Public health lessons learned from the coronavirus pandemic

Much went wrong during the coronavirus pandemic as the virus tore through a polarized nation and public health leaders, policy makers and elected officials struggled to respond.

Chronic underinvestment in public health at the federal, state and local levels has only made matters worse. In total, more than 1.1 million people have died of Covid-19 in the United States, and more than 1,000 still die each week.

More than three years after the Trump administration declared the virus a public health emergency in January 2020, the government’s response to the pandemic is now entering a new phase. On Thursday, the Biden administration will allow the declaration of a state of emergency to expire, giving it a moment to take stock of how the nation has responded to the worst public health crisis in a century.

Here are some lessons from the country’s fight against the virus.

Public health experts say when managing an infectious disease outbreak, communication is not part of the response. This Is answer.

The coronavirus pandemic has shown that misleading messages can worsen the spread of disease and undermine trust in public health institutions. But messaging during a pandemic is a tricky business. Science often changes, sometimes from day to day, and instructions from public health officials – mask or not? — also needs to change, which can cause confusion and distrust.

Experts say the key is for public health leaders to take listeners with them, explaining that the guidelines they give today may change tomorrow – and then admitting that what they said yesterday may have been wrong.

“When you talk to the public every day, you can explain those mistakes what you’ve learned from them,” said Dr. Richard E. Besser, former acting director of the Centers for Disease Control and Prevention during the Obama administration. “You can own them.”

The CDC has been paralyzed during the pandemic by outdated data systems and inconsistent data exchanges between the federal government, states and healthcare providers. And unlike the UK and Israel, which have national health systems, the US does not have a mechanism for the free flow of data between public health agencies and private providers.

Experts say responding to a rapidly mutating virus that poses different threats to different populations requires better and faster data.

“We were in the embarrassment of having to call the UK, Israel or South Africa to find out what was going on – how many people had been infected with this new infection, what was the variant of it,” said Dr. Anthony S. Fauci, who helped lead the response to the pandemic under both the Trump and Biden administrations. “How many people were vaccinated and what was the impact of this data? We literally had to wait months instead of getting it in real time.”

Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, cited school closures as an example where real-time data would help.

He said some variants of the coronavirus are deadlier to children than others, adding that if officials had access to up-to-date data on the impact of the virus on children, they might be able to adjust school closures to when students are most at risk.

“We need immediate data to know what’s going on,” said Dr. Osterholm, who advised President Biden’s transition team. “And when conditions change, we must change.”

School closures have been a particularly controversial topic, but many experts now agree that some schools have been closed for too long and that the sudden removal of millions of children from American classrooms has had a detrimental effect on their emotional and intellectual health.

Both Dr. Fauci and Dr. Ezekiel J. Emanuel, professor of medical ethics and health policy at the University of Pennsylvania, said the pandemic showed that officials should think carefully about school closures and keep them to a minimum. Both said better indoor air circulation could be one way to safely keep schools open.

“One of the things we’ve learned is that we’ve closed schools for much longer than other countries and we’ve had a terrible impact on academic performance and test scores have been dropping,” said Dr Emanuel, who also advised Mr Biden’s transition team.

Dr Fauci said that at the beginning of the pandemic, “at a time when hospitals were literally a day or two away from overflowing”, closing public places such as restaurants, bars and schools was important to keep health systems running by slowing the spread of the virus.

“But once you limit the acceleration,” he said, “you have to really check how we keep kids safe at school.”

In the early months of the pandemic, frontline healthcare workers faced dramatic supply shortages, forcing them to reuse face masks, wear ill-fitting PPE, or forego such equipment.

Since then, the federal government has significantly expanded its pandemic stockpile, giving it the upper hand in responding to the next devastating wave of the coronavirus or another viral outbreak that would require similar supplies.

Prior to the pandemic, government purchases of strategic national stocks were largely geared towards protection against bioterrorist agents such as anthrax. In March 2020, the stock consisted of 13 million N95 masks. Earlier this month, he had 352 million. In the same period, the number of ventilators increased from 12.7 thousand to 12.7 thousand. to about 150,000

As a model for responding to future pandemics, experts point to Operation Warp Speed, the Trump administration’s coronavirus vaccine development program. The initiative brought effective vaccines to the American people in record time — in part, Dr. Fauci said, because the federal government spent years investing in basic research.

Federal officials in the Warp Speed ​​program made massive bulk purchases of shots that were still in development. The federal government has funded or supported clinical trials by Moderna and Pfizer, manufacturers of two widely used coronavirus vaccines. And he lent his expertise to companies with clinical trial specialists, epidemiologists and budget experts.

Early treatments for the virus, such as hydroxychloroquine and convalescent plasma, were approved by the Food and Drug Administration without strong data from large randomized controlled trials – considered the gold standard of evidence used by regulators to remove drugs and vaccines.

Treatment trials have stalled due to lack of funding or participants. Scientists, doctors and federal regulators have relied on foreign data, such as the UK study of dexamethasone, a steroid used to treat Covid-19.

“The UK organized large randomized trials with very loose inclusion criteria, thousands of patients,” said Dr Emanuel. “Within 30 to 60 days, we learned that steroids actually saved people who were hospitalized or very sick.”

Dr. Walid F. Gellad, a drug safety expert at the University of Pittsburgh, highlighted a study currently being conducted by UK scientists that he said will soon provide results on the effectiveness of Paxlovid, Pfizer’s antiviral drug against Covid-19, which is widely used in the United States.

“We didn’t have the infrastructure to collect the data needed to make decisions,” he said of the US pandemic response.

Vaccines have proven to be the most effective bulwark against hospitalization and death from Covid-19. But attention to vaccination has often overshadowed efforts to develop and deliver treatments, public health experts say. Antibody drugs critical to immunocompromised Americans are no longer FDA approved, and experts say more antiviral drugs are needed.

The Biden administration has focused heavily on deploying booster shots, which have seen fewer and fewer people since allowing the first round in fall 2021. But other strategies to prevent the spread of the virus, such as improving indoor air quality, have received relatively modest attention.

“Short-sighted focus on the vaccines themselves to the exclusion of other areas that are really low-hanging fruit for a much better response – it’s like saying you’re going to build a house with one wall or no roof,” said Dr. Luciana Borio, former acting chief a scientist at the FDA who advised Biden’s transition team.

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