As the COVID-19 crisis continues to unfold across the country and the world like a science-fiction nightmare, many Americans long for the kind of national leadership our erratic narcissist of a president seems incapable of providing. But he’s not the only problem. Consider the sound advice of Trump’s former Homeland Security adviser Tom Bossert in the Washington Post:
[A]s evidence of human-to-human transmission becomes clear in a community, officials must pull the trigger on aggressive interventions. Time matters. Two weeks of delay can mean the difference between success and failure …
Hong Kong and Singapore acted immediately and are still holding the line, literally. Through isolation, quarantines, contact tracing, canceled gatherings, and widespread surveillance, they have achieved linear growth of the virus, meaning a reproduction number close to one. What they are doing is working.
Bossert believes a program of school closings is the most important immediate measure Americans can take. That may be right. But unfortunately, for any plan to take this drastic action systematically, we don’t have a national school czar, or even state school czars. Just in the public K–12 education system, there are 13,598 school districts in this country, most of them retaining significant autonomy. Identifying — much less applying — levers for coercing compliance with a national school-closing strategy would take too long to facilitate the kind of lightning strike on COVID-19 that Bossert is recommending.
And that’s just one example of the problems our decentralized system of Federalism, for all its ancillary virtues, poses in this situation. As Polly Price of Emory University recently explained, federal quarantine authority is pretty much limited to situations involving people entering the country. Beyond that, it’s not a job for the Feds:
[T]he average American may be surprised to learn who holds the authority to order such public-health measures. Except at the nation’s borders, the federal government, with the expertise of the Centers for Disease Control and Prevention, is not in charge. America’s defense against epidemics is divided among 2,684 state, local, and tribal public-health departments. Each one is responsible for monitoring people within its jurisdiction, imposing isolation or quarantine as needed. CDC officials are “preparing as if [the new coronavirus] is the next pandemic,” but in reality, the laboring oar falls to state and local health departments.
Indeed, state and local health departments are in charge of enforcing federal quarantine orders, in addition to dealing with public-health measures beyond federal authority.
States may choose to ignore federal quarantine guidelines, or they may decide that more drastic measures are required, such as a lockdown against a neighboring city or region. Extreme measures may be necessary in a public-health emergency, but the variation from one location to another could also make an epidemic worse as each state makes its own rules, looks out for its own interests, and relies on its own resources. Jurisdictional boundaries are enforced, among other reasons, to preserve limited budgets.
And even if states and localities are fully acting in good faith, they have varying resources for effective action:
State and local jurisdictions have limited medical and scientific resources to understand the transmission of complex diseases and to form independent judgments about the best means to control spread. Quarantine policies or other emergency measures set by the federal government are not better just because they can provide uniform rules throughout the nation — federal officials, too, can overreact in counterproductive and rights-threatening ways. But clear lines of authority may be needed.
Price believes the moral and intellectual authority of the CDC is essential to provide some sort of central coordination of the many decentralized authorities whose cooperation is needed in this sort of crisis. But that means national political leaders need to reinforce that authority and then largely get out of the way. And that brings the problem full circle to Donald J. Trump and Mike Pence. They aren’t in control of the crisis, and need to stop pretending they are, while deferring to the actual experts the federal government employes. We can’t invent a new, centralized system of public health on the fly without resorting to genuinely authoritarian actions. But a chaotic system with chaotic national leadership is a prescription for disaster.
