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Dear John,

The March 2023 issue of Health Affairs focuses on lessons learned about
public health during the COVID-19 pandemic. Articles examine the
relationship between public health and medical care, the legal framework
for public health interventions, infrastructure needs ranging from
personnel to laboratories to financing, and more.

Read The Issue
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Public Health During COVID-19

Margaret Bourdeaux and coauthors analyze the "operational cleavage"
between the public health and medical systems
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They find that the lack of cohesion between these two systems, which
each evolved separately over the past 200 years, hindered COVID-19
surveillance, transmission containment, and care of those who were
infected.

They argue for improvements in diagnostic capacity, modernization of
data and surveillance systems, and better referral pathways from public
health to medical care.

Michelle Mello and Lawrence Gostin find that current public health laws
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which were last revised heavily in response to the attacks on and after
September 11, 2001, are inadequate to address multiyear pandemics such
as COVID-19.

More than 1,000 lawsuits have been filed challenging COVID-19 orders,
and states have moved widely to constrain executive branch emergency
powers.

The authors offer recommendations designed to "strike the right
balance among empowering officials, protecting individual rights, and
ensuring democratic accountability."

Jay Varma and coauthors assess the US public health laboratory system
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which "is critical to rapid detection and monitoring, public health
guidance, and deployment of medical countermeasures to individuals and
communities."

They find weakness in COVID-19 test execution and design as well as gaps
in test reporting and monitoring, leading them to recommend improvements
to the Centers for Disease Control and Prevention's (CDC's) internal
laboratory operations and external laboratory engagement.

Read More
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Public Health Departments

Jonathon Leider and coauthors find that about half of the governmental
public health workforce
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left their jobs between 2017 and 2021. Employees in 2017 who were ages
thirty-five and younger or had five years' experience or less had
significantly greater odds of leaving by 2021.

If current trends continue, 129,000 workers, or about 57 percent of the
workforce, could be lost by 2025.

Chronic underinvestment in the US public health system, according to
Jason Orr and coauthors, can only be addressed if we do a better job
identifying how much is spent and what the returns are on this
investment.

Although more funding is necessary, the authors note that "with
greater funding follow, naturally and appropriately, calls for greater
accountability."

Gillian SteelFisher and coauthors explore trust in public health
agencies during the pandemic
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They find that "about four in ten adults (42 percent) reported a great
deal of trust in the CDC, and about a third said the same for their
state (31 percent) or local (34 percent) public health department."

Those with higher levels of trust in public agencies cited adherence to
scientifically valid research and expert staff as reasons for trust,
whereas lower levels of trust in these agencies were related to beliefs
that agency policies were influenced by politics or the private sector.

Read More
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Community Response

Shefali Oza and coauthors argue that future pandemics should be
addressed through the use of a Community-based Outbreak Investigation
and Response (COIR) framework
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COIR integrates effective surveillance and a coordinated response by
community partners with emphases on building trust and achieving equity.


Effective implementation of COIR depends upon adequate and sustainable
funding, a diverse and COIR-trained workforce, local data surveillance,
and information sharing.

New York City (NYC) announced a COVID-19 vaccination requirement for all
city employees in July 2021.

Beth Rubenstein and coauthors
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find that "workplace vaccine requirements in NYC were associated with
a significantly greater rate of change in COVID-19 vaccination
prevalence for NYC municipal employees compared with similar-age adults
in the general NYC working-age population," but only after the policy
became more stringent, eliminating an option to test in lieu of
vaccination, among other provisions.

Several times during 2020 and 2021, state health officials in
Mississippi paused nonurgent elective procedures to preserve resources
for pandemic response.

Thomas Dobbs and coauthors find a nearly 27 percent decline in intensive
care unit (ICU) admissions
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for elective procedures during these interventions, reducing ICU bed
occupancy for elective surgeries by 16.8 percent and freeing up an
average of eleven ICU beds each day.

Read More
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Acknowledgments

**Health Affairs** thanks Howard Koh of the Harvard T. H. Chan School of
Public Health for serving as adviser on the COVID-19 and public health
papers. We also thank the New York Health Foundation, Episcopal Health
Foundation, and Gordon and Betty Moore Foundation for their financial
support.

Order The Issue
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Join Health Affairs Unlimited to access our current and past issues
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This week, we're hosting a virtual issue briefing about public health
during COVID-19. Join us on Wednesday, March 8, to hear from authors
published in the March issue, and be sure to check out our additional
events this month:

* Journal Club: "Surviving The Surge: Nonurgent Procedures, Intensive
Care, And Mississippi's COVID-19 Waves
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on March 16

* Lunch and Learn: "Mass Shootings In The United States: Population
Health Impacts And Policy Levers
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on March 23

* Lunch and Learn: "Enhancing Health Data To Improve Outcomes For
Underserved Communities
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on March 30

View Full Event Schedule
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Listen To These Podcasts

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This month, we'll host featured authors in the March issue to discuss
topics like drug repurposing and development, competition and
vulnerabilities in the generic pharmaceuticals market, and more.

Recently, we kicked off the newest season of Pathways, "No One Gets Out
Of Here Alive.
<[link removed]>" In
this series, Clemson University's Tracy Fasolino explores the role of
policy and legislation on where we've been, where we are, and where we
want to go for palliative care and hospice.

Check out our podcasts, and subscribe on Spotify
<[link removed]>, Apple
<[link removed]>,
or wherever you prefer to listen.

Listen
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Today we're remembering Judy Heumann, who recently passed away at age
75. Heumann had a remarkable career as a disability rights leader, and
we're privileged to have had the opportunity to meet with her last year
to get her insight on the intersections of health, health policy, and
disability <[link removed]>.

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mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
<[link removed]> at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
<[link removed]>, and Health Affairs Sunday
Update <[link removed]>.  

Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States

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