Last week, the Ohio Department of Health rolled out a public health advisory system aimed at providing residents of the state of Ohio with county-level information on the spread of COVID-19 in their communities.
Advisory systems like this are a key tool for state governments. As the state of Ohio has eased restrictions on movement and work from its stay-at-home order implemented in March, it has devolved control of public health from the state level to the individual level, hoping that individuals, families, and businesses will be able to make decisions that will slow spread of the virus while allowing people to work, socialize, dine, and shop as needed.
Individuals, families, and businesses can’t make decisions about when to socialize and shop responsibly without good information. The purpose of a public health advisory system is to allow individuals to assess the severity of local spread and make social, family, and work plans based off this information. Ideally, a public health advisory system not only provides people with information about spread, but also with guidance on how to react to local conditions.
While Ohio’s response to COVID-19 has been serious, it has also been overwhelmingly voluntary. Ohio is not fining residents for not wearing masks or punishing the homeless for not staying indoors: It has relied on a system of voluntary compliance that lead to pretty extreme reductions in movement during the height of Ohio’s stay-at-home order.
As Ohio has eased off public health restrictions, though, guidance has not been clear. The last iteration of Ohio’s “stay-at-home” order allowed retail businesses to open without allowing people to shop there, indicating the unraveling of the system of orders.
The guidance since the lifting of stay-at-home has been less than optimally clear. Public officials have gone back and forth on the importance of wearing masks. The definition of “congregating” has been bent to the point of weddings being allowed with hundreds of people. Maybe most concerning, though, is the confusion that has caused for well-meaning people. Opening restaurants, bars, and stores for business implies safety, but COVID is still spreading and people are still dying. How is someone to know what to do and not do under these circumstances?
The public health advisory system has the possibility to be that guide that people need right now. Luckily, DeWine has eased off his previous insistence on statewide guidance only, acknowledging that the threat of COVID-19 has a geographic component to it. This should pay dividends not only in helping slow activity in areas with worse outbreaks, but also in easing political tensions in low-threat areas with businesses and politicians who wants to encourage economic activity.
The system as it stands now, however, is still not quite where it needs to be as a tool for action. Risk levels are determined by a hodgepodge of community spread, clinical diagnosis, and health care system capacity indicators that provide an educated guess at the danger of engaging in activities in the community. Risk level guidance is vague, marrying standard messaging about 6-foot rules, hand washing, and mask wearing with suggestions to “decrease interactions” at medium and high threat levels, as if we have any standard level of interaction these days to use as a baseline.
Most frustratingly, the guidance skirts the issue of what types of activities to avoid, a question that has been central to past guidance but which would open the system for criticisms by interest groups representing the entertainment industry and other industries that have an interest in promoting high-risk events.
Despite these drawbacks, the Public Health Advisory System could be a big step forward for people trying to figure out how to balance safety with social interaction. Let’s hope it is used and that future iterations provide more clear guidance to users.