Public Health Jurisdictions and the Silencing

Public trust is essential to a functional public health system. Transparency is essential to maintain that public trust.

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The Influenza Pandemic of 1918 killed more people than WWI. And while there were many factors leading to it, the scariest was this, reported in the Smithsonian:

‘At Wilson’s urging, Congress passed the Sedition Act, making it punishable with 20 years in prison to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the form of government of the United State…or to urge, incite, or advocate any curtailment of production in this country of any thing or things…necessary or essential to the prosecution of the war.” Government posters and advertisements urged people to report to the Justice Department anyone “who spreads pessimistic stories…cries for peace, or belittles our effort to win the war.”

Against this background, while influenza bled into American life, public health officials, determined to keep morale up, began to lie.’

Sound familiar? One doesn’t need to be a Public Health expert to oversee a program, but one must believe the experts to manage it effectively. Yesterday, the Vice President, an individual who, as governor, relied upon prayer rather than sound public health practices to stem an HIV outbreak in rural communities, was appointed to oversee the Public Health Emergency Response to COVID-19. While that alone is problematic, the truly terrifying part is the gag order. Government agencies have been ordered not to speak about COVID-19 unless approved by the Vice President.

Politicians telling public health officials not to speak isn’t unique to this administration. It has happened at various levels but the stakes have been lower and the public has been unaware. And fortunately, public health professionals have pushed back.

That said, I don’t fear that accurate information won’t get out.

It’s important to understand jurisdictions. Most Americans think the CDC rule all. While the media may like to portray CDC officers as the cowboys busting in to save the day, they can’t come into a city without an invitation.

Our public health system is decentralized. Each state has its own health authority, and many municipalities have their own health authority. The CDC website currently has a good description, where you can check to see how it works for your state.

In Texas, we have the Department of State Health Services with eight Health Services Regions, each with its own Health Authority. Within the state, there are many local health districts, again, each with its own health authority. In San Antonio, we have the San Antonio Metro Health District, which includes the city and unincorporated regions of Bexar County and has its own Health Authority. The other municipalities in Bexar County are served by the DSHS Region 8, which includes 28 counties in Texas, with another Health Authority.

While the state can override local decisions, it is extremely rare and there must be substantial justification for doing so.

Despite the gag order on federal agencies, the state and local entities are not prohibited from speaking or sharing information as needed. And though one state may choose to follow the federal line, we have 50 states, and many local health departments. Plenty of opportunity to speak the truth.

Social media can be problematic in an outbreak situation — a great deal of information is shared, some incorrectly, and panic can ensue. On the other hand, it may be our saving grace. Thanks to social media, it’s easier for scientists, epidemiologists and public health professionals to connect and discuss. They do it anyway, but social media can help to facilitate the exchange of information and share it with the public.

It also means those of us outside federal agencies need to step into high gear to make sure we’re getting the accurate information out there. It means the media has an enormous responsibility to accurately report on COVID-19.

It also means the CDC website may not be the most up to date source for information on COVID-19. Fortunately, there are other sites like CIDRAP . We should all follow this page anyway as the information on all things public health is sound. Your state and local health departments have websites, and there are many scientific journals that have easy-to-read blogs for general consumption.

So as I said, I’m less concerned about accurate information getting out, because we have the means to make that happen.

What terrifies me as a citizen is that gagging experts is what authoritarians do. Blocking speech is contrary to the principles of the US Bill of Rights AND contrary to sound public health principles. Preventing experts from speaking the truth sends our entire society into a downward spiral from which we may not recover. It’s not just about a pandemic. Regardless of your political party, this should terrify us all.

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