Feature Why We’re Losing the Battle With Covid-19

The escalating crisis in Texas shows how the chronic underfunding of public health has put America on track for the worst coronavirus response in the developed world.

• July 14, 2020

In the early days of May, Umair Shah, director of the public-health department in Harris County, Texas, was feeling hopeful. It looked as if his county might succeed in controlling the coronavirus outbreak. The number of new cases per day had plummeted to an average of about 50 from a peak of 239 in early April, and it was holding steady. On the charts that Shah studied on his computer each morning, the uptick — a mountain that had been rising into existence for weeks — had given way to a plateau. The virus wasn’t disappearing. But it wasn’t spreading rapidly anymore, either.

That stalemate was no small feat. For one thing, Harris County stretches across 1,800 square miles of the state’s southeastern edge. The region includes two international airports, four international seaports and the city of Houston. The first case was confirmed there in early March, around the same time that cases first popped up in New York, and modelers initially worried that the county’s hospitals and morgues would be overrun — just as New York City’s eventually were.

For another thing, the work itself was grueling. By early May, Shah’s staff had logged 16-hour days, six or seven days a week, for two months. Contact tracers and outreach workers had made thousands of phone calls: to persuade people exposed to the virus to report their symptoms, get tested and self-isolate; and to prevail on businesses, apartment complexes and nursing homes to hang more hand-washing signs and distribute informational pamphlets. Scientists had processed reams of data that flooded the health department’s offices through every conceivable portal. And computer engineers had labored ceaselessly over urgently needed technological upgrades. This work was done in what felt like the forgotten shadows of a roaring public spectacle. None of it inspired nightly rounds of public cheering, nor even much media attention. But Shah felt that it had made the difference. The fight unfolding in hospitals around the country was truly heroic, but the key to stopping a pandemic was preventing as many people as possible from landing in hospitals in the first place.