I learned some things about our system from talking more in depth with my son. Local health departments have a lot of authority in epidemics and they coordinate with the state DOH. In this case, however, it worked the other way – the state dictated down after advising the governor.
State and federal emergency declarations free up money and resources for local agencies. Emergency Management offices in counties coordinate all of the local agencies and entities involved, and, for instance, are the connector of a county health dept with FEMA or other state-level agencies outside of the DOH.
He says that the confusion the public has about the steps that have been taken arises from all the cooks that are in the kitchen from CDC down to 50 states and thousands of local health departments. Responses are supposed to be locally crafted. For example, Seattle needs a different plan than Cleveland because one has an outbreak and the other is expecting one. Yet, there is also a federal approach and each state will take their actions. There is a lot of room for confused messaging in that structure of federalism.
He also says that the sense that this wasn’t handled as good as it could have been, especially on the federal level, comes from a lack of good information. China had the opportunity to dispense good information about the virus, what worked, what didn’t, etc. but they are commies and are more interested in what is good for the Communist Party than their own people, or certainly, the rest of the world. We are just now getting reliable information from Italy.
Another cause of some response problems was a lack of experience with pandemics. We have had them, but not on the scale that this one is thought may be - and each one is unique. This means that a lot of plans that were in place were theoretical, more than practical. So, our government got caught in the trap of, “well, it sounded good in theory” and "it worked for that, but not for this". Ideally, you know exactly how the disease is spreading, its course, and its rates of hospitalization and morbidity, and from that you can craft a response that is the most effective. In this case, since reliable information was lacking, the government had to take the approach “better to do more than less” – and that has contributed to the sense that there is some over-reaction going on as well as the sense that some things slipped through the cracks.
He just about had a cow when the director of the ODOH said that “there are probably already 100K infections in the state”. She has no way of knowing that, and rule #1 of crisis management is don’t say anything you don’t know for sure because public anxiety or panic can become a major problem in and of itself.
He also said to not underestimate bureaucratic angles that can be worked here. The state DOH isn’t an agency that gets a lot of attention, it doesn’t generate as much revenue as some other agencies, and it is not funded as well as some other departments. This is their time to shine, and that opportunity will not be wasted.
As for who was right about what the right response was about this thing from the beginning, it’s still too early to know. It really depends on what you believe the goal should be. If the sole goal is to limit the disease, then what isn’t warranted and what price is too high? If your goal is to limit the disease, but not devastate the economy, then you would do and not do certain things. If your goal is to limit the disease, not hurt the economy, and allow things like sports to happen, then you get another different set of decisions distinct from the other two.
But it’s always easy to justify almost any over-reaction under the principle “err on the side of caution.” However, I suspect that when this thing is over, many people are going to think the response was out of proportion and unnecessary – which is unfortunate because they will be less likely to take it as seriously the next time when, perhaps, they should.
One final thing – saw Dr Faucci yesterday talking about the cancellations of entire tournaments and suspensions of leagues. He cited the complete cancellation as an example of erring on the side of doing more, but he said he had no problem with these events going on with limited audiences as they first proposed. I think this is one of the things people are really going to regret when this is all over. Some HS kids and college athletes missed an opportunity to compete for championships – an opportunity that is lost forever. If having the event with a limited audience doesn’t really do much to increase the risk of a spike in infections, then why did we take things away from people that cannot ever be replaced?
