Public health is the idea that you protect the individual by doing what is best for the group. The idea has served us well via things many of us take for granted — sewers to keep feces out of drinking water, immunizations to keep us healthy, standards that keep us safe in automobiles and the pasteurization of milk.
Surveillance, the unheralded front line of public health, includes early warning systems that provide timely and accurate data on cases of infectious diseases such as the measles, HIV or syphilis, which allows federal, state and local authorities to contain the spread of disease. With COVID-19, the United States squandered the month of February: By then, the seriousness of the outbreak in China was clear but we missed the opportunity for good surveillance. We did not move apace to implement widespread testing and reporting of COVID-19.
However, it is not too late to limit the disease’s spread and harm, but only if we act decisively.
In the United States, public health requires coordination with our largely private health care system. Even though we spend more on health care than any nation in the world, we do not have the largest supply of physicians or hospitals. One result is that hospitals are nearly full all the time, even before a surge in need due to the coronavirus. This is why a health department in the Seattle area hard hit by the coronavirus bought a motel to serve as a quarantine facility capable of providing medical support — there simply aren’t enough hospital beds for an epidemic like COVID-19 if, as many fear, community transmission becomes widespread. If that happens, creative steps to establish quarantine facilities will be required, such as repurposing college dormitories, military bases and apartment complexes to care for those with the virus.
Yet if our physical health care infrastructure has limitations, the mindset needed to act decisively before many people become seriously ill may be the most difficult barrier for our nation to overcome. The best public health interventions work because they operate in the background, meaning you do not have to take action to receive protection. Each time you turn the faucet to get a glass of water, you are protected by our sanitary sewer and water systems.
Public health systems that operate quietly in the background won’t be enough this time around, though. Instead, we need swift action and the willingness to face inconvenience head-on. Social distancing — not visiting a nursing home, skipping church, canceling meetings, skipping vacation, and reducing travel when possible — combined with frequent handwashing can reduce the spread of this coronavirus.
Many universities made the difficult decision to send students home and move to online instruction to limit transmission after spring break, for instance. We need more such actions. Moving to aggressively implement social distancing before a local hospital is overrun will improve our chances of meeting the hospital needs of persons sick from COVID-19, as well as buy us time to develop treatments and a vaccine. Those at low risk will have to act to protect those at high risk, and we should expand testing capacity, hone reporting of cases, and share information to develop a stronger response.
The United States is going to be changed by COVID-19, but not necessarily all for the bad. Public health protects all of us, and it is a good thing to remember that we need to invest in our shared public health infrastructure now. And then maintain the commitment to ongoing surveillance, prevention and treatment once the storm has passed, knowing full well there will be another crisis.
Donald H. Taylor Jr. is a professor of public policy in the Duke University Sanford School of Public Policy and is director at the Social Science Research Institute at Duke University.