COVID-19 Upends Pandemic Plan
| Author | John Kirlin |
| Published date | 01 August 2020 |
| Date | 01 August 2020 |
| DOI | http://doi.org/10.1177/0275074020941668 |
| Subject Matter | Institutional Responsibilities & Obligations of the Administrative State to the Citizenry IT ServesPublic Health Consequences of Deconstructing the Administrative State |
research-article2020
Public Health Consequences of Deconstructing the Administrative State
American Review of Public Administration
2020, Vol. 50(6-7) 467 –479
COVID-19 Upends Pandemic Plan
© The Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
https://doi.org/10.1177/0275074020941668
DOI: 10.1177/0275074020941668
journals.sagepub.com/home/arp
John Kirlin1
Abstract
COVID-19 quickly spread worldwide, with over 113,000 deaths in the United States by June 2020. Governments at all levels
in this nation responded. This analysis starts with a basic question: How did prior planning for pandemics shape responses? A
second question emerges: why were data systems inadequate? Expectations, policies, and procedures focused on addressing
influenza pandemics shaped responses to COVID-19. Crippled by inadequate data, federal experts did not fully understand
likely impacts of COVID-19 until early March. Planned public health processes were overwhelmed by a surge in infections
and deaths. Decision making planned to be responses by experts moved to elected officials. Needed data were provided by
sources outside government. Governors in 42 states issued stay-at-home orders, causing severe dislocations in the economy
and society at a scale never experienced before as the result of deliberate public policy choices. Possible improvements for
the future are discussed.
Keywords
COVID-19, pandemic, planning, data systems, federalism, experts, crisis
COVID-19 is a serious challenge. Emerging in late 2019 in
canceling remaining spring training games on March 12.
China, the novel corona virus quickly spread worldwide,
Planned public health processes were overwhelmed by a
with more than 420,000 dead of the disease by early June
surge in infections and deaths. Governors in 42 states issued
2020, including over 113,000 in the United States (Center for
stay-at-home orders, causing severe dislocations in the econ-
Systems Science and Engineering, n.d.). Governments at all
omy and society. In early June, those restrictions are being
levels in this nation responded. This analysis starts with a
eased.
basic question: How did prior planning for pandemics shape
In broad terms, established pandemic planning processes
responses? A second question emerges: why were data sys-
framed as responses by public health experts moved to
tems inadequate?
elected officials and broader social processes. Needed data
Particular attention is paid to how the Centers for Disease
were provided by sources outside government. Possible
Control and Prevention (CDC) engaged COVID-19, finding
improvements for the future are discussed.
that expectations, policies and procedures focused on address-
ing influenza pandemics shaped responses to COVID-19. A
Policy Making Occurs in a Specific
critical role of the CDC is issuing “guidance” used to inform
actions of state, local governments, firms and organizations,
Context
and individuals. The guidance is general, by industry, and to
Policy issues arise before and are addressed by established
“Groups at higher risk for severe illness,” including those
decision-making bodies, and always in relationship to exist-
with chronic kidney, liver, or lung disease, immunocompro-
ing policies and programs. Even a pandemic of large impact,
mised, or aged 65 years or older (CDC, n.d.-e).
such as COVID-19, occurs within a stream of similar or
Crippled by inadequate data, federal experts in infectious
related experiences. The first requirement for any public
diseases, including viruses, did not fully understand likely
policy process is attention, a key insight of Kingdon’s classic
impacts of COVID-19 until early March. Expectations that
formulation, still used effectively (Beland & Howlett, 2016;
tests could be developed and implemented centrally failed.
Kingdon, 1984). Kingdon argues that the intersection of a
Attention of the President and Congress was consumed by
impeachment through early February. Although some actions
1University of the Pacific, Sacramento, CA, USA
were taken earlier, elected officials engaged COVID-19
more fully as deaths in the United States began to rise in
Corresponding Author:
March. Responses also began outside of government in early
John Kirlin, Distinguished Professor of Public Policy, McGeorge School
of Law, University of the Pacific, 3200 Fifth Ave., Sacramento, CA 95817,
March with the National Basketball Association suspending
USA.
its season on March 11 and the Major Baseball League
Email: jkirlin@pacific.edu
468
American Review of Public Administration 50(6-7)
100000
120
100
10000
80
1000
60
100
40
10
20
1
0
01/01/2020
01/02/2020
01/03/2020
01/04/2020
01/05/2020
COVID 19 deaths
Impeachment
COVID 19
Figure 1. Google searches and COVID-19 deaths (logarithmic).
