the floodgates at will — before there is widespread testing and better data on how widely Covid-19 has spread — we’ll see renewed outbreaks and another round of orders to stay home. Most likely, given Trump’s reluctance to lead in this crisis, the country’s best hope is that more governors will band together to act forcefully on their own.

This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

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