Question: It shouldn’t be just the feds taking responsibility for testing and PPE. What role are/should States and hospital systems taking? Are they not doing enough? Were they caught off guard expecting the federal government to come to the rescue?
Answer: I have mixed feelings about assessing blame for failures while we’re still in the crisis. Part of me thinks — let’s just look forward and assess later. The other part of me thinks — if we don’t identify recent failings now, we won’t be positioned to overcome those failings as the crisis continues. So with the idea that exploring failings now is helpful to our response moving forward, here’s my starting answer:
Testing. States and localities continue to try to take responsibility for testing, but have been stymied in the initial response due to CDC’s flawed tests, FDA’s slow EUA determinations, and more (The Atlantic recently had a great overview of these testing challenges). More recently, CDC’s International Reagent Resource Center, which states and labs rely upon, is reportedly not keeping up with demand, further stymieing state/local testing capabilities.
Protective Equipment (PPE). I don’t have enough visibility into state-level resources. At the national-level, we’ve known for some time that PPE shortages will be a massive problem. WHO warned about PPE shortages becoming a global problem as early as 7 February. Given that PPE shortage is a national-level problem, it is first and foremost the Federal Government’s problem to address. Asking states to figure it out on their own diminishes the federal system, puts states in competition with one another, and limits our ability to effectively and efficiently respond. Furthermore, it flies in the face of federal responsibilities outlined in the National Strategy for Pandemic Influenza, further described below.
Pandemic roles/responsibilities. Preparedness and response is the responsibility of federal, state, and local governments with key roles for the private sector and individuals too. The roles of each of these groups vary. Back in 2005, in the wake of the H5N1 outbreak, the federal government developed our National Strategy for Pandemic Influenza. Elements of the strategy have since been updated by CDC and HHS, but for my own ease of response, I’m sticking with the 2005 list of response expectations. I’ve used the list to make this chart of domestic response expectations that includes my initial assessment of the initial response.
