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Speaking Government or Making Sense of Emergency Declarations

If you have been following the news about COVID-19, you are probably already thinking, “Based on the terminology, I’m guessing this is bad…”

That is true, but in terms of what it really means to you, there are some insights that may help you anticipate difficulties, issues and at best, that can help you participate cooperate and function as a partner in an untoward event.

An example

Recently, during Harris County (Texas) Judge Lina Hidalgo’s press conference announcing the confirmed cases of COVID-19 in the greater Houston area, she stated that the whole community could function as an extension of the health department in terms of participation, reducing COVID-19 spread and protecting the most vulnerable people in the population.

It was a good thought and right on target. Unlike Hurricanes, earthquakes or other “disasters”, a communicable illness, especially a novel one (without any population immunity) requires a whole of society response. That means partnering with the public. It means sharing the truth (even when it is scary) and engaging the community to band together.

There is much truth to the saying, “A smart person learns from their mistakes and a genius learns from the mistakes of others.”

We have but to look to Seattle, where the virus is believed to have circulated undetected for some time and where the exponential toll led to certain societal disruption such as absenteeism, impact of response personnel, deaths, and the impact on businesses and the economy to anticipate what we will likely engage elsewhere in the foreseeable future. Unlike Hurricanes, earthquakes or other “disasters,” a communicable illness requires a response by all of society. Such a response is especially important if the illness is novel and thus no one is immune. Responding suitably means the government must partner with the public. It means sharing the truth (even when it is scary) and engaging the community to band together.

Federal Public Health Emergency Declarations –

These declarations are health specific unlike a Presidential Disaster or Emergency Declaration. A Presidential declaration can include a health declaration, but not the other way around. When a president issues a declaration, it often includes an activation of the Stafford Act, which provides money and putting boots in place for response.

We are currently under a public health emergency declaration, activated by the Secretary of Health and Human Services, Alex Azar. It is finite in duration and not as broad in power as a Stafford Act declaration and must be reactivated or refreshed periodically to keep the following cascading actions going.

They include suspending restrictions in some cases of:

HIPAA (the Health Insurance Portability and Accountability Act): This act limits the sharing of patient information, in order to maintain privacy. Under the current declaration, some limitations are reduced, so healthcare personnel can share with each other certain information critical to responding and saving more lives.

EMTALA (the Emergency Medical Treatment and Active Labor Act): Basically, this act says that emergency rooms must triage and stabilize people who arrive. Under the emergency declaration, catastrophically overwhelmed hospitals mat be forgiven for not fully meeting this requirement.

CMS (Centers for Medicare and Medicaid Services) These requirements regard paperwork that healthcare providers must complete to receive government funds. Under the declaration, filing requirements are loosened or suspended so that healthcare systems and hospitals to take on patients without suffering undue financial hardship.

Emergency Use Authorizations (EUA) signed by the Commissioner of the Food and Drug Administration or FDA are permitted under a public health emergency declaration to free up as yet approved materials like the reagents we use in the COVID kits or experimental treatments or vaccines. This doesn’t just mean it’s any old material, but one where it has yet to clear for normal and routine use, but in consideration of the life-affecting nature of the disease, it is necessary.

At the state level, emergency declarations can allow a Governor to call for redirection of personnel to emergency support functions, release certain money, and act with the support of various state agencies.

At local levels, declarations are much more tactical actions. These depend on the type of government one has locally, but in a Mayoral-Executive framework it allows for a mayor to direct police actions, alter hours of free travel and exchange in the form of curfews, or suspend activities, like conferences, city government or schools.

So the details of the declaration matter, and as a citizen or resident it is extremely important to be aware of those. For reference visit the interactive website at the National Association of County and City Health Officials website and your local office of emergency management and be ready to partner up.

Matthew Minson, MD is a physician and has served as a local, state, and federal health official and is the author of the award-winning Prepare to Defend Yourself series of books promoting individual healthcare and social advocacy and published by Texas A&M University Press. He is also a contributor to C-Span, NPR and PBS.


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