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During a public health crisis in the United States, the distancing power lies with the states



At press conferences last week, President Donald Trump continued to push the idea that the United States could loosen distancing measures across the country to slow the COVID-19 outbreak until Easter, April 12. "America will be open for trade again soon," he said Monday, despite warnings from public health experts that April 12 is far too early and would be catastrophic.

Many governors (both Republicans and Democrats) and local officials reject this proposal. "We will make sure we take care of New Hampshire's needs first," said Chris Sununu, New Hampshire Republican Governor. Republican Republican Missouri governor Mike Parson said the same thing: "We plan to do this much longer than two weeks here in Missouri," he said.

They have the final say in a public health crisis like this, says Ross Silverman, a professor of health policy and management at Indiana University. "Public health powers are generally exercised at the state level," he says. The Federal Government plays an important role in the allocation of resources and can submit suggestions and expertise to the states. State and local governments are largely responsible for local decision-making.

“When we have public health concerns, most of them arise at local and state levels. The way the system is structured reflects this story in terms of public health, ”says Silverman. "It's the same reason why driving licenses are different ̵

1; it's from the same decentralized system."

Legally, states can maintain social distance orders and business closings, even if Trump says that shouldn't be the case, but communication can create problems. "It really sends mixed messages," says Silverman. This complicates the work of public health officials when people in different management positions contradict each other, said Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia, against The Verge . "It can be difficult to know which viewpoint should be given more weight and which measures and recommendations should be followed," he said.

While states can make their own decisions about the types of public health measures they deem necessary, they rely on federal government resources and regulations during an unprecedented crisis such as the COIVD-19 pandemic. For example, states had to wait for the COVID 19 tests to be approved and manufactured at the federal level. Mismanagement and errors in the disease control and prevention centers meant that they had to wait longer to get federal exams, and the Food and Drug Administration regulations meant they couldn't make their own for weeks.

In theory, the federal government also has access to reserves of drugs and protective equipment through the Strategic National Stockpile. States have no direct access to inventory. The federal government can put pressure on companies to make masks, either informally or in accordance with the Defense Production Act, whereby the president requires companies to enter into federal contracts for certain items. It also has a much larger and more flexible budget. "States respond to the crisis primarily with the resources they have," says Silverman. "The way it works is that the government gives a boost and is the backup when the states run out."

In this crisis, however, the states have difficulty accessing this surge. National inventory is more limited than the situation demands, Trump has not used the Defense Production Act to promote the manufacture of masks and ventilators, and the federal government has largely left the states to negotiate and buy supplies themselves.

It is still difficult to say how much government measures such as physical distance can control their outbreaks and how much the influence of the federal government influences these routes, says Silverman. The two levels of government should work together, with the federal government setting the tone for the response at the state level. However, the decentralized public health system in the United States combined with inconsistent and slow federal activities means that initiatives have been patchwork.

"You can see which governors are working very closely with their health experts," says Silverman. Some follow best practices, others seem to focus on other priorities.

"The current tension is between economic and public health interests," he says. "They would hope that everyone is on the same side, and that is to protect public health. That seems to have been a challenge. This will make the outbreak more difficult to manage. "


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