One needs to look no further than any mainstream news or social media outlet to realize that our public health system and hospitals are overwhelmed. Whether it be the lack of adequate testing reagents to properly monitor the current COVID-19 pandemic or the lack of adequate personal protective equipment (PPE) and ventilators to safely care for our sick, our nation’s health care system is being pushed to the brink. As hospitals and governors scramble to secure adequate supplies and personnel to care for COVID-19 patients, the need for a centrally coordinated public health system that can strategically mobilize, allocate and deploy resources when and where they are most needed is readily apparent. The United States’ apparent lack of preparedness to deal with a pandemic of this magnitude has brought into focus the importance of systems and scaling in addressing any national emergency.
Watching countries outside the U.S. combat this virus provided clear signals of what was and is to come. South Korea rapidly assumed a national approach, creating a task force that included all government ministries as well as all regional and city governments. In addition to aggressive testing and contact tracing, this national task force coordinated allocation of resources such as hospital beds and physicians. To date, South Korea has experienced one of the lowest rates of new infections and deaths of any country in the world. Italy, by contrast, took a markedly different path and instituted containment measures in a staggered fashion town by town. Italy has experienced one of the highest rates of new infections and deaths in the world. The United States’ piecemeal approach has now led to a curve of new infections with a steeper slope than Italy’s.
The COVID-19 pandemic illustrates the problem of applying a small lens to a large and complex problem. The larger the crisis, the more complicated it becomes structurally to flatten the curve across multiple geographic regions. Fifty unique state responses to a pandemic guarantee fifty unique outcomes and delayed nationwide containment. To achieve containment, fixing the flaws of federalism through system scaling and coordination across the U.S. is critical. In an ideal system, all fifty states would work in concert to rapidly expand, contract, and share resources across state lines based on need through a coordinated network. To achieve this, our public health system responsible for pandemic response must be restructured and adequately funded.
As case numbers surge, real-time data from diagnostic testing, inpatient admissions, and ventilator usage all feed into state public health departments tasked with testing, monitoring, surveillance, and public reporting. Many public health departments lack the resources needed to effectively do this in real-time. The current impossibility of performing comprehensive testing due to the inadequate supply of testing reagents leaves public health departments ill-prepared to fully quantify the problem, let alone develop solutions. Underfunding also leaves public health departments, who must simultaneously deal with other public health crises like opioid abuse, unable to provide adequate education and resources to the populations they serve.
Now is the time to repurpose, recycle, reengineer, and ultimately reimagine our federal public health system. Coordination of our public health system across all fifty states and territories that can withstand the kind of rigor to be scaled nationwide will position the U.S. to quickly and deftly outmaneuver future national threats. Other industries have successfully reconfigured and scaled systems, many doing so through a nationwide logistics network to deploy information and data and distribute equipment before they become scarce. Companies such as Amazon have incorporated supply chain algorithms that decide distribution. They also employ control theory to adjust performance so that tracking data, sharing information, inventorying, and distributing equipment and supplies are done in real-time across the country.
A single health care system or state public health department cannot confront this pandemic alone. Instead, a national emergency requires a coordinated, one-country approach, which will always outperform 50 independent state strategies to contain the virus. This unequivocally requires financial investments in our public health infrastructure. Public health is one of the single most underfunded priorities yet has one of the greatest impacts in the U.S. This pandemic has brought into focus the inextricable tie the public health system has to the U.S. economy, understanding that all industries are interconnected, and all are affected.
We would be remiss if we did not take a hard look at the current public health infrastructure and ask what is needed for the future and how we get there. That requires gaining clarity through our insights from this experience when we come out of it, allowing boldness to trump conventional ideas, and having the resolve to build a system that can be scaled across the nation as we prepare for the next emergency. When we achieve this, we can finally take solace that we are prepared.
Kelli Todd is an epidemiologist and can be reached on Twitter @KelliToddMPH. Amy Baruch is an emergency physician and can be reached on Twitter @AmyBaruch1.
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