March 3, 2020
Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize the following:
Emergency funding is critical now, with ongoing funding to prevent future emergencies
Congress should quickly approve a supplemental funding package, with significant investments in domestic and global public health, healthcare preparedness and research and development of medical countermeasures. Federal agencies should be preparing to quickly distribute funds to states and local governments, as any delay could cost lives.
Congress and the administration should not rely on transfers between health programs to solve this problem. TFAH recommends that Congress use the supplemental funding package currently being considered to back-fill programs that have already been cut to transfer funding for the COVID-19 outbreak response. Reprogramming money from other public health initiatives, such as chronic disease prevention, won’t serve the public’s health in the long run.
The emergency supplemental funding should include the following priorities:
- Domestic public health. States and local jurisdictions have stood up their emergency operations, identifying and investigating cases, isolating and quarantining individuals, screening travelers at airports, ensuring the laboratory capacity to test patients for the virus, coordinating with the health sector to guarantee needed services are available, assessing the needs of those who are most vulnerable because of social, economic or environmental conditions and communicating with the public and healthcare facilities. Attention needs to be paid to those people who seem to be most at risk for serious health complications due to COVID-19 including the elderly and people with underlying health conditions. The breadth of the response is quickly exhausting the funding provided in annual appropriations bills.
- Healthcare response. Hospitals, health centers and other clinical facilities across the nation are preparing to identify, isolate and care for patients with COVID-19. They must do so without interrupting the routine and necessary clinical services for those with other healthcare needs. This will require training for healthcare workers on the identification of COVID-19 cases, and on appropriate infection control practices and treatment. The health care sector needs resources for some of these activities and to ensure it has appropriate personal protective equipment, necessary clinical supplies and equipment, and surge capacity.
- Medical countermeasures research and development. The U.S. government should prioritize development and procurement of COVID-19 diagnostics, vaccines, and treatments. This will require special measures to anticipate and plan to meet future need and to determine how to make appropriate services available to all with special attention to those in underserved communities.
- Global health security. The U.S. must support global efforts through the World Health Organization, USAID and other agencies to boost the capacity of lower-income countries to detect and control infectious disease outbreaks. This will protect Americans as well as other countries by decreasing the likelihood of transmission as a result of travel and commerce.
- Invest in standing reserve funds. The supplemental should fully replace funds spent from the Infectious Disease Rapid Response Reserve Fund and add a significant amount of money in this fund, so new funding can be immediately accessed if needed to fight COVID-19 and as an investment in protecting Americans from future outbreaks.
The full cost of the outbreak will become clear in the next few months, but in the short term, a significant investment is needed now. Ongoing monitoring of the course of the outbreak will determine the total amount of additional funding that may be required.
Ensure that core public health is continually funded
In addition to short-term supplemental funding, Congress must prioritize ongoing investment in public health as part of the annual appropriations process. The nation’s ability to respond to COVID-19 is rooted in our level of public health investment of the last decade. That is, being prepared starts well before the health emergency is upon us and is grounded in year-in and year-out investment in public health programs. In addition, our public health system needs a highly skilled workforce, state-of-the-art data and information systems and the policies, and plans and resources necessary to meet the routine and unexpected threats to the health and well-being of the American public. The nation has been caught in a cycle of attention when an outbreak or emergency occurs, followed by complacency and disinvestment in public health preparedness, infrastructure and workforce between emergencies. These are systems that cannot be established overnight, once an outbreak is underway.
Science is key to effective response
Science needs to govern the nation’s COVID-19 response, led by federal public health experts – including the CDC and NIH leadership – who have years of experience in responding to infectious disease outbreaks. Keeping the public fully informed is critically important, if trust is to be retained. Policy decisions – from the federal to the local level – should also be based on the best available science.
Local governments and other sectors must prepare now for various contingencies.
- Healthcare facilities must plan for a surge of patients. Such planning should include taking steps to ensure continuity of operations if a sizable number of their workforce is sick. They must prioritize the safety of patients and workers, by using personal protective equipment and by providing adequate training. Healthcare coalitions – in coordination with governmental entities – should offer situational awareness and coordination between facilities.
- Employers, including those in the healthcare sector, should adopt paid sick days protections for workers to protect the health and safety of other workers and the general public. In addition, they should assure their employees that missing work due to illness will not jeopardize their job.
- Communities that are considering school or business closures or similar measures should consider unintended consequences and take appropriate action steps. If closings are necessary authorities should assist families for whom such action is especially problematic, such as low- income families and individuals without paid sick leave, and children who rely on school meals for adequate nutrition. Homebound individuals who need access to health care personnel, equipment and medications may also need additional assistance.
The full extent of the outbreak in terms of public health, healthcare and personal costs remains to be seen. We do know that taking immediate steps to mitigate the effects of the outbreak will save lives and prevent harm.