Assessing the Path Forward in the Pandemic’s Third Year

Two years ago this week, the World Health Organization declared COVID-19 a pandemic, and cities all over the world started shuttering their doors to slow the spread. On this inauspicious anniversary, we find ourselves in an uncertain state: mask mandates are lifting across the country, and though hospitalizations and deaths are also on the decline, they are still considerable. While our overall vaccination numbers continue to increase, there are still significant gaps in some corners of our country, and too many Americans remain at undue risk, including the youngest among us. As we approach a staggering 1 million American deaths (more than 6 million worldwide) from COVID-19—a shocking number that we all struggle to fully comprehend—we need to continue to vaccinate our fellow Americans and the world at large.

As we emerge from the most difficult years of the pandemic, we need to ask ourselves a series of questions. What is our best path forward? How can we best recover in ways that are as equitable as possible? What can we learn from this experience that can improve the public’s health and the system that supports it?

Making decisions to protect and promote the public’s health requires timely, accurate data—and the experts to interpret it.

For the past two years, the headlines have been filled with the grim heroics of our frontline health care workers treating the sick and dying. Their exhaustion and sacrifice are real.

But all too often, we only see the stories about caring for individuals who become ill. An equally important story highlights how dedicated public health workers across the country care for communities. Increasing neighborhood vaccination rates, where dangerously low, decreasing transmission, where dangerously high, are as immediate a need as an individual struggling to breathe. We need to get to a place where more people understand this and honor the important role of public health in protecting our communities.

Epidemiologists are critical players in this frontline public health work. These experts study data patterns—not just for infectious disease but also for chronic issues like drug overdoses and type 2 diabetes. Epidemiologists tell us where the hot spots are, why some communities are harder hit than others, and what solutions would make the greatest impact. Epidemiologists are like disease detectives, using techniques to trace the roots of our most critical health challenges.

For example, one of our members, the Houston Health Department, has been tracking the virus that causes COVID-19 in the city’s wastewater and six months ago created a public dashboard for this data. “This new dashboard is another tool Houstonians can use to gauge the situation and make informed decisions to protect their families,” said Dr. Loren Hopkins, chief environmental science officer for the health department and professor in the practice of statistics at Rice University. “A high level of virus in your neighborhood’s wastewater means virus is spreading locally and you should be even more stringent about masking up when visiting public places.”

Right now, we are woefully short-staffed in public health departments, but this was also the case before COVID. Our latest report with the Council of State and Territorial Epidemiologists (CSTE) shows that big city health departments desperately need more epidemiologists, a shortfall that puts the nation’s efforts to combat current and future pandemics at risk. To reach full capacity, BCHC departments reported they would need to increase the number of epidemiologists by nearly half (an increase of 47%).

This ties into a related lesson from the pandemic: that channeling resources into public health has a high return on investment.

Prevention is cheaper than care.

The United States spends more on health care than any other wealthy country and has some of the worst health outcomes. Why? One major factor is that the U.S. spends most of its health care dollars on treatment, while other wealthy countries spend a higher proportion on prevention.

Public health approaches our well-being from a comprehensive, prevention-oriented perspective. This means putting policies in place so that everyone has the tools they need to thrive: affordable housing, clean water, accessible public transportation, green spaces, healthy food, and more.

Consider Philadelphia, where 1,600 residents were dying each year as a result of poor diet and physical inactivity, and obesity added $750 million each year to health care costs in the city. Far more effective than intervening in individuals’ choices, the public health approach provides community-level, policy-based solutions. Through the Get Healthy Philly program—funded with just $20 million in grants—city health officials launched a wide range of health-promoting environmental changes, including 13 new farmers’ markets in low-income communities, nearly 20 miles of new bike lanes, and interventions to improve offerings in convenience stores, take out restaurants, and school cafeterias.

The positive results that Philadelphia and other cities are seeing from investing in public health leads us to a final point—that the struggle for health doesn’t end when the COVID numbers drop.

As the pandemic (hopefully) wanes, we need to return our attention to our ongoing epidemics.

COVID-19 is the most acute, but certainly not the only, critical health challenge our country faces. If anything, the pandemic experience has worsened many of our ongoing epidemics: gun violence is on a precipitous trajectory, our collective mental health has worsened, and our drug overdose and death rates have spiked.

These challenges do not disappear as the COVID hospitalization and death numbers fall. We must re-commit to creating the conditions through which people can live safer, healthier, better, fuller lives—and that means ongoing investments in the public health system and the people who work in it.

Through a policy lens, the Biden Administration’s recent, albeit tenuous, commitment to harm reduction strategies is one step in the right direction. Making fentanyl testing strips, naloxone, and buprenorphine more widely available, and expanding use of overdose prevention sites, not only saves lives but also reframes substance misuse as a public health rather than a criminal justice issue.

As we move forward into our third year, recognizing we are still living with COVID-19, we will continue to push our elected leaders and the voting public to keep the lessons of the pandemic front-and-center. We are coming to realize that this moment is one we cannot forget or simply push aside. Our nation’s health moving forward depends on not just getting back to normal, but greatly improving that normal state of being for so many Americans.