Recently Admiral Brett Giroir, pediatrician and assistant secretary of Health, declared that Dr. Tony Fauci could not truly understand the national response to coronavirus: “he looks at its from a very narrow public health point of view.” Dr. Fauci did not necessarily “have the whole national interest in mind.”(https://www.forbes.com/sites/nicholasreimann/2020/07/12/us-testing-czar-fauci-doesnt-have-the-whole-national-interest-in-mind/#12f86316569c)
Admiral Giroir’s statement helps explain the administration’s world-leading failure to control Covid-19, and why America’s public health statistics approximate Cuba’s despite spending more money on health care than anyone.
What is Public Health?
The WHO definition – the complete physical, mental and social well-being of a population. It has several correlates:
A healthy economy requires a healthy population.
A healthy population requires a healthy environment.
Consider these correlates regarding America’s response to Covid-19:
People who are dead do not work.
People who are sick do not work, or if they show up, work well. They also may infect others.
People scared entering hospitals will get them sick won’t go – a major cause of excess American and Italian deaths from Covid-19. Why go to the hospital with chest pain if you then die of the virus?
People who are scared of workplaces where you get sick will try not to go – like teachers. (Many workers have no real choice, including meatpackers when the Defense Production Act was invoked to make them an essential industry.)
People who think they’ll get sick in restaurants won’t dine out.
People who think they’ll get sick on an airplane won’t fly.
People who think they’ll get sick in a crowded church won’t go there to pray.
People who think they’ll get sick in a crowded theme park won’t buy tickets.
This list could grow very long. The meaning is clear – until you control the virus, you don’t get back your economy.
People need to feel safe to shop, work, and spend. That’s a basic tenet of public health. The rest of the world has known this for decades, with America the truly “exceptional” nation.
Why People Live Long
The rise in human lifespan during the twentieth century is one of the great success stories of mankind. It was accomplished primarily through the advances of public health.
Four factors are usually pointed to as major contributors: sanitation (clean water, air, and food); education; nutrition; vaccination.
Americans generally equate health care with health. That is how we can spend twice as much per person as European nations and live several years less, with far worse health metrics throughout the life cycle.
One simple illustration: antibiotics had only a small, perhaps 5% effect, on overall human mortality to infection. Perhaps one of the most profound and miraculous medical therapies only added a small bit to what had been accomplished by sanitation, education, nutrition, and vaccination.
Ignore basic public health principles and you imperil your country, its economy, and its standing in the world.
Tackling Covid-19 through Public Health
Recently I watched Florida Governor Ron DeSantis at a filmed Bradenton press conference. He proudly declared Florida was testing more citizens in a day than Taiwan, with a population of 24 million, had throughout the entire pandemic.
The reason why Taiwan has so few tests: they’ve experienced seven dead total since January despite having five percent of their population living in the country where the pandemic started. In Florida, we produce that many deaths every hour.
Taiwan knew it had to control the virus immediately or face catastrophe. With pandemics you panic early. The government bought 60 mask making machines and had the military set them up in businesses, mandated their use, set their cost, and rationed them. A vigorous program of testing, tracing, tracking, isolating, and supporting everyone who had or might get Covid-19 allowed them to keep their nation and economy running.
For what is the point of testing if your results take weeks to return? Why test if potential victims of Covid-19 are not socially isolated and supported so they will not infect others? Why test if you cannot trace and track the contacts of infectees, and isolate them? Without a functioning public health infrastructure, testing cannot do its job.
Taiwan has had .3 deaths per million, Florida 210. Recently Taiwan did have an active new case of Covid-19; now they primarily appear from travel into the country. Florida has had officially as many as 15,000 cases a day (Taiwan’s total for six months is 452.) Pundits now declare Florida may soon surpass New York’s death totals, where the death rate stands at 1670 per million (https://www.worldometers.info/coronavirus/#countries).
Why is this happening? You don’t control an epidemic until you can trace and track contacts. Recently Melbourne went into lockdown for six weeks, as it could not trace the contacts of over half the people who got sick. If you don’t know where your new infections are coming from, you don’t prevent larger outbreaks.
Australia’s Covid-19 death rate is 4 per million, versus 424 in the U.S.
Florida now has so many cases you cannot accurately estimate how many new infections come from known cases. Several weeks ago, under far better conditions, it was over two thirds.
Where there is no vision the people perish. Viruses do not respond to political dictation. The public health is not a “narrow view” but a basic requirement to a powerful, economically efficient country.
Until we create an effective public health infrastructure we will not control the virus. Until we control the virus we will not get the economy back.