Public Health Lessons Learned From the Coronavirus Pandemic

In the coronavirus pandemic, much has gone wrong as the virus tears apart a polarized nation and public health leaders, policy makers and elected officials struggle to cope.

Chronic underinvestment in public health at the federal, state and local levels has only exacerbated the situation. In total, more than 1.1 million people in the United States have died from COVID-19, 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 pandemic response is entering a new phase. The Biden administration will allow the state of emergency to expire on Thursday, giving it time to consider how the country has responded to the worst public health crisis in 100 years.

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

Public health experts say communication is not part of the response when managing infectious disease outbreaks.that teeth response.

The COVID-19 pandemic has shown that confusing messages can exacerbate the spread of the disease and undermine confidence in public health agencies. But messaging during a pandemic is a tough business. Science changes frequently, sometimes daily. Directions from public health officials to wear masks or not? — must also change, which can lead to confusion and lack of trust.

The key, according to experts, is for public health leaders to explain that the guidance they are giving today could change tomorrow, and then what they said yesterday may have been wrong. By acknowledging that it is not, it is said that it is to bring the audience along.

“When you have a regular conversation with the public, you can describe those mistakes and what you learned from them,” says Richard E., former acting director of the Centers for Disease Control and Prevention during the war. Dr Besser said. Obama administration. “You can own them.”

The CDC was crippled during the pandemic by outdated data systems and inconsistent data sharing among federal, state, and health care providers. And unlike the United Kingdom and Israel, which have national health systems, the United States does not have mechanisms for the free flow of data between public health agencies and private healthcare providers.

Experts said better and faster data are needed to address a rapidly mutating virus that poses different risks to different populations.

“We are embarrassed to have to call the UK and Israel or South Africa to find out what is going on, how many people are infected with this new infection and what its variants are. I was in a position,” said Dr. Anthony S. Fauci. He helped lead the pandemic response in both the Trump and Biden administrations. “How many people were vaccinated and what impact did the data have? Instead of getting it in real time, we literally had to wait months.”

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

Some coronavirus variants are more lethal to children than others, he said, and if authorities had access to timely data on the virus’ impact on children, students could He added that school closures could have been coordinated at a time of greatest risk.

Dr. Osterholm, who advised President Biden’s transition team, said, “We need instantaneous data to know what’s going on.” “And as things change, so must we.”

School closures are a particularly controversial topic, but many experts now have mixed feelings about how some schools have been closed for too long and the sudden exclusion of millions of children from America’s classrooms. agree that it is having a negative impact on their physical and intellectual health.

Dr. Fauci and Ezekiel J. Emanuel, Ph.D., professor of medical ethics and health policy at the University of Pennsylvania, said the pandemic has shown that authorities should consider school closures carefully and limit them as much as possible. They said improving indoor air circulation could be one way to keep schools open safely.

“One of the things we’ve learned is that schools are closing for much longer than other countries, which is having a devastating impact on educational attainment and lowering test scores,” said Dr Emmanuel. advised. Biden’s transition team.

In the early days of the pandemic, “when hospitals literally fill up in a day or two,” Dr. Fauci said, closing public places like restaurants, bars and schools could slow the spread of the disease and keep the health system running. said it was important to keep going. virus.

“But once the acceleration is slowed, we need to seriously consider how to get children to school safely,” he said.

In the early months of the pandemic, frontline health workers faced dramatic shortages, reusing masks, wearing ill-fitting personal protective equipment, or not wearing such equipment at all. I was forced to wear it.

The federal government has since significantly expanded its stockpile of pandemic supplies to give it a head start in responding to another devastating wave of coronavirus or another virus outbreak that requires similar resources. made it

Prior to the pandemic, government purchases of the National Strategic Stockpile focused on protection against bioterrorism agents such as anthrax. As of March 2020, 13 million N95 masks were stockpiled. Earlier this month, it had 352 million. During the same period, the number of ventilators he had increased from 12,700 to about 150,000.

Experts point to Operation Warpspeed, the Trump administration’s coronavirus vaccine development program, as a model for future pandemic response. The effort brought an effective vaccine to the American public in record time, partly because the federal government has spent years doing basic science research, Fauci said. .

Federal officials who participated in the Warp Speed ​​Program have purchased large quantities of shots in development. The federal government has funded or supported clinical trials conducted by Moderna and Pfizer, manufacturers of two widely used coronavirus vaccines. We have provided our expertise to companies with clinical trial experts, epidemiologists and budget experts.

Initial viral treatments such as hydroxychloroquine and convalescent plasma are considered the gold standard of evidence used by regulators to license drugs and vaccines. No strong data from large randomized controlled trials. approved by the Food and Drug Administration.

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

“The UK has set up a large randomized trial with very loose entry criteria involving thousands of patients,” said Dr Emmanuel. “Within 30 to 60 days, we found that steroids were actually helping people who were hospitalized and seriously ill.”

Dr. Walid F. Gerard, a drug safety expert at the University of Pittsburgh, noted: current trial The study, conducted by British researchers, will soon yield results on the efficacy of Pfizer’s antiviral drug Paxlovid, which is widely used in the United States, against COVID-19, he said.

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

Vaccines have proven to be the most effective bulwark in preventing hospitalizations and deaths from COVID-19. But public health experts say the focus on vaccination has often overshadowed efforts to develop and deliver treatments. Antibody drugs important to immunocompromised Americans are no longer cleared by the FDA, and experts say more antiviral drugs are needed.

The Biden administration has focused on introducing boosters, which have seen a steady decline since the first round was authorized in the fall of 2021. But other strategies aimed at preventing the spread of the virus, such as improving indoor air quality, are also being evaluated. A relatively modest note.

“Myopic focus on vaccines alone and excluding other areas that can be very easily achieved to achieve a much better response is like building a house with one wall or no roof. It’s like there is,” Dr. Luciana said. Borio is a former acting FDA principal investigator who advised Biden’s transition team.

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