The COVID-19 pandemic has put a bright spotlight on our state’s and nation’s public health systems, demonstrating its importance, and also exposing deficiencies in its capacity to address what is perhaps the greatest threat to the public’s health since the Spanish flu of 1918.
The Spanish flu pandemic was the deadliest in history, infecting an estimated 500 million people worldwide — about one-third of the planet’s population — and killing an estimated 20 million to 50 million victims. While the novel coronavirus, COVID-19, is spreading rapidly throughout the world, particularly now in the U.S., and has had a devastating impact on the global economy, it has not had anywhere the degree of morbidity or mortality (illness and death) as the Spanish flu.
There are lots of reasons that might explain this, the most important being the difference in virulence of the viruses responsible, but I want to give credit to what seems overlooked in the daily news reports, and that is the success of our collective public health efforts to date. It is hard to measure what doesn’t happen, but things could have been a lot worse.
Mistakes have been made in responding to the pandemic, including delays in testing, insufficient personal protective gear, lab tests and ventilators. There have been uneven and confusing communications of vital health data from the federal government, perhaps the most important component of being able to mount an effective response.
However, in my opinion much more has been done right than wrong in addressing this public health threat, but this is not apparent from many media reports. For example, one recent study estimates the shutdowns in the U.S. prevented about 4.8 million confirmed COVID-19 cases and up to 60 million COVID-19 infections. This is thanks to our collective efforts to implement public health measures throughout the nation.
This should make a great headline, but instead we hear unending reports, many from “Monday morning quarterbacks,” who carp about what should have been done sooner or differently. Many “news” items seem based on opinion, not fact, which just contributes to our already high anxiety.
Nonetheless, we are unfortunately still in the midst of this pandemic and need to do all we can to prevent the spread of this virus — by wearing masks, social distancing and attention to personal hygiene, e.g. frequent hand washing — these are simple things we can all do.
Beyond these measures, it is now a matter of great debate about whether lockdowns, or sheltering in place, is effective public policy and essential for containing the spread of COVID-19. Recent economic analyses seem to indicate that more targeted restrictions on movement would be appropriate.
It is unfortunate that as our elected officials have addressed this situation that a virus has become a political football, that some of our politicians have sought to blame each other and their political parties for failures to respond to the pandemic optimally. Germs are no respecter of persons, and infect all on an equal basis, but especially the elderly and those with pre-existing health conditions, regardless of the political affiliation (if any).
For example, liberals seem to want national guidelines, to standardize policies related to wearing masks, work-place policies, benefits etc. Conservatives in general are against government rules and regulations, implying their personal freedoms are more important to them than reducing health risks. Hopefully, these differences can be resolved, as they have in the past.
A landmark in the annals of public health law helps us understand why in certain circumstances there is an important and appropriate role for government. In the Jacobson vs. Massachusetts case, the U.S. Supreme Court ruled “in every well-ordered society charged with the duty of conserving the safety of its members the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.”
This was related to mandatory smallpox vaccination, but has relevance to our current efforts to find a balance between government policies and individual freedoms.
Utah has responded promptly and for the most part correctly to the public health crisis posed by the COVID -19 pandemic. The collective efforts of the Utah Department of Health, our 13 local health departments, our hospitals, doctors, nurses and other health professionals, has been impressive and commendable – together they have undoubtedly saved many from contracting the virus, and likely prevented many deaths.
But the real champions are our public health professionals whose training and expertise have been, and are, of critical importance in addressing this ongoing pandemic. While often unseen and unappreciated, they, and our public health response are of paramount importance.
David N. Sundwall, M.D., Salt Lake City, is chief medical officer of Rocky Mountain Care and professor of public health, emeritus, at the University of Utah School of Medicine.