by James A. Bacon
The Northam administration plans to dispatch $650 million of federal helicopter dollars directly to cities and counties to help cover the cost of responding to the COVID-19 epidemic. The state’s priorities for monies received under the federal CARES Act are expanding testing and hiring public health staff to conduct contact tracing, reports the Richmond Times-Dispatch.
“Testing and contact tracing are going to be reserved right off the top,” Secretary of Finance Aubrey Layne said Monday. ‘That’s going to be the number one priority because that’s the key to both the health and economic situation going forward.”
In the abstract, it makes sense to spend the money as Layne suggests: on testing and contact tracing. But questions arise that are not answered in the article. Who decides which protocols to follow with the testing and contact tracing? Will each locality make its own decision? The advantage of letting localities decide is that they are closer to the situation than state bureaucrats in Richmond and better able to apply the resources where they are needed most.
Conversely, should the state set standard protocols? The advantage of standard protocols and coordinated testing is that more meaningful conclusions can be drawn about how the virus is spreading and how best to combat it.
On Friday Governor Ralph Northam announced a pilot program with the City of Richmond to aiming to “increase equitable access to personal protective equipment in underserved communities.” His chief diversity officer, Janice Underwood, explained that the administration wants to ensure that “the most under-resourced communities in Virginia have access to testing, life-saving PPE, and culturally affirming educational materials in preferred languages and formats.”
How will these tests be delivered? Through local hospitals and health clinics? What criteria will be used to test someone? If the purpose of testing is to accurately estimate the prevalence of the virus by geography, income group, and racial/ethnic group in order to inform decision making on economic shutdown measures, a representative but randomized testing protocol is called for. Is that what we’ll get?
Contact tracing is a potentially useful tool as well. People testing positive for the virus are queried about their whereabouts over the previous few days, and people they may have encountered are contacted and informed of their possible exposure. If done properly, contact tracing can serve a double benefit — it can reveal high-risk behavioral patterns that can inform public health authorities about which measures work, and which don’t.
Where are people contracting the disease? The workplace? In family environments? At Wal Marts or the CVS? In large gatherings taking place in violation of the no-more-than-ten-people-together rule? In the great outdoors? Perhaps control measures need to be tightened in some areas and relaxed in others. Also, it might be useful to know if the disease is spread by a relative handful of careless high-risk individuals who infect a large number of people, or by the population at large. Such knowledge would help people adopt appropriate self-isolation practices.
Who decides which goals to pursue — the state or the localities? Who ensures that our multi-million investment in contract tracing yields the maximum public health benefit?
In sum, the $650 million to be spent on combating the virus could be an extremely beneficial investment or a total waste of money…. depending on how it is spent. I would feel far more reassured if Northam would explain his thinking to the public.
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