Coronavirus Control Plan

What Indiana Needs to do Now to Control the Spread and Impact of the Coronavirus

March 17, 2020

A new coronavirus is the cause of COVID-19, a worrisome new disease outbreak sweeping the globe. It’s one Indiana and all other states must prepare for. While state officials have taken action, Indiana needs to go further in its preparedness.

As Indiana State Health Commissioner in the late 1980s, I navigated a similar public health threat when we struggled as a state and as a nation, with our response to HIV/AIDS. Then, we were frequently mired in fear, misinformation and distrust. It’s reminiscent of what’s happening across Indiana today amid the coronavirus pandemic. Not all public schools are equipped to hold classes remotely if forced to temporarily close and parents are concerned what a disruption means for students; workers are worried about their employment security if they become ill or must stay home to care for a child due to school or daycare closure; some in the medical community question whether Indiana has the appropriate resources to ensure that it can effectively respond to the crisis as cases of coronavirus increase. According to a 2019 report from the Trust for America’s Health, Indiana ranked 49th in the nation for public health spending, investing only $17.58 per person compared to Alaska that invests $63.28 per person and is ranked 1st in the nation. We’re already behind.

The most important missing element today is the public’s confidence that the measures taken thus far are sufficient to curb the rapid spread of the virus. Disagreement and confusion at the federal level are evident. When Dr. Anthony Fauci of the National Institutes of Allergy and Infectious Diseases, in congressional testimony, tells us that virus testing efforts have been a failure thus far, I believe him and not Vice President Pence whose testing availability predictions and projections have been and continue to be wrong.  Indiana can’t afford to wait for Vice President Pence to get it right.

COVID-19 is different than HIV, with a different form of transmission. However, the need for public education and accurate communication is the same when it comes to both viruses. Communication and education are just as important as the actions our state takes to mitigate the economic and public health effects of this virus. As of today, Governor Holcomb hasn’t done enough. He’s holding back action and keeping legislators in the dark and as a result  Hoosiers are more vulnerable to this public health threat.

If I were elected Governor, I’d:

