"(America will need) a new army to hunt down the coronavirus."

This paragraph hints at the fundamental problem.

The erosion of the public-health workforce has taken place even as the U.S. health-industry workforce swells. In addition to medical staff doing heroic work right now, untold numbers of workers spend their days adjudicating zero-sum disputes over medical bills that add complexity and cost without healing anyone. One analysis found 10 administrative workers for every physician.

Why do we tolerate a system that doesn't work for us?

The following appeared on Friday at Bloomberg's Bloomberg Prognosis, a daily coronavirus newsletter.

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Without a trace

As the U.S. begins to consider how to lift measures to slow the spread of Covid-19, it’s going to need a new army to hunt down the coronavirus.

As many as 100,000 contact tracers will be needed to track down people exposed to the virus and prevent them from spreading it, according to a new estimate this week from the Johns Hopkins Center for Health Security.

How big a lift is that? Across the U.S., about 130,000 people work for local health departments full-time, according to the National Association of County and City Health Officials. About 91,000 more work in state health agencies, down 15% in the past decade as a consequence of government belt-tightening.

“Clearly over time that capacity has eroded,” John Wiesman, Washington State Secretary of Health, said on a call with reporters Wednesday.

Public-health departments will have to train thousands of people to do the rigorous work of retracing the steps of coronavirus patients, reaching out to others they may have encountered, and ensuring they can safely isolate to interrupt chains of transmission. Students of medicine and public health may be good candidates, along with retired medical staff or others who simply need jobs – as millions do now.

The erosion of the public-health workforce has taken place even as the U.S. health-industry workforce swells. In addition to medical staff doing heroic work right now, untold numbers of workers spend their days adjudicating zero-sum disputes over medical bills that add complexity and cost without healing anyone. One analysis found 10 administrative workers for every physician.

It’s a cliché to say the U.S. doesn’t have a health-care system, it has a sick-care system. Covid-19 has exposed some of the risks of skimping on prevention and public health, even as we spare few expenses on costly treatments. The core operations of local health departments can keep cases from becoming clusters, and keep clusters from exploding into uncontrolled spread.

In one sense, they constitute the country’s immune system. That was weakened when coronavirus arrived in the U.S. As the virus runs its course, can the system’s strength be renewed?—John Tozzi