5 Ways Public Health Could Change Due to COVID-19
By Debra Wood, RN, Contributor:
The novel coronavirus has brought public health to the forefront of people’s minds.
“Public health is vital to all of us, all of the time,” said Susan Swider, PhD, PHNA-BC, FAAN, a professor at Rush University College of Nursing in Chicago, quoting former Surgeon General C. Everett Koop.
“We want nurses to continue to be a valuable part of public health, and we can perhaps get on top of things like COVID-19, prevent them before they start or be a little less intense,” she said.
Public health nurses focus on improving an entire population’s health by emphasizing prevention and addressing inequalities, according to a definition by the American Public Health Association (APHA). During the current pandemic, they are testing people for the coronavirus, tracing contacts and promoting social distancing, which has high social, economic and other costs.
Waiting for a vaccine, the country continues to use century-old methods of case finding: case isolation; contact tracing, monitoring and isolation; more testing; and social distancing.
“The problem with COVID-19 is when the numbers were small enough to be able to do that, we did not do that test–isolate, test–isolate,” Swider said. “Now, it is difficult.”
Once the number of cases decrease, public health officials must be able to test and isolate. Without that capacity, a resurgence could occur, Swider said. Educators should be providing nursing students more education about public health, she added.
“Everyone should know more about public health,” said Lisa Carlson, MPH, MCHES, president of APHA.
Carlson and Swider offered some insights into what might be ahead for the field of public health, due to changing perceptions and practices during the coronavirus pandemic.
Potential changes in U.S. public health due to COVID-19
1. Expanding funding
“We have a cycle of public health funding, where there’s crises, and we get a bolus of funding,” Carlson said. “Then things are under control and funds tend to decrease, and then we have another crisis, and we’re unprepared to deal with it, which is where we are right now.”
Carlson explained that when the funding goes away, so does the infrastructure to quickly deal with a public health threat.
APHA is advocating for $4.5 billion in additional funding for public health, for the Centers for Disease Control and Prevention (CDC) and local and state public health departments, which is about $13 per person in additional public health expense.
“Hopefully, that would bring us back to be able to modernize, be prepared and fend off pandemics like this one in the future,” Carlson said.
On the other hand, some people are less optimistic. Robin Taylor Wilson, PhD, associate professor of epidemiology and biostatistics at Temple University College of Public Health in Philadelphia, said she cannot speculate as to what will happen regarding future funding for the public health workforce.
2. Hiring more people
Additional funding would allow for more hiring for contact tracing and in general. Carlson reported that public health has lost more than 50,000 public health jobs since 2008.
“We need to do more hiring to have enough people to do this work,” Carlson said.
The Association of State and Territorial Health Officials (ASTHO) estimates the country needs 100,000 more public health professionals to conduct contact tracing of COVID-19.
“We will only be able to recover when we have the capacity to quickly isolate new cases and track those that have been near infected individuals,” said Michael Fraser, chief executive officer of ASTHO, in a statement.
Those individuals may be nurses or community health workers, Carlson said.
“We do not have the people we want to do the thing we need to do,” Swider said.
The State of Massachusetts, in partnership with Partners in Health of Boston, created a COVID-19 Community Tracing Collaborative to scale up the state’s ability to contact trace. Partners will hire nearly 1,000 people to aggressively trace contacts of people diagnosed with COVID-19.
3. Addressing social determinants of health
Social determinants of health refer to factors that affect people’s health, such as unstable housing, poverty, unsafe neighborhoods and a lack of education, according to the CDC.
“There are big social issues that impact health and structural inequalities,” Carlson said. “All of those play a role in public health.”
Minorities have been disproportionately affected by COVID-19, which has drawn attention to inequities in the health care system. Crowded living conditions or many people in a home, increases someone’s risk of contracting COVID-19, Swider said.
“I hope we put attention to fixing these social and structural inequalities,” Carlson said.
4. Embracing technology and telemedicine
The use of telemedicine has soared since the pandemic left broad swaths of the country closed, creating new ways for people to access health care. Many providers are managing medications and chronic conditions virtually.
“I think the dramatic acceleration is here to stay,” Carlson said. “This is an opportunity for us to learn how to do things differently.”
Apple and Google are developing a contact tracing tool, which will let people learn if they have had contact with someone positive for COVID-19. The person testing positive would need to notify the server. However, testing remains scarce, so people may not know they are positive. It also will require an upgrade to the operating system and downloading a public health app, which not everyone will do. Additionally, privacy concerns exist.
5. Gaining appreciation
Anthony Fauci, MD, who heads up the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), has become a household name. Daily briefings by local and state health officials have raised awareness of public health and the role leaders and practitioners in this field play.
Swider encourages all nurses and healthcare providers to understand public health and contribute to the education of society.
“We are not hearing enough from people saying, ‘Thank you for the work public health nurses are doing in fighting the good fight,’” Carlson concluded. “I appreciate the work everybody is doing.”