The United States versus Other G-7 Nations: COVID-19 Preparedness and Emergency Relief Legislation

Overview

The year before the coronavirus (COVID-19) pandemic hit, the Global Health Security Index ranked the United States first in pandemic preparedness. However, 1.01 million American deaths later, it is crucial to reflect upon the actions of other countries in considering what could have gone differently in the United States. This brief will compare how the United States implemented medical leave policies, addressed hospital capacity issues, and dealt with medical supply/device shortages during the course of the pandemic, with the approaches of other countries. 

Medical Supply and Device Shortage

When an outbreak of a novel pathogen occurs, the United States federal government utilizes two tools to ensure states have the needed medical supplies and equipment: 

• The Strategic National Stockpile, which keeps medical supplies, equipment, medicines, and devices on hand to distribute amongst states during public health emergencies
• Invoke the Defense Production Act, which encourages and obliges private companies to mass produce any products that are in high demand. 

During the first two months of the pandemic, the Trump administration did not use these resources immediately, and opted to pass responsibility for medical supplies on to states. Competition for medical supplies in global markets became intense, and the Federal Emergency Management Agency (FEMA) started confiscating the personal protective equipment (PPE) that states had ordered. The prices of N95 and surgical masks soared because of global export restrictions. Furthermore, the Strategic National Stockpile was not fully equipped after being depleted by the 2009 H1N1 influenza pandemic. By March, the Defense Production Act was put into effect, two months after the first case of COVID-19 was discovered in the United States. 

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), passed in March 2020, took several steps in an attempt to address the issues with the Strategic National Stockpile and supply/device shortages, including: 

• Amending the Public Health Service Act so the stockpile was required to include PPE, ancillary medical supplies, and supplies needed for drug administration, vaccines, other biological products, medical devices, and diagnostic tests
• Raising reporting requirements for manufacturers to prevent drug shortages 
• Having the Secretary of Health and Human Services develop a publicly available and updated list of medical devices in shortage
• Having the Secretary of Health and Human Services and the National Academies of Sciences, Engineering, and Medicine work jointly to analyze the impacts of increasing domestic production and the levels of international dependence within the United States’s medical supply product chain

In December 2020, an additional $3 billion dollars was allocated to improving the Strategic National Stockpile by The Coronavirus Response and Relief Supplemental Appropriations Act. 

The Biden administration passed the American Rescue Plan, which invested $30 billion into the Disaster Relief Fund to purchase medical supplies/PPE and provided reimbursement to states, local governments, and Tribes for critical emergency response resources (such as the deployment of the National Guard). Another $10 billion was set aside for the expansion of domestic manufacturing of pandemic supplies. 

France reacted similarly in delegating the storage of PPE to individual healthcare facilities and self-employed physicians, and this strategy also caused chaos, but for different reasons. Overall, France faced difficulty when passing responsibility down from the national Ministry of Health to Regional Health Agencies (ARS) and local healthcare institutions. Due to mixed messaging from the government regarding mask necessity, masks were not readily available to the general population until July 2020. Contrary to the United States, France prioritized reducing mask stocks after the H1N1 pandemic hit, as they were criticized for their abundance of mask supply because it was seen as an overreaction to the severity of the outbreak. By early 2020, approximately 600 million masks were supposed to be destroyed and replaced per the French Public Health Agency and the Ministry of Health’s recommendation, as many of the stocks were found to be expired (but not ALL of them were expired). This inadvertently affected healthcare workers outside of hospitals the most, and it was weeks before they had an adequate supply of masks. 

Hospital Capacity

The United States did not have enough ICU and acute care beds to meet the demands of the pandemic. Even after the cancellation of elective procedures, in January 2021,  ⅕ of hospitals were still at 95% capacity in the Intensive Care Unit (ICU). Makeshift acute care units were set up in other hospital wards and spaces including lobbies and parking lots. Healthcare professionals were in high demand, and affluent hospitals retained more employees because they had the resources to pay them more, leaving rural and under-resourced hospitals short-handed. In response to such issues, the CARES act secured a portion of $150 billion for increased hospital capacity, and expanded telehealth services. The Coronavirus Response and Relief Supplemental Appropriations Act allocated funds to increase support for healthcare providers. 

Canada’s federal government compiled a list of suggested actions for regional and local healthcare authorities. Recommendations included training medical personnel in other departments to work in ICUs so that all ventilators and beds could be adequately monitored, and advance planning for transporting patients to other facilities in the event of hospitals reaching their maximum capacity. They too rescheduled non-urgent surgeries, relied on telehealth services, and decreased emergency visits by half through establishing off-site screening facilities. The early implementation of this plan contributed to Canada’s lower hospitalization and death rates than in the United States or the European Union during the first wave of the pandemic from January to April 2020. 

Medical Leave

The Families First Coronavirus Response Act (FFCRA) was passed by Congress in March 2020 and stayed in effect until December 2020. It guaranteed that:

• Full-time employees would receive up to two weeks of paid medical leave at their full salary rate if they were unable to work due to being quarantined and/or were symptomatic and getting tested for coronavirus 
• Full-time employees would receive up to two weeks of paid medical leave at ⅔ of their full salary rate if they had to care for someone quarantining or a child under the age of 18 that could not attend school or daycare due to closures attributed to COVID-19
  • Applicable to public employers and private employers with fewer than 500 employees
  • Excluded federal employees from the expanded family and medical leave provisions but left the paid sick leave provision covered under Title II of the Family and Medical Leave Act
  • Part-time employees would be covered for the average number of hours they work over a two-week period
  • Under the same provisions listed for childcare, employees could receive up to an additional ten weeks of paid leave at the same rate so long as they have been employed for 30 calendar days
    • Employers with less than 50 employees could qualify for exemption from these provisions if compliance would put their business at stake

The American Rescue Plan extended some of the benefits of the FFCRA until September 2021. This bill:

• Renewed the paid medical leave requirements and removed the exemptions for private employers with more than 500 employees and less than 50 employees
  • Made 106 million more workers eligible for paid medical leave
• Allowed employees to receive up to an additional twelve weeks of paid leave versus 10 weeks, under the same provisions listed for childcare, employees could 
• Gave all federal employees the same benefits as other full-time employees
• Guaranteed that eligible workers earning up to $73,000 annually would receive a maximum paid-leave benefit of $1,400 per week
• Provided employers with less than 500 employees the right to use refundable tax credit in order to be reimbursed for covering medical leave
• Paid medical leave reimbursement costs for state and local governments 

Germany used paid medical leave to incentivize its population to get vaccinated (a higher percentage of Germans are vaccinated than Americans). The most recent policies for paid medical leave are as follows:

• In order to qualify for up to six weeks of paid medical leave (employers are reimbursed for these costs by state governments), you must be:
  • Fully vaccinated and boosted
  • Symptomatic 
• If you meet the above criteria and need more than six weeks of paid medical leave, once the seventh week commences, you will receive a sickness benefit that is less than your salary from your health insurer instead (as long as you can provide a sick note from your doctor)
• One could apply for up to 30 days of child sickness benefits through their health insurance that would amount to 90% of their net income (with more days allotted to single parents and families with several children) if they:
  • Can provide documentation to their health insurer that confirms their child’s school or daycare facility is closed
  • Have public health insurance or are civil servants