What should governments do to tackle the COVID-19 pandemic?
The HMPgovlab team
To effectively address the COVID-19 pandemic, governments need to be doing four broad categories of things:
They have to govern (yes, seriously)
They have to ensure enough testing and contact tracing is happening.
They have to use their public health powers to protect people.
And they need to put policies in place to support people in need.
This seems like simple advice, but apparently there’s some confusion.
So let’s spell it out.
Govern
The role of the Executive at both national and subnational levels is important in determining the success of government’s response to the pandemic. In times of crisis, we expect political leaders to share messages of unity and reassurance and model good behavior. Leadership is crucial in terms of the messages that leaders send to the public through their actions and words.
Most Governors have now been photographed in public wearing a mask…
Data from HMPgovernancelab.org.
…although far fewer states have mandated mask wearing for the general public.
Data from Raifman J, Nocka K, Jones D, Bor J, Lipson S, Jay J, and Chan P. (2020). "COVID-19 US state policy database.”
The Executive more broadly needs to take the lead in gathering relevant data, making timely decisions (and communicating the reasons for those decisions), coordinating policy responses and distributing resources across disparate parts of the country or state and among relevant stakeholders.
In the early stages of the pandemic, the President and some state governments declined to govern, opting to do very little and hoping that the problem would go away. In more recent weeks, many states have reopened without sufficient capacity to tackle disease spread in place (see testing and tracing below), resulting in a surge in cases.
Our divided legislatures and broken electoral system played a role in this too. In particular, it looks likely that the way in which the US Congress approached constructing a relief package for the pandemic -providing inadequate relief for state governments and inadequate income support for individuals- contributed to early reopening and a resurgence in cases.
The President, meanwhile, has taken actions that most likely made the problem worse. These include threatening to withhold essential protective equipment from states he viewed as political enemies, sidelining CDC guidance, inciting hate by calling COVID-19 the ‘Chinese virus’ and ‘kung flu’, promoting a potentially harmful drug as a preventative measure, suggesting that people should drink bleach to get rid of the virus, refusing to wear a mask, trying to take away people’s healthcare, supporting the use of violent police tactics against protesters that caused harm and likely increased disease spread, holding campaign rallies, attempting to force universities to hold in person classes and schools to reopen, and trying to withdraw from the World Health Organization. This is not a complete list.
Test and Trace
The second thing that governments need to do is test AND trace. There’s a reason why we put these two actions together.
Access to adequate testing is important not just for individuals to know if they’ve been exposed but also matters at the population level. A government that doesn’t test enough just doesn’t know the full extent of the presence of the disease within their population.
Some US states are likely doing enough testing. The best way to measure this is to look at the test positivity rate, the proportion of tests that are returning positive results. If the test positivity rate is low -ideally below 3 per cent of tests coming back positive- it’s likely that the data says something accurate about the presence of the disease within the population.
The problem is that even among those US states with enough testing, not many also have adequate contact tracing capacity. Contact tracing is a vital piece of the puzzle because testing data alone doesn’t paint a complete picture of how the disease is spreading. Isolating the infected person, then rapidly identifying people who have been in contact with the infected person (within 48 hours) and isolating them also, is essential. The aim is to identify exposed people quickly, before they can spread the disease to others.
Increased activity resulting from re-opening the economy will likely always lead to some increase in cases. But re-opening the economy without adequate testing and tracing is likely to lead to outbreaks that are difficult to control. According to analysis by Covidactnow.org, on July 9th, Vermont was one of only three US states with a low overall COVID risk:
The data for Arizona, however, looked very different:
Overall on July 9th, the prospects for most US states did not look good, with most being classified as ‘high risk’ or ‘trending poorly’ by tracking web sites.
This analysis from covidexitstrategy.org on July 9th comes with an explanatory note: “Unfortunately when a map becomes all "red", it becomes less useful. We will be making an update shortly that will adjust our color scale and how each state is graded.”
Protect
The third thing that governments must do is use their police powers to put protective measures in place. Governments across the US have used these broad powers to prevent the spread of disease by issuing stay at home orders, physical distancing requirements, closing work places and schools, banning large gatherings and isolating those who have been infected, among other measures.
In the absence of effective treatments or vaccines, we know that these restrictions are both legal and effective. But they are not ideal. Restrictions on individuals and businesses aren’t sustainable as a longterm solution to the pandemic. They are a desperation measure designed to prevent the spread of disease in the short term while governments figure out what’s happening and put testing and tracing capacity, as well as other protective policy measures in place.
This is where many states have failed. Under political pressure and concerned about their own budgets, many re-opened without necessary testing and tracing resources in place to tamp down outbreaks. Many are unwilling or unable to reverse course. The result has been renewed spread of the disease.
Support
The fourth thing that governments must do to tackle the pandemic is support those in need. Support policies haven’t been given much attention in public discourse about the pandemic, which tends to focus on daily case counts and policies to stop the spread of the disease, but they are a key factor in minimizing the effects of the virus on society, communities and individuals.
First of all, health and social policies prevent the disease from spreading. People with access to paid sick leave are less likely to have to risk going to work when infected. Labor rights can protect people from having to work in a dangerous environment (such as a workplace that is too crowded) and prevent them from being fired for speaking out about non-compliant businesses. Requiring masks in situations such as indoor spaces like grocery stores and on public transport protects employees, businesses and the public. Income replacement schemes help businesses to retain their workforce and allow employees to receive income. Making sure that people get to keep their homes, instead of evicting them, is not only humane but a good policy decision in terms of controlling the spread of disease and reducing economic disruption. Giving people healthcare is not only upholding their human rights but also helps disease surveillance and control because it helps people to come forward for testing and treatment.
Support for coronavirus survivors is also essential. For all survivors, but especially those who spent a long time in hospital and / or received invasive procedures such as intubation, the ability to get back to anything like normal life will depend upon the extent to which they can get support -not just from family and friends or charities, but from government. Can they get help with physical rehab? Do they have access to treatment for longer lasting or permanent physical damage from the virus such as kidney failure or brain damage? How can they deal with the costs incurred during hospitalization or other necessary medical bills? What about the mental health toll of the disease on survivors and their families? If they were working before catching the virus, can they return to their job? And if not, what policies exist to help them financially?
It is vital that we realize many health and social policies are win-win-win: they support individuals, they promote economic recovery and they help communities and society by preventing the spread of disease.
Is it surprising that the US is dealing with the pandemic so poorly?
No, not really. At the start of the pandemic, the impression among some experts was that the US had enough resources to handle the coronavirus. Despite our extreme inequality, the US was still a rich country with the ability to conduct relevant medical research, obtain essential medications and supplies and employ a large health workforce. Communicable disease experts around the world held the Centers for Disease Control and Prevention in high regard.
But the pandemic has laid bare both the inadequacies in our political system and the poverty of our public health, healthcare and social infrastructure.
At the best of times, it is hard to implement policies in the US. Our political environment is highly polarized and our political system is rife with opportunities to prevent action. During the pandemic, political polarization, the problems of federalism and institutional fragmentation have prevented unified, timely action.
In terms of health and social infrastructure, we are reaping the results of years of underinvestment in disease surveillance and the public health system and failing to provide healthcare and vital social support to those in need.
The result has been the unchecked and unnecessary spread of a virus that we know will cause longterm harm and economic disruption and further entrench inequality. Governments need to revisit the basics: they must govern in ways that control the pandemic, test and trace to address outbreaks, protect people and communities and support those in need.
