The COVID-19 pandemic has revealed a startling lack of capacity for handling emergencies in the U.S. public health system. But physicians are convinced we can learn and innovate as we respond to this global health crisis. Exploring the current pandemic response through the lenses of the academic, private, and government sectors can provide insight on the best ways to achieve durable preparedness. Hofstra University’s School of Health Professions and Human Services convened a panel of experts to dig into these issues as part of its State of H.O.P.E. (Healthcare Opportunities and Policy Exchange) lecture series.
The “Closing the Gap on Health Emergencies” panel was moderated by Hon. Kemp Hannon, a former New York state senator with extensive experience in public health policy. Panelists included Hofstra professors Anthony Santella, DrPH, MCHES, and Jacqueline Moline, MD, and Joshua Moskovitz, MD, MBA, MPH, FACEP, who manages the Department of Emergency Medicine at Jacobi Medical Center in New York City.
Here are some of the insights they shared:
Because it’s a new virus, treating COVID-19 is an immense challenge and response systems are relying on non-pharmaceutical strategies.
“These non-pharm interventions are things that are not new in our profession. They’ve been happening for thousands of years,” Dr. Santella said. Today, there are four basic public health interventions deployed on a large scale to combat COVID-19: testing, isolation of infected individuals, contact tracing, and quarantine. The goal of these strategies is to slow or stop the spread of the novel coronavirus. While some of these methods are not new, there are modern concerns specific to 2020. For example, research suggests that COVID-19 impacts some populations more than others. The novel coronavirus has disproportionately impacted communities of color, both in number and severity. In order to achieve an equitable public health outcome, these factors must be part of the public health response.
Hospitals are rolling out new strategies to cope with the sudden surge in demand, but there’s not a lot of slack in the system.
“We were probably operating at 90-100% capacity before COVID-19. When COVID-19 hit, how do you expand up from there?” said Dr. Joshua Moskovitz. He likened the business model of hospitals in the United States to hotels. Empty beds mean lost profit, so managers typically wanted to run as near capacity as possible. But that leaves Emergency Departments and hospitals with precious little room to handle surges in demand. At Jacobi, Dr. Moskovitz oversaw several innovations designed to maximize patient capacity at the hospital, at one point establishing a tent-based intake system in the parking lot. “Our volumes were crazy high,” Dr. Moskovitz said. “We were seeing at one point upwards of 75 patients a day in the tent. … We were using providers from all over the hospital to help us.” The new intake system helped separate possible COVID-19 cases from other emergency medical needs in an attempt to limit the spread of infection.
Even for those who have had COVID-19 and recovered, future treatment can be full of uncertainty.
“What are the long-term implications for someone who has had coronavirus or COVID-19 in terms of their overall health? When does their pulmonary function return to normal? Will it return to normal? What are the services they’re going to need?” asks Dr. Jacqueline Moline, who studies epidemiology with Northwell Health. In large part because COVID-19 is so new, researchers are still trying to determine the best ways to contain and mitigate spread. That’s where longer-term study will be needed. Researchers must examine how effective masks might be to stop the spread of the virus, whether antibodies provide any immunity to future infection, and precisely how many people may spread the disease while they are asymptomatic. The more definitive information researchers can accumulate and disseminate, the better public health officials will be able to strategize for the future. As metropolitan areas attempt to resume some activities, information such as testing will be key to containing new outbreaks of COVID-19.
Public health delivers a vital service, but it must be adequately funded to be effective.
“You can’t underfund and undervalue something as critical as public health and then expect at a moment of crisis to dump millions of dollars and have it work just like that,” says Dr. Santella. As the world seeks a new normal, it becomes increasingly clear that things will have a hard time going back to the way they were. And mitigating the spread of COVID-19 will require buy-in from the public, so education and awareness are vitally important. That’s part of the problem, according to Dr. Moskovitz, “Public health is so important because when it works, you don’t see the problem.” Preparing for the next public health emergency will mean internalizing and remembering the lessons of COVID-19. As all three panelists noted, this crisis will impact every single person on some level. Closing the gap on health emergencies could start with that shared experience.