I am a Vermont primary care pediatrician with a background in public health. The U.S. public health response to the Coronavirus (COVID-19) outbreak has been a slow-motion train wreck that highlights the fragility of public health networks. It’s what happens when leadership is slow to respond, when science is ignored and facts are distorted, and when leadership defunds critical infrastructure.
It has been more than two months since the onset of this epidemic and our CDC (Centers for Disease Control and Prevention) is only now beginning to provide for timely testing, albeit only in limited quantity. Without easily available testing, we are violating a critical public health injunction to identify infected individuals and their contacts as soon as possible to interrupt the spread of the virus. As more and more people become infected this becomes less and less effective.
Widespread testing should not have been difficult. South Korea has tested tens of thousands and China probably millions. As of March 6 less than 2,000 people have been tested in the U.S. and 10% were positive. Our CDC’s test was flawed. The World Health Organization’s test was successful. We could have adopted that, but we didn’t. Failure of leadership.
Leadership matters. President Trump has repeatedly made false pronouncements that undermine our career public health professionals. He has undercut the CDC and downplayed the severity of the Coronavirus threat. He even seemed unconcerned about infected people returning to work. On Feb. 26 he said cases were declining, when the CDC said just the opposite. He falsely said the case fatality rate was lower than for influenza (it is about 10 times higher than influenza), and he said a vaccine would be forthcoming shortly, in weeks to months, when it will require more than a year, if all goes well.
He has referred to COVID-19 as the “Corona flu,” conflating this dangerous virus, which none of us have immunity to, with the more prosaic yearly flu. They are not the same.
Harvard epidemiologist Marc Lipsitch told CBS News that “40 to 70 percent” of the global population could become infected with coronavirus and that it’s “almost inevitable” that the virus will impact the “entire globe.” Most will be asymptomatic but capable of spreading the virus to others, many of whom are elderly or with illnesses or immune compromise that put them at risk for severe disease.
This large range of estimates underlines how little we know of this particular virus and its epidemiology. Only vigorous testing will clarify the burden of colonization and infection with the virus. Feeling well does not equate with being virus-free. We really are still in the dark and we are in need of informed leadership by qualified public heath experts and political leadership that acts on science instead of “hunches.”
My pediatric office will be radically challenged with strict infection control. We anticipate parental anxiety and demands for testing and treatment. We are in the midst of flu season. Without robust testing how can we differentiate COVID-19 from seasonal flu or the other upper respiratory infections going around?
Although children are less likely to become ill from COVID-19, almost certainly many are vectors, carrying the COVID-19 virus without symptoms, spreading it to more fragile adults and the elderly with chronic illnesses or immune suppression that makes them susceptible to severe disease and death. To curtail the spread we must identify the carriers of this virus. Compounding the testing challenge is the shortage of protective gear and respirators for health professionals.
We know how to contain threatening viral outbreaks like COVID-19. Our public health authorities successfully managed outbreaks of SARS in 2003, MERS in 2012, and EBOLA in 2014 – 2016. After Trump came into office he began proposing cuts to critical CDC programs aimed at stopping pandemics.
In 2018 the funding for containing global disease was slashed by 80% as funding ran dry and was not renewed. Specifically, efforts in China were scaled back. In March 2018, National Security Council director for global pandemics Rear Adm. Timothy Ziemer suddenly left and his team was dismantled by John Bolton. These positions have not been refilled. A $30-million emergency response fund was cut. Trump’s 2021 proposed budget slashes 16% from CDC funding and removes $3 billion earmarked for global health programs.
Commenting on the U.S. mishandling of COVID-19, Dr. Michael Mina, an epidemiologist at Harvard University, said: “The incompetence has really exceeded what anyone would expect with the CDC.” Others have echoed his criticism. Students of public health will study the COVID-19 epidemic as a case study of the failure of public health institutions.
It should be a reminder that science matters, that carefully built institutions can be degraded quickly to the detriment of all. This is a cautionary tale of the fragility of public health institutions that took many decades to establish and only months to cripple.
Jack Mayer, MD, MPH, is a writer and Middlebury pediatrician at Rainbow Pediatrics, which he established in 1991. He is the author of “Life In A Jar: The Irena Sendler Project” and “Before The Court Of Heaven.”