The Continuing Need for a National Health Policy

Several weeks ago, I wrote a post about the need for a national health policy regarding the pandemic.  Obviously that hasn’t happened.

As the President and state governors have been talking about slowly opening up the economy again, stepping back from the restrictions on people’s movements, and in a few cases taken such action, I need to repeat my call for a national health policy.

When it comes to controlling a pandemic, the fact of states’ rights makes no sense.  Since all states are connected in many ways, but especially commerce and freedom of movement, it is critical that there be a national policy controlling the actions of people.

A national health policy does not mean “one size fits all.”  It means that there are national standards that will be applied.  Under those standards, some states may be allowed to open up before others, and those decisions would be made in concert with the governors, but it must all be coordinated under a federal standard.  

For those who say that under the constitution states have to be left to go their own way … nonsense!  The interstate commerce clause allows the government to regulate anything that impacts interstate commerce.  This has been read broadly and is the basis, for example, for federal civil rights laws.  Certainly it would provide a basis for a national mandated policy on efforts to control the coronavirus pandemic.  To not have a mandated national policy in situation would be madness.

People are the key to either containing the virus or spreading it.  There is thus only one effective way of controlling the virus.

When we come out of the lockdown phase, all experts agree that testing and contact tracing combined with quarantine is key to insure that the virus does not spike again.  Everyone who has symptoms should be tested, and if that is not available, should self-isolate on the assumption that they have the virus.  Under CDC guidelines, once they have been fever free for 3 days without medication, have had no symptoms, and it’s been more than 7 days since the onset of symptoms, they can assume they are virus free and can come out of quarantine.

Every contact someone has had (which could be as minimal as being in the same room or talking) with someone who is infected needs to be traced and told to self-isolate for 14 days, the incubation period, and be tested before being free to be out and about since one could be asymptomatic and still pass the virus to others.

In addition, because experts agree that the rapid spread has occurred in part because asymptomatic people have not been tested and quarantined, yet have passed the virus on to others, random testing should be done of a large percentage of the population to insure that asymptomatic cases are detected and quarantined until they test negative.

Ideally, all people who test positive and who live together with family or other communal situations, would be removed from their home and placed in an environment where they will be isolated so as to remove the threat of an entire family or living group becoming infected.  This is especially important if people are living in crowded environments with no private space available.  This will probably only be possible in limited situations for a variety reasons, and so following guidelines for separation in the home are critical.

Everyone arriving in the U.S. by plane or any means of transportation must at a minimum be temperature screened for the virus before being allowed to enter.  Interstate travel should be restricted to critical travel and all arriving passengers should be temperature screened.

What to do about people who travel by car interstate?  If everyone could be counted on to follow the rules, to keep to their quarantine, then one could assume that anyone traveling is free to move about.  However, that would be a naive assumption, plus testing is likely not to be as rigorous as it should be.  That means that people crossing state borders by car should be temperature screened.  This will felt as a burden on states and invasive to travelers, but the government must take every necessary action to contain the virus.

But all of this leaves the question … when and how do we end or ease the lockdown restrictions.  One suggested guideline has several criteria:  new cases falling consistently over 14 days; hospitals no longer maxed out; capacity to test all who should be tested; and the capacity to trace all those who should be.  Added to that list should be the ability to isolate outside the home those who are living in severely crowded living spaces.

Although ideally there should be no opening up until most everyone who needs to be has been tested or contact traced, and isolated if necessary, that is not feasible.  The ramped up testing and tracing will have to be done while people are beginning to move about.

Thus, when restrictions are loosened, everyone must continue to wear a mask when out in public and continue to practice social distancing to limit the number of new cases because the inescapable fact that some people will still be walking around with the virus.