“Responding to a public health crisis requires decisive action, near unity, and a readiness to adapt as we learn about what causes the disease to spread and about what actions can minimize that spread." (1) Two years into this pandemic, we have painfully learned how COVID-19 spreads and the actions of vaccination and wearing masks can minimize that spread. Decisive actions have been taken. In September, President Biden required all federal workers including the military to be vaccinated and all businesses employing more than 100 workers to require vaccination or testing of their employees. However, a marked lack of unity throughout the nation on the implementation of these decisive actions has resulted in continued high numbers of cases and deaths related to COVID-19. The partisan differences in approaches to this disease, reported every day in the media and documented in previous articles published in this journal, are remarkable in the resulting needless toll and suffering, all for questionable political gains. This January issue on COVID-19, our third in the last year, titled Addressing the Continuing Challenge, aims to provide additional information on how COVID-19 spreads and provides examples and impetus for decisive action.
In terms of decisive actions to contain the pandemic, case investigation and contact tracing (CICT) are vitally important, but as pointed out by Rainisch and co-authors, these steps have been difficult because of varying public acceptance and limited resources, especially of trained staff. They investigated the number of COVID-19 cases and hospitalizations that could be averted by CICT. Recommendations are issued to improve the effectiveness of this activity. Using data from 14 jurisdictions, they found that after other non-pharmaceutical interventions, for every 100 cases, CICT could prevent between 4 and 97 additional cases. Jurisdictions varied widely in the proportion of cases isolated after identification. Of note was the finding that by decreasing time to case isolation by one day increased averted case estimates by up to 15 percentage points.
A COVID-19 outbreak occurred among workers at a meat processing plant in Utah in the spring of 2020. The harvesting section of the meat processing facility had the highest attack rate. There were significant transmission differences by race, language spoken, and work section. In terms of discrete actions to mitigate COVID-19 transmission, Rogers and co-authors outline a multifaceted public health response including hand washing and social distancing. They also found workers were apprehensive about taking sick leave. Specific recommended actions included employers addressing work leave policies and tailoring complex health communication messages to languages spoken among the employees' social networks.
With the beginning of the school year in the summer of 2021, hundreds of schools have had to close because of clusters of COVID-19 among students. Divisiveness about mask wearing, recommended by the Centers for Disease Control and Prevention, has erupted in many jurisdictions. Governors of Texas, Florida, and others have prohibited schools from requiring masks even where local communities or school boards have favored this measure. In this issue of the journal, two articles have demonstrate that we have available means of mitigation to keep schools open and avert outbreaks of this disease. Miller and co-authors model the impact of mitigation strategies on the transmission of COVID-19 in prekindergarten to grade-12 schools. The CDC recommended mitigation strategies include mask wearing, cleaning and disinfection, hand hygiene, and social distancing. They find that these mitigation strategies and contact tracing can indeed limit the number of COVID-19 cases in schools, reducing transmission by at least 69%. An actual example of this is provided by another article in the issue: “Private High School Reopened Safely During COVID." Bellin and co-authors report that the CDC recommendations for COVID-19 of masks and social distancing do not describe a scalable surveillance solution such as one they applied in this New Jersey school. The symptoms of all school participants were reported daily with physician follow-up interviews. Masks, distancing, and aggressive contact tracing, combined with Internet-supported contact tracing and consistent application of quarantine protocols successfully permitted in-school education in a high prevalence area.
The availability of a vaccine has not been sufficient, for reasons discussed, to end the COVID-19 pandemic. Scherer and co-authors examine vaccine distribution in New York City through the lens of equity and determinants of health. Luo and co-authors describe the willingness of Medicare enrollees to get COVID-19 vaccine and reasons for hesitance. At the time of the study, in the fall of 2020, greater than 61% of Medicare beneficiaries were willing to get a vaccine. Fortunately in the fall of 2021, a higher proportion of seniors has been vaccinated. Luo also found vaccine hesitancy with some individuals concerned about safety and this resistance was greater in racial and ethnic groups.
With our January/February issue, we are publishing a supplemental issue Public Health Interventions to Address Health Disparities Associated with Structural Racism. This issue is sponsored by the W.K. Kellogg Foundation. Policies, processes, and systems rooted in racist ideologies, such as redlining, school segregation, etc. have directly impacted the health and well-being of marginalized communities. Public health departments have an opportunity to target the health disparities caused by structural racism. Strategies that center on utilizing culturally relevant programmatic development, sustainable policy change, and include all stakeholders have been shown to make significant positive impacts. Mary T. Bassett, MD, MPH, Director of the FXB Center for Health and Human Rights and the FXB Professor of the Practice of Health and Human Rights at the Harvard School of Public Health, is guest editor for this important issue. An advisory panel assisted in the development of this issue. Members included Oxiris Barbot, MD, Peggy Honore, DHA; Philip Musa, PhD, MPH, MBA; LaQuandra Nesbitt, MD, MPH; Gulzar Shah, PhD, MStat; MS, Tricia Penniecook, MD, MPH; and Ben Truman, MD, MPH.
- Slavitt, A. Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Corona Virus Response. St. Martin's Press, New York, NY 2021 1-314 p. 4
Lloyd F. Novick, MD, MPH Justin B. Moore, PhD, MS
Editor-in-Chief Associate Editor