I was fortunate enough to take a trip to Barcelona earlier this year with my family and, as usual for me, I took along what I expected to be a lighthearted fictional book to give my brain a break. The book I chose is called “Romantic Comedy” by Curtis Sittenfeld. It was, in fact, mostly a romantic comedy, but what struck me was that it took place over the course of the COVID-19 pandemic, with the main characters getting to know each other from afar. Unexpectedly, my mind went back to those days and the uncertainty and fears that we all experienced.
I recall my first trip to the grocery store in March 2020. I made a mask out of some fabric I had in the house and two hairbands. No one else in the store was wearing masks, and several people were coughing. I left literally shaking with fear and swore I would not go back unless it was absolutely necessary.
ACP's recent policy paper, “Preparing for Future Pandemics and Public Health Emergencies,” which was published July 25 by Annals of Internal Medicine, also reflects on insufficient leadership, planning, and execution in several aspects of the pandemic response. This includes the significant confusion around appropriate mask usage and social distancing, such as I experienced in the grocery store. This new paper also reflects on such issues as inconsistent federal funding to state and local public health agencies; an overwhelmed health care system; the failure of the U.S. to implement a widespread testing and tracing system; the lack of CDC authority to mandate case reporting; racial and ethnic disparities in COVID-19 case and death rates; and lack of clarity over the purpose of the Strategic National Stockpile.
The probability of us experiencing another major pandemic in our lifetime is about 38%, with an expected recurrence time of about 59 years, according to an article published in the Proceedings of the National Academy of Sciences in August 2021. This is due in large part to increasing globalization and climate change. Therefore, as ACP's new paper outlines, we all have a responsibility to reflect on our experiences with COVID-19 to identify both the good and the bad, assess the current state of pandemic preparedness, and implement a comprehensive plan.
So, what are some of the good things we experienced? Probably the most obvious was the rapid development of COVID-19 vaccines via Operation Warp Speed. It is simply remarkable that in one year, these vaccines were developed, tested, distributed, and administered, faster than any vaccine in history. I recall the moment I was able to register myself and my family members to receive the vaccine. We were out to dinner—eating outside, of course—when the text from the Maryland Department of Public Health came though. Normally, we do not allow phones to be used at dinner, but this was an exception as we immediately clicked the link to get our vaccinations scheduled. I also remember getting the vaccine with my kids, who were over 16 at the time, waiting in our car in line at Six Flags for hours. It was such a relief to finally feel like we were heading to the other side of this terrible event.
I had tested positive for COVID-19 just a couple of months prior to that, thankfully the only time I have had it so far. I was terrified not only of the immediate effects but also of the potential long-term impact, which we had just started to hear about. This leads me to one of the other positive outcomes of the pandemic: increased access to telehealth services. While there was no treatment or vaccine available to me at that time, I was deeply grateful that I could have a visit and follow-ups with my internal medicine physician. It was also reassuring to be able to schedule telehealth visits for my kids when needed and not have to bring them into the office. Given the benefits of virtual visits, ACP is pushing to continue appropriate payment for them into the future.
ACP's paper on pandemic preparedness makes a number of important recommendations to start transitioning these reflections into meaningful plans, including:
- Calling on the federal government to develop and maintain a comprehensive, unified federal pandemic preparedness and response plan that is evidence-based and informed by appropriately qualified professionals,
- Stressing the need to prioritize health equity when creating and implementing such a plan,
- Providing consistent, timely communication regarding risk and evidence-based strategies to combat a pandemic,
- Noting the importance of congressional funding for a modern national public health data infrastructure,
- Exploring measures to secure and bolster the health care supply chain,
- Supporting sufficient first-responder capacity and training,
- Developing and maintaining a reserve of physicians and other health care and public health professionals to ensure an effective health care response during a pandemic,
- Putting measures in place to reduce infection in the workplace, including federal mandates for workplace protections,
- Ensuring universal access to sick leave policies, and
- Utilizing public-private partnerships to develop and distribute vaccines that are used in accordance with the CDC's scientific recommendations.
In addition, the paper stresses the importance of safety and well-being during public health emergencies and the need for public and private payers to provide direct financial support to practices, particularly those in underserved areas.
ACP built on previous policy to develop this new paper, including “Partial Resumption of Economic, Health Care and Other Activities While Mitigating COVID-19 Risk and Expanding System Capacity,” released in May 2020, and a number of other ACP guidance statements published from 2020 to 2022. These new recommendations are also related to another recent ACP policy paper, “Modernizing the United States' Public Health Infrastructure,” which was published in Annals on July 18. We need this infrastructure in place not only to address future pandemics but also to address persistent health inequities, high maternal mortality rates, a mental health and drug overdose crisis, gun violence, declining immunization rates, and high rates of chronic disease.
ACP's paper on infrastructure specifically calls for the U.S. Department of Health and Human Services (HHS) to “designate a public-health focused official to guide federal, state, territorial, tribal, and local public health departments in systemwide efforts to respond to public health challenges and address infrastructure needs.” This work will need sufficient, sustained, and stable year-to-year funding from Congress to truly be supported and successful. ACP also notes that other private sources of funding can and should be explored, as this should really be an all-hands-on-deck effort.
One of the biggest challenges to achieving these goals is the politicization of public health issues, including COVID-19, racial and ethnic disparities, and gun violence, fed in large part by an epidemic of mis- and disinformation (something ACP is actively working to fight against). This has led not only to excessive morbidity and mortality but also to increased burnout and workplace violence for our physicians and other health care workers (see the cover story on mitigating workplace violence and abuse in this issue). We must take action to increase the number of public health and other health care workers through policies like competitive salaries, loan repayment, and educational assistance. Additionally, safeguards are needed to directly address mis- and disinformation through fact checking, health and media literacy training, and other interventions. The well-being of physicians and other health care workers needs to be prioritized, and criminal penalties must be put in place for those who harass, intimidate, commit violence against, or bully the public health and health care workforce.
It was wonderful to be able to read my book on a balcony in Barcelona earlier this year, with the hope that the worst of the COVID-19 pandemic is behind us. But the book also triggered those feelings of fear and uncertainty that lasted throughout much of 2020 and 2021. It is important to remember those times and reflect on what we have learned—but now it is time to move forward and build the infrastructure and plans we need to do better when the next pandemic hits, which will likely be in our and/or our kids' lifetimes.