When a country faces a pandemic, public health depends upon the quick and effective ability of local health officials and public leaders to follow pandemic prevention standards. These standards are ever evolving, but have been established after years of research. During the last century there have been five influenza outbreaks, alone, and each one has been handled differently as we adopt new technology and face different cultural expectations.
The most recent COVID-19 outbreak has been especially difficult to address, with it’s wide-reaching global implications. Many countries have chosen to handle the current pandemic with different strategies and different levels of urgency. However, most countries have implemented at least some policies regarding quarantine, social distancing, and closure of public spaces.
Looking back at the last ten months, and the wide-range of strategies implemented around the world, we can begin to evaluate how effective the United States Centers for Disease Control and Prevention (CDC) guidelines for pandemics are, and how well the government and public responded to them.
What are the CDC Guidelines?
The CDC have developed an action plan to use as guidance in the case of a global pandemic. There are six stages of the CDC’s action plan to follow when a novel virus is identified in humans. The first three are the investigation, recognition, and initiation stages. In the beginning of a pandemic, research and discussions by public health officials take place as they begin planning the necessary precautions.
If the pandemic continues, the next steps of the action plan are acceleration, deceleration, and preparation. It is during these final stages that actions are taken to prevent the further spread of a virus. Active pandemic monitoring and preventative measures will take place in the event of a second wave of outbreaks.
The objective of this action plan is to stop, slow, or otherwise limit the spread of a pandemic in the United States. Depending on characteristics of the virus and public health response, the length of each stage will inevitably vary, and if the outbreak continues, some steps may need to be revisited. The CDC provides assessments and other resources used to determine when one step is approved to move onto the next. The CDC guidelines, when used properly, are in place to help ensure quick and effective federal, state, and local public health decisions.
Who Is In Charge of Implementing and Enforcing the CDC Guidelines?
In a pandemic, the federal government and the state governments have shared responsibilities, but it certainly isn’t solely a state and local matter. And the unique division of labor around national emergencies, such as a pandemic, make timely and coordinated responses difficult.
Because the United States is a federalist nation, The Constitution designates specific powers to the federal government—like the power to regulate commerce and declare war—and the 10th Amendment designates the remainder of powers to the states. Which means, the responsibility for stemming the current outbreak officially lies within the jurisdiction of each state. Under the 10th Amendment, governors have “the authority to take public health emergency actions, such as setting quarantines and business restrictions,” according to the American Bar Association.
As a result, when a pandemic reaches the initiation stage, it’s the local state health departments and community leaders who are in charge of making public health decisions and developing interventions that people are encouraged to follow. During this stage, the public may be asked to practice measures such as social distancing and good hygiene, as has been the case with COVID-19. This is also when leaders will rapidly develop further guidelines to be put in place, should the pandemic continue to worsen.
If the pandemic reaches the acceleration, or “speeding up” phase, many guidelines are no longer optional. At this point, the pandemic has become dangerous enough that emergency orders can be issued by the federal government. It is at this stage that schools, child care centers, and public gathering spaces are closed. Governors, county officials, and business owners across the United States may also begin mandating requirements, such as wearing a face mask when in public for all those over the age of two. It then becomes up to local officials to determine what, if any, legal action can be taken against those who do not follow the requirements put into place. So far, in the United States no such enforcement has been made.
Many complications surrounding United States pandemic prevention standards are now being brought to light due to the current global outbreak. Across the country it has become painfully clear there is great disparity between funding for public health departments at the national, state, and county levels. This has led to weak and uncoordinated response strategies between states.
Furthermore, as each state sought the best way forward, the lack of cohesive information being given to the American public by the nation’s leadership, deeply impacted compliance with recommended, and in some cases required, measures at the state level.
Protecting The Most Vulnerable
The CDC guidelines set the stage for how the United States will handle a pandemic, as a nation; it’s up to each state to determine their individual response; and then it’s ultimately the hospitals and other healthcare clinics and facilities that must prepare to handle, test for, and curb the spread of an illness. Healthcare workers are on the front lines and are responsible for providing timely and effective treatment to patients who become ill due to an outbreak.
The CDC guidelines outline the process at each step, including step two where the recognition of the increased potential for ongoing transmission of a virus is established. It is at this step that the need for extra precaution is heralded and the donning of more serious personal protective equipment (PPE) for frontline workers is made necessary. If an illness has been identified, and it is known to be highly contagious, the healthcare workers treating incoming patients must also be able to protect themselves in order to continue in good health to treat and care for patients, this is absolutely imperative for stymying the spread of a virus.
But, even with precautions, screenings, and other COVID-19 specific systems in place widely around the United States, availability of testing has been limited and other barriers are preventing individuals from access to safe care, including a lack of personal protective equipment (PPE) for healthcare professionals. This means healthcare staff are not only unnecessarily exposed to the virus, but that they also hold the very real potential to become carriers of the illness, spreading it around hospitals and clinics, themselves. Furthermore, hospitals have reportedly had difficulty implementing their own safety standards around non-medical facilities, such as cafeterias, where the virus may also be easily spread.
State of the Nation
As the United States continues to battle the global COVID-19 pandemic, the statistics from week-to-week change, drastically. Regardless, though the CDC compiles this data to the best of their ability, not all tests are reported and in many cases, individuals are not tested unless seriously ill. This means there is likely a large number of untested people who may be carrying and spreading the virus, unknowingly. As of September 2020, just over 600 thousand of the 4 million Oregon residents have even been tested for Covid-19.
Healthcare professionals are battling unprecedented circumstances as the number of patients continues to rise and space in care facilities declines. This begs questions regarding the standard of care, and whether or not physicians are able to consistently abide by it during crisis, like a pandemic. And if not, does a failure to do so constitute medical malpractice? One would assume, yes, however with exemptions like the ones offered for HIPAA violations beginning in April 2020, there may be unintended consequences yet to be understood.
With no clear guidance or coherent national strategy, many states have been left on their own to decide which steps to take next and when. Some states rushed to reopen several months into the pandemic, encouraged by the federal government, and by the end of the summer cases surged in 20 of those reopened states. Clearly this was not the correct course of action. As of today, the United States, with a population of 328 million, has almost twice as many cases as India, which has a population of 1.3 billion.
A Challenging Year
Despite the swift response and the adherence to the outlined process, the spread of the virus was not limited effectively, as the United States continues to struggle where other countries globally are already seeing the outbreak resolve in their respective locales. The onset of cold and flu season promises yet another spike in United States cases, and bodes poorly for stopping the spread of the virus in 2020.
Determining how effective the CDC measures have been for patient care can only be known with more time, but given the circumstances, we can begin to conclude that there are major issues with the United States’ ability to respond to a pandemic in a manner that is safe and coordinated. All six stages of the action plan were technically followed and implemented by local health officials across the United States, but whether or not step two of the CDC guidelines was met, without being able to properly prepare healthcare workers, begs serious questions that demand further evaluation. However, the data is ever-changing, and even with serious questions around how the pandemic has been handled, the United States may be slowly moving to the declaration step of the action plan as researchers work diligently to develop a vaccination.
Undoubtedly, the year 2020 has created massive challenges to the United States healthcare and government systems. Pandemic prevention strategies are developed and implemented in order to stop or slow the spread of a virus, however, they are not necessarily effective without the public’s cooperation or enough resources to be implemented fully. Many patients who sought hospital treatment for COVID-19 will wonder if they received the highest level of care amid a global pandemic or if they were unnecessarily exposed to the virus during a hospital stay. Many more will wonder if there was more that could have been done to prevent a pandemic from wiping through the United States with such devastating consequences.