With increasing numbers of cases of coronavirus disease 2019 (COVID-19) globally and in the United States, Health and Human Services (HHS) Secretary Alex Azar declared a national public health emergency on January 31.1 The emergency declaration of the HHS authorizes additional resources, enhanced federal powers, interjurisdictional coordination, and waivers of specific regulations. State and local public health emergency declarations are also likely. During crises, government has a special responsibility to thoughtfully balance public health protections and civil liberties.
Public Health Risk Assessment
While epidemiological data are evolving, human-to-human transmission of COVID-19 has been documented over an incubation period of 2 to 14 days.2 Based on available data, the case fatality rate appears lower than that associated with other novel coronaviruses (severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]), likely no more than 2%. China has reported the majority of cases and deaths, especially in Wuhan and surrounding Hubei Province. The US population currently is at low risk, but infections could escalate if sustained transmission occurs. Absent rapid diagnostic tests, effective vaccines, or antiviral medications, health officials are focused on identifying cases and separating persons exposed or infected.
Emergency Health Powers
Emergency declarations enhance national or regional response capabilities through limited liability protections for first responders and volunteers; reciprocal licensure requirements; and real-time development and acquisition of countermeasures (eg, vaccines, antivirals, medical equipment). Hospitals that have staffing or supply shortages can shift to crisis standards of care.3 Declarations also expedite public health powers to test, screen, or isolate individuals and restrict travel.
The US Constitution grants primary public health powers to the states, which they may delegate to localities. Narrower federal health powers historically center on preventing spread of infectious diseases into the US or across states. However, the HHS has exercised federal powers in response to COVID-19 beyond those used for previous health emergencies such as SARS, H1N1 influenza, and Ebola. The administration premised the exercise of federal powers on the need to avert “cascading public health, economic, national security, and societal consequences.”4
Author：Lawrence O. Gostin, James G. Hodge Jr