Dr. Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security, responded to reader questions about coordinating response efforts and protecting the vulnerable.
Since public health is mostly funded and carried out by the states, how do we improve preparedness across America and how do we educate people about the importance of having a coordinated common response? — Rich Scott, Sunnyvale, Calif.

Caitlin Rivers: I’m glad you asked, because this is a topic that I’m passionate about in my work at Johns Hopkins. Many people do not realize that the U.S. public health system is federated. Most legal authorities and budgetary controls reside at the state, and sometimes county, levels. The Centers for Disease Control and Prevention and public health associations like the Council of State and Territorial Epidemiologists provide technical support and coordination when needed. This system is flexible enough to tailor outbreak responses to the needs of local communities, which is helpful, but performance from one jurisdiction to the next can be uneven. I would like to see more standards, common operating procedures and other process improvement measures for outbreak response. There should be an engine of progress to ensure we are constantly evolving and improving.
America has always failed to protect the most vulnerable Americans (people with disabilities, the elderly, people with chronic conditions). What can be done to protect vulnerable folks going forward? What sensible steps can we take to ensure the health and safety of those who live in large nursing homes and care facilities in particular? — Ann E. Green, Bala Cynwyd, Pa.

Rivers: It’s such an important question. I hope that the pandemic has expanded awareness that older adults and people with medical conditions are more vulnerable to severe illness — not only from Covid-19 but other common infections as well.
I have a few ideas: First, certain health care facilities (like those that treat people with immunocompromising conditions) should continue to require masks. Facilities should also ensure adequate indoor air quality with proper ventilation and filtration. In nursing homes and long-term-care facilities, more stringent staffing and training standards should be implemented to better protect residents. Finally, disease outbreaks in long-term-care facilities should continue to be reportable to public health authorities. That was a pandemic-era policy that should become permanent.

Individuals can take steps to help protect people who are vulnerable, too. Stay home if you feel unwell, and I recommend wearing a mask while in public if you have been exposed to someone who is sick. Also, be respectful of people’s preferences — nobody should be made to feel uncomfortable for wearing a mask in public.