[Goose]

I think it's an interesting idea to have local services help, and maybe they can, but I still think there needs to be leadership at a federal level.



If historically, this is not something that the USPHS has been tasked with, then it needs to be changed.

It isn't an "interesting idea". It is how it is planned to work, and there are lots of reasons for that. Concentrating all the expertise and capability at the Federal level is a prescription for ensuring this kind of failure to respond. Under the current plan the USPHS is responsible for coordinating the response and for enforcing the "Federal  Quarantine" (which it looks like they are about to have to do around NY and NJ). The reasons we have a local police force and a County Sheriff are the same ones that require an effective City and County health department. Federal police don't know that El Camino intersects Page Mill Road. Contact tracing in a country of 320 million people and 3.5 million square miles is not efficiently done by a central agency. This was proven during previous epidemics and the long fight against TB.

There's a significant motive to fix things. That is part of the leadership vacuum.

Yes, their is a leadership vacuum, and that is exactly why it is not wise to put all our eggs in that basket. If there is a single point of failure, and it fails, then what?

People at the local level probably can be trained to help, but it needs coordination from the top.

Only people at the local level can do the work. If you want the USPHS to do it, they would need a detachment in each county all the time ready to go when we need them. If the Senator from Kentucky cuts the budget, we get one guy on a motor scooter. At one time, the USPHS was a much bigger organization (relatively) than it is now. Even then, the States had TB facilities of their own, as did many counties.

There are 3,007 counties in the United States. Should each of those 3,007 counties develop their own contact tracing software? Should each of them design their own websites and data sharing capabilities? From a software perspective, you'll have 3,007 different data formats, with different definitions for each label. You'll have 3,007 different training procedures for workers. Many smaller, poorer counties will be starting with very little.



If there's an outbreak in Santa Clara County, which moves to San Francisco, then later to the Central Valley, then to Las Vegas, there won't be enough knowledge sharing. Firemen in Reno will be starting from scratch even though there's a team with experience in the Bay Area. That's why it's so effective that China was able to send 1,500 epidemiologist to Wuhan, afterwards, they can move them wherever there is a new outbreak, and they'd take all that experience and hard-won knowledge with them.

Which is fine until the 1500 aren't enough. The you are SOL, because there is nobody else. We have actually used that model in the US recently, where the USPHS has backstopped the local resources in small outbreaks of disease. It works great until it doesn't work at all, because there are no more resources available. This is an old argument about the "correct" sharing of activities between County, State and Federal governments. Our police departments seem to function fine without massive federal oversight. They are smart enough and self-interested enough to avoid the stupidities you outlined above. Yes, we need an FBI, but it doesn't catch speeders or burglars. I for one do not want our response to all problems to require POTUS or Congress make good decisions and good plans. We are now seeing what happens if they don't and if we allow our local capabilities to atrophy.

Other things, like making more N95 masks isn't something a county really can do. I don't think Sara Cody can  show up at CISCO and demand they start making N95 masks. It's not like Sara Cody can demand more companies build more ventilators, nor can she single-handedly move America's testing capabilities up to South Korea's.



I do share your frustration that there appears to be a learned helplessness and lack of entrepreneurship at every level of government. Even though I don't think Sara Cody can or should single-handedly increase N95 mask production or approve new ways of running tests, I think SCC *needs* her to step up and create a county capability unlike any other. And Governor Newsom runs the 10th largest economy in the world. He, like others in CA and NY, should simply expect that no help is coming. The state has the ability to do a lot more on its own. Even if CA only tried to solve these problems at a state level, it would make Californians' lives better, and would also help the country. It might even show an example to the POTUS of what a real leader is supposed to do.

Sara Cody can't protect the USA. There are powers she doesn't have. The USPHS can and should exist, and does have a regulatory, R&D, and coordination function to fulfill. They aren't ready for what is happening. FWIW, we want the surrounding counties to have a capability equal to what Santa Clara County has, because if they don't it will make Sara Cody's job harder. However, as much as I feel the POTUS is <fill in appropriate comments here>, that isn't the problem. Our national public health system at all levels isn't prepared for what's happening. It needs to get prepared in a hurry, and to do so every level has to up their game RTFN.

