By RICHARD SKOLNIK
Los Alamos

As I have done before, I would give Los Alamos County significant credit for its work in providing access to adult vaccines and to COVID testing.

However, about 30 months into the pandemic, Los Alamos County is about to sponsor its first open forum on COVID. This follows more than two years in which the County did not implement wastewater monitoring, produce a regular newsletter on COVID, or add technical expertise to its COVID team. 

I believe there are four reasons why our County has failed to act on important aspects of COVID in a pro-active, timely, coherent, and technically sound manner.

These are noted below:

• First, the County has never had a strategy for addressing COVID. I don’t believe that anyone in the County Council or County staff could outline for the public tomorrow anything resembling a strategic approach for County efforts on COVID.
• Second, the County lacks a strategy at least partly because it has failed to understand or answer the fundamental question about its role in addressing COVID: “In a state with a unified health system, what efforts must be carried out locally to help address the most important pandemic in modern times?” 
• Third, the County has almost no public health expertise. There is a local Health Council with considerable expertise, but the County has chosen not to seek its help. There are also other people in the community with expertise in public health matters, but the County has also chosen not to seek their help in any coherent manner. 
• Fourth, as a result of the above, the County’s approach to COVID beyond making adult vaccines and testing available has been almost entirely reactive. The pandemic began in early 2020. Yet, the County recently initiated wastewater monitoring in earnest – only after a group of concerned citizens wrote to the County Council Chair on this. The County began a newsletter this year – only after public pressure to do so. The County hired an epidemiologist this year – only after concerned citizens repeatedly advocated for adding such expertise to its team and drafted terms of reference for such a position. 

It is, of course, impossible to make definitive statements about how COVID would have evolved in Los Alamos if the County had: 

• Articulated an evolving strategic plan for dealing with COVID from the inception of the pandemic
• Recruited at the beginning of the outbreak a technically competent person to lead and coordinate the County’s response to COVID, including tracking the outbreak, informing the County Council and staff of key issues as they arose, and suggesting actions to address them
• Created a COVID stakeholder group from, for example, the medical community, the Health Council, LANL, the LAPS, the Chamber of Commerce, and local houses of worship to further advise the County Council and staff on approaches to the outbreak and how they could best be implemented in Los Alamos
• Kept the community regularly informed from the beginning of the outbreak about the state of the pandemic in Los Alamos and measures to help keep the community as safe as possible

All of the above are what we call “essential public health functions” but which New Mexico’s unified health system has shown it cannot play locally. Had the above been done from the inception of the pandemic in Los Alamos, I believe we would have had a more unified approach to COVID locally, with fewer infections and lower educational, social, and economic costs to the community. We might also now have better access to the COVID treatment that has been hard to get in Los Alamos.

Sadly, COVID is not likely to go away. The County’s continuing on the same path it has been on since the pandemic started will not be helpful. Thus, I summarize for the County one more time above, in the simplest possible terms, what is still missing in the County’s approach to COVID. I hope others who agree with me will also strongly encourage the County to act as noted and hold the County accountable for its action or inaction. 

Editor’s note: Richard Skolnik is the former Director for Health for South Asia at the World Bank. He was the Executive Director of a Harvard AIDS treatment program for three countries in Africa and taught global health at The George Washington University and Yale, at which he holds a Lecturer’s appointment. Skolnik is also the author of the widely-used Global Health 101, Fourth Edition and Global Population Health: A Primer and the instructor for the Yale/Coursera course Essentials of Global Health.