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Op-Ed: The U.S. COVID-19 Failure Is Federal

The lab director’s mask kept falling off her nose, and I kept telling her to pull it up.

I had come from the morgue, where I was in charge of the COVID-19 response for a San Francisco Bay Area sheriff-coroner office, to find out why it was taking 48 hours to get our test results instead of the 8 hours we were promised. The lab director explained that their machine had 96 wells, and they had to wait for it to fill up with samples from clinics all over the county. By the time they stocked and ran the machine and it finished its cycle, it was after quitting time.

“Can you pay someone overtime to stay late so we can have the results the next morning?” I asked.

“I’ll check,” she said.

“How about getting another machine dedicated to the coroner samples, so we don’t have to wait until all 96 wells are full?” I said. “We can’t do our autopsies — or contact tracing — ’til we know if the bodies are infected or not.”

“I’ll ask.”

That was weeks ago. People kept dying. Nothing changed.

The San Francisco Chronicle‘s COVID-19 tracker shows that most Bay Area counties have a death rate over 1%. That means, based on what we know about this disease, that we are likely under-testing. The story of one local woman, Patricia Dowd, demonstrates that we are also missing COVID-19 as the cause of death in people we aren’t testing. Dowd, currently believed to be the first American to die of community-spread coronavirus, was initially asymptomatic. It is highly likely, however, that she wasn’t actually patient zero, and that prior coronavirus deaths in vulnerable individuals were attributed instead to their pre-existing conditions. As COVID-19 has entered nursing homes and homeless shelters, the likelihood increases that deaths from the disease, in the absence of widespread testing, will be instead misattributed to patients’ underlying pre-existing conditions, such as dementia or substance abuse.

In the county where I worked, we tried to enact basic safety protections for our coroner staff: separate shifts to establish exposure “bubbles”; monitored temperature checks at the front door; mandatory face mask usage indoors; limiting the number of people entering the building; requiring that field deputies wear protective gowns before entering a house to pick up a decedent. My supervisor’s initial response to most of these requests was “we can’t do that.” I had to spend weeks lobbying the chain of command, appealing all the way to the county’s board of supervisors, before we could get these life-preserving workplace protections in place.

I quit 3 weeks ago. The day I did, field deputies were still dodging the temperature checks by coming into the building from the back lot, and police officers were repeatedly being allowed into the building to view autopsies without being screened, or wearing masks. When my supervisor refused my offer to re-examine old cases to ensure we hadn’t missed any from COVID-19 — as the governor and the Department of Public Health recommended we should — she said, “you don’t get everything.”

My boss was right. I don’t get everything. I can’t have the tools I need to combat COVID-19 or remain safe at work, because my county — even in this, our nation’s biggest and richest state — can’t provide them. Only the federal government can. I shouldn’t be bickering over a 96-well machine when we need to ramp up testing into the tens of thousands locally. Only the Feds can coordinate the scale needed to bring testing into the millions. Only the president can invoke the Defense Production Act to compel companies to fill warehouses with the needed test kits, swabs, and personal protective equipment (PPE). Only the CDC has the authority to set best practices, and only the U.S. Congress can fund their initiatives.

Just this past week, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, testified that the reason the U.S. government was not recommending masking in the early days of the pandemic was because they wanted to preserve PPE for healthcare workers. Instead of misleading the entire nation about the known efficacy of masking, the CDC could have instead recommended personal usage of cloth masks while ramping up the national supply chain of hospital-grade PPE before doctors ran out of it. Instead, in the trenches, healthcare workers were forced to re-use masks that were not meant to be reused, and on the state level we saw governors hiding supplies from hostile Washington bureaucrats and forming their own consortiums to fight the unchecked pandemic profiteering that has prevented them from buying necessary equipment for their frontline caregivers.

Epidemiologists and public health experts all agree that 125,000 dead Americans is a gross undercount. Testing of decedents is being done haphazardly on the local level, without a coordinated national strategy to make sure we medical examiners and coroners find and document all COVID-19 deaths. In California, most counties test cadavers only if the decedent had reported respiratory symptoms — even though half of COVID-19 positive individuals may be asymptomatic or presymptomatic. COVID-19 kills some people — like Dowd — suddenly and unexpectedly; with social distancing in place, some will die at home without having reported any coronavirus symptoms. Until we get serious on a national level about testing, we’re burying our mistakes.

Other countries have successfully managed this pandemic. The one thing they have in common is a coordinated national response coming from the highest levels. Our local officials can’t manage a pandemic, and there is only so much any governor can do to fight a nationwide disease outbreak. In the absence of federal leadership, states are competing for supplies, bickering over policies, and blaming Washington for inaction. Unless Washington listens, Americans who didn’t need to die will keep right on dying. My colleagues will be there, in their morgues, counting.

Judy Melinek, MD, is a forensic pathologist and CEO of PathologyExpert Inc. Her New York Times bestselling memoir, co-authored with her husband, writer T.J. Mitchell, is Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. They’ve also embarked on a medical-examiner detective novel series with First Cut, now available from Hanover Square Press.

Source: MedicalNewsToday.com