[Goose]

I think it's an interesting idea to have local services help, and maybe they can, but I still think there needs to be leadership at a federal level.



If historically, this is not something that the USPHS has been tasked with, then it needs to be changed.

It isn't an "interesting idea". It is how it is planned to work, and there are lots of reasons for that. Concentrating all the expertise and capability at the Federal level is a prescription for ensuring this kind of failure to respond. Under the current plan the USPHS is responsible for coordinating the response and for enforcing the "Federal  Quarantine" (which it looks like they are about to have to do around NY and NJ). The reasons we have a local police force and a County Sheriff are the same ones that require an effective City and County health department. Federal police don't know that El Camino intersects Page Mill Road. Contact tracing in a country of 320 million people and 3.5 million square miles is not efficiently done by a central agency. This was proven during previous epidemics and the long fight against TB.

There's a significant motive to fix things. That is part of the leadership vacuum.

Yes, their is a leadership vacuum, and that is exactly why it is not wise to put all our eggs in that basket. If there is a single point of failure, and it fails, then what?

People at the local level probably can be trained to help, but it needs coordination from the top.

Only people at the local level can do the work. If you want the USPHS to do it, they would need a detachment in each county all the time ready to go when we need them. If the Senator from Kentucky cuts the budget, we get one guy on a motor scooter. At one time, the USPHS was a much bigger organization (relatively) than it is now. Even then, the States had TB facilities of their own, as did many counties.

There are 3,007 counties in the United States. Should each of those 3,007 counties develop their own contact tracing software? Should each of them design their own websites and data sharing capabilities? From a software perspective, you'll have 3,007 different data formats, with different definitions for each label. You'll have 3,007 different training procedures for workers. Many smaller, poorer counties will be starting with very little.



If there's an outbreak in Santa Clara County, which moves to San Francisco, then later to the Central Valley, then to Las Vegas, there won't be enough knowledge sharing. Firemen in Reno will be starting from scratch even though there's a team with experience in the Bay Area. That's why it's so effective that China was able to send 1,500 epidemiologist to Wuhan, afterwards, they can move them wherever there is a new outbreak, and they'd take all that experience and hard-won knowledge with them.

Which is fine until the 1500 aren't enough. The you are SOL, because there is nobody else. We have actually used that model in the US recently, where the USPHS has backstopped the local resources in small outbreaks of disease. It works great until it doesn't work at all, because there are no more resources available. This is an old argument about the "correct" sharing of activities between County, State and Federal governments. Our police departments seem to function fine without massive federal oversight. They are smart enough and self-interested enough to avoid the stupidities you outlined above. Yes, we need an FBI, but it doesn't catch speeders or burglars. I for one do not want our response to all problems to require POTUS or Congress make good decisions and good plans. We are now seeing what happens if they don't and if we allow our local capabilities to atrophy.

Other things, like making more N95 masks isn't something a county really can do. I don't think Sara Cody can  show up at CISCO and demand they start making N95 masks. It's not like Sara Cody can demand more companies build more ventilators, nor can she single-handedly move America's testing capabilities up to South Korea's.



I do share your frustration that there appears to be a learned helplessness and lack of entrepreneurship at every level of government. Even though I don't think Sara Cody can or should single-handedly increase N95 mask production or approve new ways of running tests, I think SCC *needs* her to step up and create a county capability unlike any other. And Governor Newsom runs the 10th largest economy in the world. He, like others in CA and NY, should simply expect that no help is coming. The state has the ability to do a lot more on its own. Even if CA only tried to solve these problems at a state level, it would make Californians' lives better, and would also help the country. It might even show an example to the POTUS of what a real leader is supposed to do.

Sara Cody can't protect the USA. There are powers she doesn't have. The USPHS can and should exist, and does have a regulatory, R&D, and coordination function to fulfill. They aren't ready for what is happening. FWIW, we want the surrounding counties to have a capability equal to what Santa Clara County has, because if they don't it will make Sara Cody's job harder. However, as much as I feel the POTUS is <fill in appropriate comments here>, that isn't the problem. Our national public health system at all levels isn't prepared for what's happening. It needs to get prepared in a hurry, and to do so every level has to up their game RTFN.