There’s an old saying about elected lawmakers that the more local they are, the more real impact they have on our day-to-day lives. The same can be said for public health officials, and their expertise has never been more important than during the coronavirus pandemic.
To be sure, public health officials have had it tough during the pandemic. They were the faces behind measures taken to mitigate the spread of the coronavirus. In some states and communities those measures included recommending the use of nonpharmaceutical interventions (NPIs) such as wearing a mask, practicing social distancing, limiting the size of gatherings and more.
Coronavirus mitigation became politicized; the public pushback has been fierce in some communities. Lawmakers and public health officials came under fire. Because of the stress caused by the backlash, more than 181 local public health leaders across the country quit their jobs last year, according to an Associated Press investigation. Still, a year into the pandemic, following and continuing to follow the guidance of federal, state, and local public health officials may be the most important lesson we all take away from this experience.
We are all part of the solution
“When we look back on this moment, I hope we can return to trusting public health officials and the science they rely on to make difficult decisions in their states and communities,” said Julie Crumly, Ph.D., MCHES, ORAU evaluation specialist and senior scientist. “They know best what’s happening on the ground in their communities. There is a lot of information and data to keep up with and situations change hour to hour. So they’re the ones that are best positioned to know what we need to be doing and how we need to change.”
Local public health departments are one of the cornerstones of emergency preparedness, said Freddy Gray, MPH, MCHES, ORAU director of public health and healthcare. In addition, every community has its own stakeholders, like faith-based organizations and businesses. Whoever the key stakeholders are, the foundation of relationships have been built long before a response is needed.
What happens, though, when the response is prolonged and cracks begin to show in that foundation? So-called “COVID fatigue” set in. The first cases of the coronavirus were diagnosed in January 2020 in the United States, and the first recommendations for the public (stay at home and safer at home orders, masking requirements, physical distancing) were put in place.
However, some people are still taking unnecessary travel, congregating in large groups with those outside of their households, and are not wearing face masks in public due to pandemic fatigue, politicization, and/or misinformation.
This disregard for science and public health recommendations led to the significant rise in the numbers of cases, hospitalizations and deaths that occurred during the holiday season and into the New Year.
“People are more inclined to listen to and follow their ‘social media neighborhood’ versus listening to the experts in the public health and health care fields who have the expertise and science to make accurate decisions and recommendations,” Gray said.
We still have to do all the things
In a pandemic, mitigation measures are critical to slowing viral spread but they work best with adherence, Crumly said.
“The ability to respond is directly proportionate to people’s willingness to follow recommendations. The healthcare infrastructure can only withstand so much demand. Following the recommendations helps prevent the breakdown of infrastructure and the utilization of crisis standards of care,” she said.
Crisis standards of care go into effect when patient demand outpaces a hospital’s ability to provide treatment, whether because of unavailable bed space, lack of staff or lack of equipment like ventilators. When operating under crisis standards of care, hospitals and health care systems have to make exceedingly difficult decisions about which patients to treat to avoid premature death and which patients receive comfort measures.
Hospitals in California, Arizona, Oklahoma, New York and elsewhere operated under crisis standards of care at various points during the pandemic because they were overwhelmed by COVID patients. That this happened at all leads back to failure to comply with mitigation measures.
“Failure to comply does not just impact that one person,” Crumly said. “It impacts the entire system. Collectively, one person’s choice to not wear a mask can quickly impact and overload the system.”
Crumly, Gray and all public health experts recognize that recommendations to slow viral spread have consequences at the community level. “A mitigation strategy is designed to reduce the spread,” Crumly said. “And the faster we can reduce the spread, the faster the economy may be able to recover.”
There’s a lesson there, too.
“I imagine that some businesses, especially grocery stores and big box home improvement stores to name a few, may have better realized just how much they are part of their community’s public health infrastructure and that they play a role in a public health emergency response, or at least are far more involved than they may have realized,” Crumly said.
Surveillance and vaccination
Surveillance is a primary strategy to prevent viral spread because surveillance tracks where and among whom the virus is spreading. That’s why we’ve heard so much about contact tracing. “Contact tracing is key to being able to, first of all, identify who has been exposed and then use that information to identify people whom that person might have come in contact with so you can isolate those people so they don’t spread the disease further,” said Rachel Vasconez, MBA, MPH, ORAU project manager for health communication and marketing.
By and large, contact tracing has been difficult in the United States. When the coronavirus became so widespread in late 2020, it was virtually impossible for contact tracers to keep up with the need. By the end of the year, local public health and health system officials were preparing for the rollout of the first vaccines available to fight to virus.
Similarly, there was a lag in getting shots into arms in the early weeks of the vaccine rollout. Just a few million vaccinations were administered by the end of 2020, far short of the 20 million that had been promised. Access to vaccines, staffing issues because of the surge in cases during the holiday season and funding needed to set up mass vaccination sites were all cited as issues.
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) hopes to change that. ORAU has been contracted to develop a response and recovery Rapid Assessment Framework to help the HHS OIG improve the speed of information delivery from the OIG to federal agencies. HHS leaders can use this information to implement recommendations for improvement in the current and future public health emergencies.
Crumly is working with colleagues from the University of Nebraska Medical Center to develop the Rapid Assessment Framework. “There are always lessons learned during and after every public health emergency, and there is always room for improvement,” Crumly said. “Oftentimes, though, the next public health emergency is upon us while we’re still learning from the last one. The hope is that this Rapid Assessment Framework will make change happen at a quicker pace.”
Where do we go from here?
The availability of two vaccines with more on the way is a light at the end of a dark tunnel, but experts predict it will be several months, probably Fall of 2021 or later, before enough people are vaccinated for life to truly go back to any form of “normal.”
At the same time, new, more infectious variants of the coronavirus have been discovered, which will continue to impact the health care system. Whether the new variants are impacted by the vaccines remains an open question. That means complying with mitigation measures—masking in public, physical distancing, reduced gathering sizes and handwashing—will continue to be necessary, Crumly said.
Adherence will be important until enough of the population has been vaccinated to reach herd immunity. In the meantime, Crumly hopes that work like her project with the HHS OIG and others will result in meaningful changes in our public health response system for the next public health emergency. “I hope we really figure out our lessons learned and make changes in our systems so that we don’t have to learn the same lessons all over again,” she said.
To hear more about lessons learned during the COVID-19 response, listen to the Further Together podcast.