Public health law professor speaks in the face of Covid-19

Professor Lance Gable

By PAULA NEUMAN

Professor Lance Gable has been warning the public and the government for many years that the nation is not prepared to handle a pandemic.

An associate professor of law at Wayne State University and an internationally known expert on public health law and bioethics, Gable has a master’s degree in public health from The Johns Hopkins University and a law degree from Georgetown University Law Center.

He has published books and journal articles on pandemic preparation, and also articles in more popular publications, including “Three Ways the U.S. Should Prepare for the Next Flu Pandemic” in Salon.com and The Conversation in 2018.  In 2012, he led a committee for the Michigan Department of Community Health to create a set of ethical guidelines to assist the healthcare system and public health officials if they have to ration resources such as ventilators during a public health emergency.

Now the nation faces the Covid-19 pandemic health emergency, and an increasing number of situations where hospitals are running out of resources to treat patients.

But public health guidelines, including an Obama-era National Security Council playbook on fighting pandemics, were ignored by federal officials for months.

“As somebody who’s worked on these issues for 20 years, it’s incredibly frustrating,” Gable said. “We’ve been planning for years and years. To see that not being used is incredibly frustrating. We could have made it so much less bad. It’s tragic.”

A lot of what happens going forward with the pandemic depends on what governments and people do, he said.

“We can take steps to greatly reduce its impact,” Gable said. “We need to keep these (stay at home) measures in place for much longer than two weeks to stop the outbreak from growing, and we’re not going to be out of the woods at that point either. The virus isn’t just going to go away. The strategies we should use are testing and targeted self-separation. The problem is that we need to have the political will and social will to do that.”

With widespread testing for the virus, measures such as stay-at-home orders and school and business closings can be targeted to only the areas where they’re necessary. It’s what should have happened months ago in Washington State, when the virus first got a foothold in the country, he said.

Even now, with extensive testing, “we could allow more things to get closer to normal without spreading the disease the way it’s spreading now,” the professor said. “It’s kind of what they did in South Korea.”

A significant shortage of tests for the virus was the case early in January, and there still aren’t enough tests nationally. Testing availability today varies by state. One problem early on was that the initial test kits from the Centers of Disease Control and Prevention were faulty, Gable said, and the federal government seemed to have a “lack of urgency” about the matter, declining to use kits from other nations.

“Other tests were being used effectively in other countries, but we decided we were going to make our own,” he said.

Now, with the virus widespread, some hospitals, including those in Wayne County, are short of equipment, including ventilators, to deal with the crisis, and are facing difficult choices of just which patients will get resources. Those decisions ethically can’t be based on factors such as ethnicity, sexual orientation or disability statuses unrelated to the immediate prognosis, Gable said.

“We can’t use it as a reason to devalue the overall lives of people who have chronic health conditions,” he said. “Health care workers are confronting this. These are such tough situations to try to work through.”

The health care system has to have capacity for situations that aren’t related to the virus, too — heart attacks, strokes, emergency surgeries, he added.

Right now, with the virus rapidly spreading through different parts of the country, including Wayne County, we need to adhere to the state’s stay-home order, use good hygiene, listen to scientists, and support each other as much as possible, Gable said.

“We have to have some measure of social solidarity,” he said. “We’re in this together.”

We also need to make sure there’s a moratorium on home evictions and utility payments for those without resources, and make sure people have access to extended unemployment benefits to support everyone and keep them safely at home, he said.

“Our poorest communities are going to be affected the worst, and they’ll have the least opportunity to access the programs to help,” Gable said.

“There are many possible end results to this situation — everything from society falling apart to having a much greater cohesion. I think people tend to support each other and are more willing to help others when times are dire. Hopefully, that’s actually what happens in this crisis, as well. We need ways to help each other socially and financially.”

The $2 trillion federal relief bill enacted March 28 is a good start, but we’re going to need more, Gable said.

“It’s going to take a long time to recover from this,” he said. “We really need to have support systems in place that can help people survive — financial support, health care. The more we can reassure people that we’re not going to let them fall through the cracks, the better. We’ve got to adapt and think about how we can find support for the people in our communities.”

In the short term, the pandemic will “require our government to be much more aggressive in providing social support for people,” Gable said. 

“Even if we miraculously have this thing in control in a year or a year and half — maybe we have a vaccine — even under those circumstances, we’ll have gone through significant trauma. Tens of thousands of people are going to die. Our society is going to take years to recover from this.

“I can’t imagine this doesn’t change our politics. I think it’s inevitable that it will. We’re going through a situation that affects many fundamental aspects of our society. I think inevitably, in the long term, it will look different. We should be thinking about how to make our society better. We may end up better in the long run, but that’s going to take some very deliberate action. We can’t let this happen again.”

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