The January/Feburary issue of the Journal of Public Health Management and Practice focuses on the Public Health Workforce and is accompanied by a special supplement on COVID-19, sponsored by the Association of State and Territorial Health Officials (ASTHO), Big Cities Health Coalition (BCHC), and the de Beaumont Foundation.
“COVID-19 and Public Health: Looking Back, Moving Forward," a supplemental issue publishes with our January issue. Guest editors Chrissie Juliano of the Big Cities Health Coalition, Michael Fraser of the Association of State and Territorial Health Officials, and Brian Castrucci of the de Beaumont Foundation developed this comprehensive supplement because of the need for information to illuminate the public health crisis facing our nation. This supplemental issue tackles the question of how the richest nation in the world, with the most expensive health care resources and known methods of containing the virus, fails to address the COVID-19 pandemic. The knowledge presented in this issue will aid efforts to stem the pandemic.
Commentaries in this issue on the pandemic include those directed at racism, equity, protecting the homeless, implications for LGBTQ communities, and lessons learned from the AIDS epidemic. Included is an article that recounts the experience and leadership of public health officials in this pandemic. Since March 2020, more than 55 state, territorial, and local health officials have left their positions. Most of this turnover was due to heightened public scrutiny and harassment of these officials even extending to death threats related to their efforts or recommendations that were a public health response to the pandemic. This commentary recounts the controversy and conflict public health leaders experience when acting as policy advisors to elected officials.
The scientific articles in this supplemental issue provide ample evidence on the occurrence of COVID-19 in our communities as well as interventions mounted to reduce illness and deaths. These interventions include articles on surveillance, COVID-19 case investigation, and contact tracing. Also included are articles on the public health laboratory and public health law.
Chen and Krieger report on the unequal burden of COVID-19 by income, race/ethnicity, and household crowding. Prior to this study, no public health agency or scientific investigation had reported rates of COVID-19 outcomes (deaths, confirmed cases, positive tests) in relation to county or zip code measures of socioeconomic characteristics or residential segregation. This study provides evidence of marked social gradients in rates of COVID-19 outcomes at both county and zip code metrics.
In the absence of medical measures to prevent transmission of SARS-CoV-2 (COVID-19), we have relied on individual compliance with recommended nonpharmaceutical interventions (NPIs) such as wearing masks, washing hands, and social distancing, including business closures, travel restrictions, and stay-at- home orders. Michael Fraser and co-authors provide the details of these measures by locality in their article “Variation Among Public Health Interventions in Initial Efforts to Prevent and Control Spread of COVID-19 in the 50 States, 29 Big Cities, and the District of Columbia." NPI implementation varied widely by jurisdiction. State preemption of authority was an important factor as some big cities had more restrictive community NPIs than states, leading to conflicts between local and state governments.
Field reports from health departments in Michigan and the San Francisco Bay area are of particular interest. Joneigh Khaldun, Chief Medical Executive, State of Michigan, describes the data challenges and communication skills needed for public health leaders in this pandemic. She points to the importance of partnerships with business, universities, and non-profit organizations in efforts to counter the pandemic. Tomas Aragon, health officer for the City and County of San Francisco, and health officers from six other Bay Area counties, issued legal orders on March 16, 2020, for 6.7 million residents to shelter-in-place to prevent the spread of SARS-CoV-2. The Bay area was the first region in the United States to shelter in place. Decision making by public health leaders in this situation is described.
The guest editors, in their lead editorial and commentaries, have decried the absence of a coherent national, federally led strategy to combat this pandemic. Other countries, though smaller, including South Korea, New Zealand, Singapore, and Taiwan, have successfully contained COVID-19 with a uniform national approach that has included local jurisdictions. Currently, national organizations of public health leaders, Association of State and Territorial Health Officials (ASTHO), and National Association of County and City Health Officials (NACCHO) have not been consulted or engaged in the pandemic response. Recommendations are outlined for future pandemic control, including addressing the chronic underfunding of our public health system at all levels. Investments in public health workforce, the Centers for Disease Control and Prevention, and a $10 billion investment in vaccine development are opportunities to address the ravages of COVID-19.
As this issue goes to press, daily counts of COVID-19 cases are exceeding 180,000. President-elect Biden has formed an advisory board and promises a national strategy. Pfizer and Moderna have announced effective vaccines, and other companies will hopefully also announce progress on vaccines. The next two months of winter weather provide a grim outlook, but these positive developments, particularly a national approach, may bring improvement this spring.
Lloyd F. Novick, MD, MPH Justin B. Moore, PhD, MS
Editor-in-Chief Associate Editor