“problem stream” of issues warranting public action, a “pol-
(“Pelosi Tours San Francisco’s Chinatown to Quell
icy stream” of experts developing plausible policy options,
Coronavirus Fears,” 2020). New York City Mayor deBlasio
and a “political stream” of factors such as a crisis, changes in
often minimized risk, on March 9 saying
national mood, or advocacy campaigns must interact in a
“policy window” for public policies to be enacted.
It’s not people in the stadium, it’s not people in the big open area
COVID-19 initially competed for attention of policy
or a conference and all . . . It’s people close up to each other,
makers, the press, and the public with the attempted impeach-
deeply engaging each other to the point that the inadvertent
ment of President Trump. The Senate rejected impeachment
spitting that comes with a conversation sometimes, or a sneeze
on February 5, 2020. Figure 1 shows Google searches for the
or a cough, directly goes at the other person in close proximity
(Blake & Rieger, 2020).
term “impeachment” and for “COVID-19” between January
1 and May 22, 2020. Impeachment dominated attention as
In Kingdon’s framework, the United States political
COVID-19 emerged. Google searches for COVID-19 accel-
stream did not fully engage COVID-19 until March, but the
erated as COVID-19 deaths rose in the United States. These
“problem” was becoming larger and somewhat better
death data are shown in logarithmic form, reflecting rate of
defined, policy options were being advanced, and some
change. All policy making this year continues within the
important actions taken. On January 30, the US Department
context of heated political conflict building toward a presi-
of State warned travelers to avoid China. On January 31,
dential election in November.1
President Trump banned foreign nationals from entering the
COVID-19 is now known to have spread widely in the
United States if in China during the prior 2 weeks. The first
weeks following outbreak, but inadequate data from China
known death from the virus in the United States was on
slowed understanding and response. The World Health
February 6. In that same time frame, Stanford University and
Organization (WHO, 2020) reported “pneumonia of other laboratories developed tests following WHO protocols
unknown cause” in Wuhan, China, on January 5, 2020. On
but the U.S. Food & Drug Administration (U.S. FDA) did
January 30, WHO designated the outbreak a “Public Health
not allow their use. On February 26, Vice President Pence
Emergency of International Concern.” By mid-January, the
was appointed to lead the White House Coronavirus Task
CDC (2020e) began to screen passengers from Wuhan at
Force, replacing Health and Human Services Secretary Azar.
four airports. However, Dr. Fauci, Head, National Institute of
Allergy and Infectious Diseases, was not yet alarmed on
Well-Prepared for Influenza
January 26, saying “The American people should not be wor-
ried or frightened by this. It’s a very, very low risk to the
Very importantly, the “policy stream” of options to consider
United States, but it’s something we, as public health offi-
in response to COVID-19 remained anchored in past plan-
cials, need to take very seriously.”2
ning for pandemics, dominated by an “influenza” model.
Elected officials often downplayed the risks of COVID-
Indeed, “pandemic” plans at the CDC are explicitly identi-
19 in February, with statements of President Trump widely-
fied as influenza pandemic planning. The revealing logic of
covered. As an example, on February 29 he tweeted a positive
URL hierarchies shows cdc.gov/flu/pandemic-resources.4
report about “GREAT agencies” working with China to
The 1918–1919 “Spanish Flu” dominates planning for pan-
address the outbreak.3 He was not alone. As individuals were
demics. A H1N1 Influenza A virus, it killed 50 million world-
already beginning to self-limit exposure before public orders,
wide and 650,000 in the United States (CDC, n.d.-e). Within
Speaker Pelosi visited San Francisco’s Chinatown on the CDC (n.d.-a), the very large HIV/AIDs pandemic is
February 24, urging customers to come to dine and shop
addressed in a separate division of HIV/AIDs prevention.
Kirlin
469
Reinforcing the influenza lens was H1N1, a novel influ-
enza A virus (2009–2010). It was much more lethal than
SARS or MERS, with 151,700–575,400 dead globally and
8,868–18,306 dead within the United States (CDC, 2009).
This is often referred to as the “swine flu,” detected first in
the United States and linked to pigs but genetic...
To continue reading
Request your trial