Covid-19 has exposed major weaknesses in the United States’ federalist system of public health governance, which divides powers among the federal, state, and local governments. SARS-CoV-2 is exactly the type of infectious disease for which federal public health powers and emergencies were conceived: it is highly transmissible, crosses borders efficiently, and threatens our national infrastructure and economy. Its prevalence varies around the country, with states such as Washington, California, and New York hit particularly hard, but cases are mounting nationwide with appalling velocity. Strong, decisive national action is therefore imperative.
Yet the federal response has been alarmingly slow to develop, fostering confusion about the nature of the virus and necessary steps to address it. States and localities have been at the leading edge of the response but have exercised their public health powers unevenly. Because science-based social distancing and targeted quarantine measures can succeed only if implemented wherever the virus is spreading, the lack of interjurisdictional coordination has and will cost lives. CONT.
Rebecca L. Haffajee (RAND) & Michelle M. Mello (Stanford), New England Journal of Medicine