Public Health Strategies Contain and Mitigate COVID-19: A Tale of Two Democracies

In the US, in 2013, the Bill and Melinda Gates Foundation conducted a comprehensive review of worldwide data and predicted that a pandemic would occur during the next decade, most likely due to coronavirus. In 2015, the US government created a Pandemic Emergency Response Task Force which was disbanded in 2018. Ironically, in early 2016, the World Health Organization noted that the US was in the best position of any country to address any future pandemic. Upon introduction of the first US case, the official position adopted by the government was that there would be no further cases. Thus, no containment or mitigation strategies were initiated. Two months later, during which time the virus was exponentially spreading, the US government mounted a fragmented mitigation strategy that relied on separate state and local initiatives with limited and inconsistent federal involvement. Thereafter, containment and mitigation strategies in the US have resulted from individual responses of individual states. For example, New York and New Jersey, the initial US epicenters of the pandemic, accounted for >50% of cases and deaths before effective mitigation. These public health measures have markedly diminished cases, hospitalizations, and deaths. At present, however, the US remains the epicenter of the pandemic worldwide, due, at least in part, to the massive surge in cases in Florida, California, Arizona, and Texas. In addition, only California and Texas have issued statewide mask mandates. In contrast, the governor of Georgia is suing the mayor of Atlanta for issuing a mandate to wear masks. Not surprisingly, during the last 72 hours the US states reporting the highest numbers of cases of COVID-19 are, in order, Florida, California, Texas, Georgia, and Arizona.