It is clear that many people and many businesses are sympathetic to protecting public health, and also understand the risks they face trying to conduct business as usual during the COVID-19 pandemic. However, there are too many people not practicing social distancing, and not wearing face coverings in the community. The lack of compliance by some of our businesses and citizens is now driving the surge of cases in Florida, and we should ask why this is happening.
The simple answer is that poor compliance with COVID-19 precautions in restaurants, retail stores, bars, and other places of transmission in our community happens because businesses and patrons think they can get away with not following the rules and guidance from our authorities.
But its more complicated than that. In addition to the wrong messages from some of our leaders, and disrespect by some for the rules, our agencies are partly to blame for non-compliance. Given that there is little transparency with state agencies in Tallahassee, there appears to be a lack of coordination between the agencies that technically have the ability to hold businesses accountable to follow the accepted guidance and rules.
Lack of political support for the Florida Department of Health, and poor leadership at the agency over many years, has silenced what should be the most effective agency with the means of controlling COVID-19 in Florida’s communities. In recent years, the DOH has lost jurisdiction over food services, childcare and institutions-including healthcare facilities. Those responsibilities have been divided between the Florida Department of Business and Professional Regulation- FLDBPR, The Florida Department of Agriculture and Consumer Services-FLDACS, and the Agency for Health Care Administration-AHCA There is poor coordination between these agencies in regards COVID-19 control, and no discernable central command, so to speak. Therefore, there appears to be no expedient way to bring the varied rules these agencies operate under into a cohesive enforcement effort. Currently, Florida has a disconnected patchwork of rules and agencies, with the remarkable result that ACHA and DBPR are now tasked with protecting public health during a deadly pandemic!
The problem is, neither AHCA nor DBPR are public health agencies. While they do have the capacity to take action against a licensed establishment, the problem is with the agencies themselves. DBPR suffers from having to maintain the political support of the Florida Restaurant and Lodging Association lobby, for one thing. Another is that some field staff in these agencies do not have science backgrounds, or even college degrees, and yet they make sometimes complex public health decisions, i.e., identifying and managing an outbreak, or who stays open and who gets closed.
I am not aware of a formal mechanism for DBPR, AHCA and DOH to work together to investigate COVID-19 compliance issues. When a cluster of cases is suspected in a facility, our agencies should be coordinating together to investigate the cluster, apply their respective expertise and take the corrective actions as necessary to protect the public. The DOH has limited jurisdictional powers and cannot even enter a nursing home without being invited in by the licensing agency, much less enforce a rule. That is even more troubling, considering the terrible loss of life in Florida’s nursing homes.
Another observation is that there is little visible evidence of effective public health promotion at the DOH, even though the disciplines of Public Health Promotion and Education can be effective functions when communication channels are properly utilized. In order to change negative public opinion, messages must reach the community explaining to them the “why’s” of social distancing, and face coverings.
Enforcement of COVID-19 rules is now a policing issue in a growing number of Florida municipalities. Sending a police officer to deliver a citation, or levy a fine may deter some violations, but this method of dealing with COVID compliance is a scattershot approach, and may not be sustainable.
The root-cause of the present dysfunction in enforcement is the politicizing of the existing agencies tasked with protecting public health and safety. Little by little, DOH’s jurisdiction has been taken apart, piece by piece by Florida’s legislators.
Now that we have a crisis, where is the strong and effective public health agency, the one agency whose mission it is to protect public health? It sits on the sidelines. We barely hear anything from DOH outside of telling us about the gruesome statistics.
It seems ironic, but it is the public that must support public health. The public must understand that undercutting health protections for political purposes has put them at risk. Our citizens should demand that our legislature reverse the gutting of DOH programs and provide DOH with political support, sufficient manpower, and funding. We should not let lobbyists in Tallahassee dictate public health policy as they continue to do.
What has happened to the Department of Health is an insult to our citizens and should be remembered in November. Voters need to send a strong message: Public Health, Safety and Welfare are the Overriding Goals of ALL Regulatory Agencies! We need emergency legislation to amend the Florida statutes and administrative codes, and give back to the Florida DOH its rightful jurisdictional power, allowing them to do the professional public health work they have the responsibility for.
While Florida’s governor has recently come out in favor of enforcement, there must be other initiatives. Alone, measures such as shutting down bars and pulling a few alcohol licenses do not address the long-term compliance and transmission problems we are surely facing.
The reluctance of businesses to enforce the required COVID 19 controls is now backfiring, and injured persons are filing lawsuits and seeking damages. The public’s disrespect for social distancing and face coverings is also backfiring, with the state of Florida now considered a nationwide COVID-19 transmission hot spot.
It is obviously in the best interest of everyone to comply with best practices. Education, the application of science, and enforcement, when necessary, will get us out of this dilemma- but we need to get on with it.
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