Most of my great public health colleagues are greatly over-estimating the likelihood that the U.S. can mount a national test, trace, and isolate program as have countries like Germany and South Korea. My friends are mistaking a political-cultural challenge for a technical one 1/9
Public health professionals are working out the technical side brilliantly. How many tests? What type? Who makes and processes them? How many health workers are needed for tracing? But solving these technical problems means nothing without widespread political consent 2/9
In countries with successful testing programs, deference to government authority is higher than in the U.S. Information on where people live and work is often less closely guarded. And acceptance that the state has a monopoly on force is virtually uncontested. 3/9
Testing programs depend on all that; they depend on people being so compliant that they will stay home for 14 days because a health worker told them to. Meanwhile, in Detroit last week a grocery store security guard was shot in the head for asking someone to wear a mask. 4/9
Hard questions public health professionals haven’t answered include “What do you do when millions of Americans refuse to take your tests?” and “What do you do when many of the people you order to isolate, or to close their business, angrily refuse?”. 5/9
These political challenges are not obvious to public health planners because virtually everyone in the field believes public health emergencies should override concerns about privacy and autonomy. And in general, public health specialists usually support expanding government. 6/9
But these propositions have never been universally shared in America. Indeed we’ve debated them for centuries. You don’t have to venture far off campus to see that many, many, Americans don’t subscribe to the politics that are normative within public health. 7/9
Of course, some places do broadly share these politics. They will produces patches of reduced infection via test, track, and isolate – a Massachusetts here, a San Francisco or Seattle there. But in a mobile nation, you can’t build a “no peeing” section in the swimming pool. 8/9
That’s why America is more or less going to end up with Swedish coronavirus policy, not because we universally agreed to consciously choose it, but because we couldn’t universally agree – and never have – about fundamental issues surrounding politics and health. 9/9
