The US Public Health System’s Playbook for COVID-19

Photo of Eduardo Sanchez, M.D., M.P.H.Eduardo Sanchez, M.D., M.P.H., Chief, Center for Health Metrics and Evaluation

There is reassuring news in the midst of the uncertainty that has permeated many in our nation over the past several weeks: we have a science-based playbook for public health agencies to effectively respond to emergencies such as COVID-19.

The Centers for Disease Control and Prevention (CDC) guidance on Public Health Emergency Preparedness and Response Capabilities – National Standards for State, Local, Tribal, and Territorial Public Health, updated in January 2019, specifies six domains (community resilience, incident management, information management, countermeasures and mitigation, surge capacity and biosurveillance) and 15 distinct, interrelated capability standards to enhance the capabilities of state and local public health systems.

Think of these national standards as the “Get With The Guidelines” for public health preparedness and response. Many of the terms and topics that you have heard or read about in the context of COVID-19—public information, vaccines, masks, ventilators, isolation, quarantine, social distancing, precautionary protective behaviors, laboratory testing—are included in the standards document as anticipated topics to address in the context of public health emergencies.

As part of CDC’s responsibility to respond to public health emergencies, it provides support to state, local, tribal and territorial public health departments when public health challenges are national or international in scope or when local public health challenges require additional assistance. US states, tribal areas and territories have had over 20 years of funding and guidance from CDC to support preparedness and response. In 1999, CDC awarded $40 million to the states and four major metropolitan areas to support bioterrorism preparedness and response, and the responsibilities and capabilities have expanded to include other public health emergencies such as disease pandemics.

The 2019-2024 Public Health Emergency Preparedness (PHEP) Cooperative Agreement offers $602 million over five years for preparedness and response in states, tribal areas and territories. The overall funding for PHEP was reduced by 20% from 2010 to 2019. The cooperative agreement identifies five mission areas (prevention, protection, mitigation, response, recovery) that align with the US Department of Homeland Security and FEMA (Federal Emergency Management Agency) mission areas.

You can be certain of this: the competency and capacity of local, state, tribal and territorial health departments is at the table with local clinical care and health systems—and now with the coordination and logistical support of FEMA)—to do what is needed to contain the virus where it’s still possible and to mitigate its health effects in people with COVID-19.