Underfunded and Underinformed, Health Agencies Flounder
Underfunded and Underinformed, Health Agencies Flounder
(Bloomberg) -- The hardest thing to find amid the coronavirus pandemic isn’t hand sanitizer. It’s a straight answer.
A slow-moving federal response and a trickle of often-changing advice have largely left the critical job of setting front-line policy to overburdened, under-resourced state and local health departments. Often, they themselves don’t have enough information to form plans to combat a brand-new disease.
Scott Morrow, a doctor with San Mateo County Health Office south of San Francisco summed up the frustration in an update to the public on the agency’s website this week.
“I have been asked to make significant policy decisions with very little information on which to base them,” he wrote.
“I have 35 years of experience as a physician, and almost 30 years of experience in local public health, more local public health experience than almost anyone in our state. If I am filled with uncertainty, I can only imagine how the general public must be feeling. People want very specific answers to their questions, and they deserve them. But in many cases, there are not satisfactory answers to give them.”
The bafflement is the product of federalism. The U.S. Centers for Disease Control and Prevention in Atlanta is the nation’s top public-health institution and has emergency powers, like its recent order to quarantine people returning from infected areas of China. However the CDC rarely flexes those muscles, instead merely offering guidance and information and deferring to local agencies. The White House virus task force hasn’t held a briefing since Tuesday. So states and counties are improvising and overwhelmed.
Empire Medical Training, a Florida company, experienced the information vacuum firsthand after hosting a four-day Manhattan workshop. Four days after the conference ended on March 2, organizers learned from an attendee that another participant had tested positive, New Jersey’s first case of Covid-19. The company tried in vain to find out whether it was true and what it should do.
Empire workers called the CDC and were told to call the local health department. After hearing that 300 people might have been exposed, the CDC recommended the state health department, said Sarah Cotta, the company’s business development manager. The company called New York and New Jersey officials, and were told in each state that they had the wrong person and given other numbers to call.
Empire finally confirmed the diagnosis with the patient himself and began informing attendees. “We were just a company trying to do our due diligence here,” said Cotta. “We kind of got the runaround.”
In New York, community leaders in Richmond Hill, Queens, are taking it upon themselves to get out information. “Everyone is confused about what to do,” said Sanjeev Jindal, an insurance broker active in South Asians for Empowerment, which is organizing community meetings with doctors.
Communication Breakdown
Much like their own citizens, state and local governments have also struggled to get facts.
In Princeton, New Jersey, at least five guests at a 47-person party Feb. 29 have tested positive. The town’s health department has been trying to track down attendees and test those showing symptoms. Several samples are being handled by private labs, and results are still unknown. The state has no authority to expedite things, Mayor Liz Lempert said in a Thursday letter to her community.
“The bureaucracy and difficulty in obtaining timely test results is extremely frustrating to all of us,” Lempert said.
In Illinois, Governor J.B. Pritzker, a billionaire Democrat, has been complaining about the lack of clarity during daily press conferences. He said this week that the CDC hadn’t initially defined what it considers a large gathering when it recommended such events to be canceled, for instance, and that President Donald Trump’s administration hadn’t given out trustworthy information: “To the extent that there is confusion that has been stoked out in the public, it has been brought on by the White House.”
Even communicating the simple number of infections has been a challenge.
New Jersey Assistant Health Commissioner Christopher Neuwirth on Monday told reporters that the state had yet to receive CDC confirmation of its first cases, despite submitting samples five days earlier. “We’re unaware of exactly what’s causing the delay,” he said.
At a press conference in Atlanta, Georgia Department of Public Health Commissioner Kathleen Toomey apologized, saying the state was not allowed to call a test positive until it had been sent to and confirmed by the CDC.
“What may be confusing is that we say these are presumptive positives,” she said. “That’s because the CDC hasn’t give us the clear go-ahead that we can be the final word.”
Awaiting Word
Georgia clinics and local health agencies refer all requests for testing to the state health department, even though private labs began testing late last week with federal blessing. In Cobb County, north of Atlanta, an otherwise exhaustive health department web page on the virus still says that only the state can test. Spokeswoman Valerie Crow said she’s not sure that’s still true: “I’m waiting for someone to tell me what to replace it with,” she said.
Local and state agencies on the front lines are underfunded and understaffed, said John Auerbach, a former Massachusetts health commissioner and CDC deputy director who is chief executive officer of the Trust for America’s Health in Washington.
Funding cuts during the 2008 recession never were really restored, he said. Since the recession, local health agencies have lost more than 55,000 jobs, and state departments another 10,000. “Public health is prioritized during an emergency or when there’s a significant health risk and then forgotten about after that, even though the work that’s done before an emergency occurs is critical,” Auerbach said.
The lack of planning has led to conflicting approaches. CDC experts were called into some counties to track down connections to confirmed cases, while other municipalities have given up on “containment mode” and are simply recommending the cancellation of large gatherings.
California’s Sacramento County told residents exposed to the virus to go into a 14-day quarantine only if they show symptoms. Georgia’s chief epidemiologist Cherie Drenzek said the same. New York Mayor Bill de Blasio, meanwhile, advised all New Yorkers to voluntarily quarantine for 14 days if they had recently returned from China, Iran, Italy, South Korea or Japan, regardless of symptoms.
One of the most effective ways of containing the virus is school closings, which CDC guidance appears to endorse without specifying when or how they should be done. On Thursday, Maryland, Ohio, Michigan, Minnesota, and Kentucky closed all their schools after days of waffling and policies that varied from district to district.
On Monday night, Georgia’s Fulton County Schools, one of the state’s biggest districts at more than 93,000 students, had abruptly closed its schools after a teacher fainted and tested positive at a local hospital. The sweeping move drew a warning from Governor Brian Kemp.
“While it’s ultimately a local decision, we strongly encourage any district or school considering closing to first contact the Department of Public Health for guidance” Kemp said.
On Thursday, he recommended that all the state’s schools close.
--With assistance from Henry Goldman, Shruti Date Singh, Matthew Leising, David R. Baker, Sophie Alexander and Josh Wingrove.
To contact the reporters on this story: Margaret Newkirk in Atlanta at mnewkirk@bloomberg.net;Elise Young in Trenton at eyoung30@bloomberg.net
To contact the editors responsible for this story: Stephen Merelman at smerelman@bloomberg.net, Brendan Walsh
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