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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.
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Public Health During COVID-19
Margaret Bourdeaux and coauthors analyze the “operational cleavage” between the public health and medical systems.
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, 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, 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.
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Public Health Departments
Jonathon Leider and coauthors find that about half of the governmental public health workforce 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. 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.
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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.
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 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 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.
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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.
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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:
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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." 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, Apple, or wherever you prefer to 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.
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About Health Affairs
Health Affairs is the leading peer-reviewed journal 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, Health Affairs Today, and Health Affairs Sunday Update.
Project HOPE 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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