The government plays an outsized role in protecting our public health. A little more than half of the employees at the Department of Health and Human Services -- 41,203 out of 82,148 -- would be furloughed, according to the department's 2017 contingency plan.
That means entire projects will stop and whole safety programs could go on hiatus.
If the shutdown happens, workers considered "nonessential" stop working until Congress can agree on a federal budget bill. At its peak of the 2013 government shutdown, about 850,000 employees were furloughed per day, according to the Office of Management and Budget.
Social Security checks will still go out and food stamps are still funded, but other public health work cannot go on as planned.
1. Flu fighters may be furloughed
Emergency rooms across the country are filling up with flu cases -- doctors say it's one of the worst flu seasons in recent years -- but despite the demand, the flu fighters who monitor the outbreak and help with testing at the US Centers for Disease Control and Prevention might not stay on the job.
"The 2013 shutdown gives us a good window into what could happen this time, and if we are not careful, something could happen because things are not being well surveyed," said Dr. Irwin Redlener
, director of Columbia University's National Center for Disaster Preparedness.
Managers help decide who is essential or not and during the 2013 shutdown, the CDC had to furlough 68% of its staff in the United States and around the world. This time, the plan is to furlough 61% of the staff.
However, the CDC's immediate response to urgent disease outbreaks, including seasonal influenza, would continue, the agency said Friday. It said the Department of Health and Human Services "would use the full extent of the authority under the ADA (Americans with Disabilities Act) to protect life and property under a lapse in appropriations."
The CDC said it would continue collecting data reported by states and hospitals and report "critical information" needed for authorities to track and treat the flu.
In the 2013 shutdown, public health surveillance work was left undone, and the flu surveillance program that helps people get flu shots and tracks cases shut down, making it hard to keep the country safe from the flu, according to a study in the Journal of Science Policy and Governance
. That meant scientists were making public health decisions based on "luck," rather than actual information like the gold-standard CDC data the agency usually collects, former CDC director Dr. David Satcher wrote at the time. Programs that monitored hepatitis and tuberculosis cases that crossed state lines stopped, too.
2. Food safety concerns
If CDC workers are sent home that also means they are no longer going to be able to help state and local agencies track any other unusual outbreak, including problems that might impact the nation's food supply. The Food and Drug Administration will also have to cancel routine health and safety inspections that ensure food is kept and processed in sanitary conditions and reduce the number of problems with foodborne illness. During the 2013 shutdown, the FDA delayed nearly 500 food and feed domestic inspections and about 355 additional food and safety inspections under state contract.
This isn't a theoretical problem. A week into the 2013 shutdown, there was an outbreak of drug-resistant salmonella
in raw chicken products. PulseNet
, which monitors clusters of foodborne diseases, was down to a skeleton crew. It was so slim and there was so much work that the CDC had to call in 30 furloughed workers. Dr. Thomas Frieden, then the director of the CDC, said at the time
that it was "an imminent threat to health and safety."
3. Drug discovery
Patients hoping for lifesaving drugs may have to wait longer to get help. A government furlough means hundreds of patients will not be allowed to enroll in vital clinical trials conducted through the National Institutes of Health.
In general, a lot of important scientific work stops during a furlough. Four of the five Nobel prize-winning scientists who work for the federal government were furloughed during the 2013 government shutdown, according to an analysis from the OMB.
Last time, 98% of the National Science Foundation (NSF) staff, and nearly three-quarters of NIH workers, were furloughed. The plan this time would send 77% of NIH workers home. And despite the opioid epidemic, 90% of Substance Abuse and Mental Health Services Administration workers would go home, too, according to the government's shutdown plan.
The shutdown could also delay FDA approval of new drugs, medical products and devices. About 55% of FDA staff would keep working, but it could mean whole blood and blood components for transfusions go unreviewed. And if you have a general question about food safety or vaccines, medical devices or blood products, you'll have to wait as the people who answer those questions at the FDA also will be told to stay home.
4. Vets must wait longer for help
Veterans hoping to get disability help will have to wait longer. The backlog of veteran disability claims piled up during the 2013 shutdown, according to the OMB. That meant vulnerable people who fought in this country's wars and who needed help to pay their rent or put food on the table had to wait even longer than usual for the help.
The services that help veterans understand their benefits also stop. That means hotlines and education centers go dark. Counseling services go away. Services that help soldiers transition to civilian life stop.
5. Your environment and devices
The EPA's non-emergency inspections could also stop. During the 2013 shutdown, inspections at about 1,200 drinking water systems, chemical facilities and hazardous waste sites were put on hold. The agency that looks at the health impact of new industrial chemicals shut down. Pesticide reviews were halted.
The Consumer Product Safety Commission, which recalls products that are unsafe, is allowed to finish its work only on products that are considered an imminent threat. That means the routine screening of products like children's toys could stop.
During the 2013 shutdown, the National Highway Traffic Safety Administration announced there would be no recalls or evaluations of safety complaints. That meant inspectors were not sent when the battery in a Tesla Model S caught fire
and subsequently other fires were reported in the same model car.
Routine inspections from the Occupational Safety and Health Administration
, which help keep us safe at work, could also stop. During a shutdown, OSHA is allowed to respond only to workplace catastrophes, fatalities and situations that create an imminent danger, the government shutdown plan says. In 2013, OSHA was never fully able to catch up with the backlog of inspections that piled up, a study showed.
The Chemical Safety Board investigators were sent home at the time, delaying an inspection of a fertilizer plant explosion in the Texas town of West.
"The thing that is particularly frustrating is that the reasons for this shutdown are so blatantly political," said Redlener. "We cannot understand why lawmakers are putting politics ahead of the health and well-being of this country. It doesn't make any sense."