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Several bills proposing changes to how local public health officials do their jobs are being considered by the Montana legislature. The proposed changes appear to have been motivated by responses to COVID-19. This focus on a single infectious disease is potentially shortsighted.

For one thing, public health officials deal with more than infectious diseases. Substance abuse, sewage and waste disposal and mental health take up a large part of their time. It is not clear how the proposed bills will impact work and decision-making on those issues.

Secondly, the main characteristic shared by the large group of infectious diseases is that they are infectious. They differ widely in other important ways including transmissibility, mortality and morbidity rates, and in the vulnerability of different demographic groups. Focusing on one disease can lead to restrictions on the authority of public health officials that are not appropriate for other diseases.

For example, COVID-19 has a high case fatality rate for the elderly but is seemingly a minor illness for 20-year-olds; seemingly because the jury is still out on the long term effects of this illness. But the discussion on the ability of public health officials to isolate and quarantine should consider the possibility the next infectious disease will be relatively innocuous for the elderly but highly lethal for teenagers or 20-somethings. Something similar to that actually happened a little over a hundred years ago with the 1918 Influenza Pandemic.

The elected officials pushing these bills should step back, take a deep breath, and make sure they get this right. It should be possible to address concerns about the authority of public health officials while leaving them with the tools, and the flexibility to use those tools to protect the public during infectious disease outbreaks.

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Steve Cherry