  1. Immediately appoint and convene a taskforce on COVID-19, the Indiana Coronavirus Leadership Group (ICLG), with representation from health care, state and local government, leaders from both chambers of the General Assembly, labor, business, education, law enforcement and the public to rapidly develop recommendations for Hoosiers, state and local governments and businesses to mitigate the impact of COVID-19. The Indiana State Department of Health (ISDH) advisory committee is too limited in scope to be fully effective. Within 10 days of the (ICLG) convening, it would release an initial report with recommendations on ways to mitigate the impact of the pandemic across all areas of government, including recommendations on adaptations of policies and modification of state laws to address the threat of COVID-19 to all Hoosiers and to ensure a coordinated response by local and state agencies. The Group would continue to recommend actions as appropriate and responsible.
  1. Close all Indiana schools immediately, and then reassess continued closure. Through the use of the state surplus, provide schools and parents with the technology required for online learning. This would include guidance on its proper use and facilitate cross-state and state-district collaboration and sharing of online education classes and resources.
  1. Provide direct outreach and assistance to local government and essential Indiana businesses. Indiana Department of Homeland Security (IDHS) has posted forms and guidance online for state agencies, local governments and businesses to use to develop Continuity of Operations Plans (COOPs). But the state should go further. IDHS should take affirmative steps to assist those entities that don’t already have COOPs in place to develop them without delay. These plans are critical to ensure that essential functions by government continue to be performed during this health crisis.
  1. Call a Special Session of the Indiana General Assembly to adopt necessary changes to state law to maximize protection of Hoosiers. The General Assembly adjourned for the session on Wednesday, March 11, without passing critical stopgap measures to protect the financial security of Hoosiers.   
  • Press lawmakers to pass an emergency paid leave law to allow sick employees to take time off of work without fear of retaliation or retribution due to COVID-19. The Indiana law would expand beyond proposed federal legislation and include all Indiana workers infected with the virus, regardless of employer size. ISDH has recommended that Hoosiers stay home if they’re feeling sick. That’s why Indiana needs an emergency paid sick leave law to truly provide workers with the ability to stay home from work when they become ill with flu-like symptoms until testing is complete and when the virus is confirmed.
  • Authorize immediate and initial emergency appropriation of $100 million, in addition to any assistance provided by the federal government from the State Rainy Day Fund (Counter-Cyclical Revenue and Economic Stabilization Fund). I’d direct all state agencies to exert every reasonable effort to maximize what federal assistance Indiana receives and to use state and local resources, if necessary, to minimize harm to Hoosiers.
  • Waive cost-sharing requirements associated with COVID-19 and clinically-related testing for all individual and group health insurance plans, state health plans (including Medicaid, the Children’s Health Insurance Program and Hoosier Healthwise) and health maintenance organizations, with additional action to remove prior authorization to testing and treatment.
  • Pass stronger price gouging laws. It’s already starting to happen, whether it’s the cost of hand wipes or bottled water or facemasks (which aren’t helpful except in cases of known infection or presumed exposure). The greedy are raising prices to induce panic buying, which will then create an environment where prices are raised even higher. It’s likely to get worse before it gets better and Indiana’s price gouging laws don’t go far enough to ensure consumers are protected.
  1. Direct state agencies to adopt needed changes and/or additions to state rules and policies related to COVID-19 ASAP. For example:
  • Delay the requirement to file Indiana state taxes by 60-90 days for both individuals and for Hoosier businesses. COVID-19 is dominating the consciousness of us all. Let’s not compound the anxiety by enforcing this deadline during a crisis.
  • Expand unemployment benefits for workers impacted by COVID-19, like Illinois and Washington have done.
  1. Give Hoosier businesses that remain open more tools now. Weekly webinars should be conducted for all employers and labor leaders where factual information is presented and where questions can be asked and answered by medical professionals. We should make non-invasive thermometers (that don’t touch the patient) available in multiple settings so quick determinations can be made if a fever is present such that appropriate next steps to protect the individual and the public might begin.
  1. Convene the leaders of our hospitals, clinical laboratories, out-patient clinics and urgent care centers to find out what they need from the state and federal government to offer appropriate laboratory testing services to the public as quickly as possible. We already know that virus testing efforts have been a failure so far. We can’t rely on the federal government to make testing in Indiana a priority. We must do it ourselves. Until virus testing is universally available with quick and reliable results, we won’t know how extensively the virus has spread, and where clusters exist here in Indiana.
  1. Create an inventory and real-time database of all negative pressure hospital rooms in Indiana and make it available 24/7 to all Indiana physicians. We need to provide infected patients with the best clinical care available, and we desperately need to avoid that patient spreading the virus to others. That’s why knowing in real time what facilities have capability and capacity to care for seriously ill coronavirus patients is vital. Italy’s hardest hit region from COVID-19 has 3.7 hospital beds per 1,000 people compared to the 2.7 per hospital beds per 1,000 people available statewide in Indiana – and we already know that Italy’s health care system has been pushed to the breaking point.
  1. Develop contingency plans now for those individuals in confined settings not easily moved. Nursing homes. Jails. Prisons. All are examples of confined settings where separating those infected with the virus from the uninfected will immediately become challenging. Contingency plans must be created immediately and shared with the public.
  2. Institute “drive-thru” clinical evaluation protocols and establish locations to test patients while protecting health professionals, starting in our major population centers and expanding throughout the state, as rapidly as feasible. Patients shouldn’t be expected to tell the difference between influenza, pneumonia, emphysema, asthma and coronavirus infection. Health professionals are trained to ask the right questions and request the right testing to determine the right diagnosis and prescribe the right treatment.
  1. Issue an executive order to facilitate public control of private resources as required, during the period of this public health emergency. The state, through the National Guard and through cooperation with local officials, would be able to temporarily seize hotels, motels and other private assets to permit or enforce isolation protocols and to treat patients with COVID-19 when required. Not every Hoosier has the means to self-isolate, and not every Hoosier has the means to care for his or her family during this crisis.

This health threat will test our state in ways it hasn’t been tested in the past. We need a governor and an administration that fully understands the potential impact COVID-19 could have on our state. We need immediate implementation of an enhanced response plan to mitigate its effects. We need a governor who isn’t afraid of the political consequences associated with leading an appropriate, effective response, putting patients before politics.

 

SOURCES:

“The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2019”, Trust for America’s Health, LINK 

“Coronavirus ‘tsunami’ pushes Italy’s hospital to breaking point, Financial Times, 3/11/2020, LINK and Hospital Beds per 1,000 population by Ownership Type, KFF, 2018, LINK

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