As 2020 wears on, Shah and others are grappling with a new and bitter reality: Because of the economic crisis, which was triggered by the current pandemic, which was worsened by a lack of public-health investment, public-health agencies will probably suffer more budget cuts in the coming years. “It’s not like the environmental movement or even the health care reform movement, where you have activists and lobbyists and advocates fighting to change the status quo or to secure their piece of the pie,” Hearne told me. “It’s a lot of isolated departments across the country, saying, ‘Oh, we’ll just keep doing God’s work over here, and if our budget gets cut again, we’ll just make do somehow.’”
To change this, Shah, Hearne and others say, the public-health community will need to muster more political will than it has in the past. In the years preceding the coronavirus outbreak, the United States faced a host of public-health disasters: a resurgence of measles and syphilis; an uptick in food-borne illness; and a continuing lead-contaminated-water crisis. None of those issues captured even a fraction of the attention that universal health care did. In fact, while the health care system was discussed relentlessly in 2019, as it tends to be almost every election season, public health was barely mentioned at all. “No one is going to vote for you or name a hospital wing after you because you kept them from getting something that they didn’t think they were susceptible to in the first place,” Frieden says. “The people who cure diseases are glorified, not the people who prevent them.”
In late June, Abbott reversed course again and ordered the state’s bars to close and restaurants to reduce their capacity to 50 percent (they had been at 75 percent for several days). He also issued an executive order requiring all Texans in counties with more than 20 active Covid-19 cases to wear a mask in public. Scientists worried that it was too little too late, and by early July, the numbers seemed to prove them right. On July 8, the state hit a record 9,952 new coronavirus cases reported in a single day. The state’s positivity rate — the portion of all tests done that come out positive — also rose to 15.6 percent, from 7.9 percent just three weeks earlier.
Hospital beds were filling up, hospital floors reconfigured and surge units readied. Doctors and nurses, in Harris County and elsewhere, have begun a worrying and familiar census-taking of ventilators and personal protective equipment. And the same stories that played out in Wuhan and Lombardy and Seattle and New York were beginning anew. And not only in Texas. In more than 35 states, including some that had previously brought their outbreaks under control, daily case counts are rising, positivity rates are rising and new grim records are being set — and then quickly surpassed. People in Texas, Florida, California and New Jersey are bracing for a second wave of outbreaks in the fall, even as the first wave has yet to fully recede. The root of this catastrophe, doctors, scientists and health historians say, is our failure to fully incorporate public health into our understanding of what it means to be a functioning society. Until we do that, we will be unable to effectively respond to crises like this one — let alone prevent them.
In Harris County, Hidalgo and her advisers have created a numerical and color-coded warning system so that residents know how dire the threat level is and exactly how cautious they need to be. “We needed something that was clear and concise, because the back and forth with all the orders was confusing people and causing them to tune out,” she told me. “I went with colors and numbers because some people like one and some people like the other, and I really just want this to stick.” Right now, Harris County is at the highest threat level: one (or red), meaning that the outbreak there is severe and uncontrolled and that people should leave home only to meet essential needs. As with all things coronavirus-related, it will take a while to see if people hear the message and heed it.
In the meantime, the political and cultural battles over how to respond to the coronavirus crisis have continued unabated. The Texas Education Agency said they would withhold funding for schools that don’t enable students to attend full-time, in-person, this fall. On July 8, the mayor of Houston, Sylvester Turner, prevailed on the city’s convention center to cancel the state Republican convention that was scheduled for mid-July. The state party has challenged the move in court.