One of the most stunning sets of statistics that we ’ ve seen in the pandemic is the tremendous disparities in cases , hospitalizations and deaths by race and ethnicity with an enormous increase in stress among people and communities of color in the United States , ultimately leading to a significant difference in the impact of the pandemic on life expectancy .”
I would argue that our focus must be on building systems for infection prevention and for stewardship that will not only improve outcomes every day but could withstand the crises that lie ahead . It was never a matter of if a pandemic would arrive , it was a matter of when a pandemic would arrive . Hopefully when that day comes , we will have rebuilt our systems in a way that will be prepared to withstand them .”
In his 2021 IDWeek presentation , “ How Will COVID-19 Change Healthcare ,” Joshua Sharfstein , MD , reminded how other public health crises that left their mark on healthcare but that they can also lead to progress , ultimately . He pointed to the 1976 swine flu outbreak , which began with the death of a recruit at Fort Dix in New Jersey and very quickly led to an influenza pandemic to which President Ford responded by announcing that every man , woman and child needed to be vaccinated .
“ That vaccination campaign continued full steam even when there were no cases of the swine flu ,” Sharfstein explained . The danger had passed , but nonetheless the government went forward , vaccinated tens of millions of people and this caused some problems including cases of Guillain-Barre syndrome . The vaccination campaign had to be suspended and it caused not just the embarrassment of the CDC , but it was a seminal event in terms of vaccine hesitancy . People still cite the 1976 swine flu debacle . The reporting on it by 60 Minutes was brutal and some people say that it really did not help President Ford in his election in 1976 , which he lost . So , one thing we learned from this crisis is that failed crisis responses can cast a long shadow . It ’ s important to note that crisis can lead to change , but it can also lead to problems .”
Sharfstein used the example as a springboard to a discussion about what changes are needed post-pandemic .
“ One change I think is urgent is addressing causes of inequity ,” he said . “ One of the most stunning sets of statistics that we ’ ve seen in the pandemic is the tremendous disparities in cases , hospitalizations and deaths by race and ethnicity with an enormous increase in stress among people and communities of color in the United States , ultimately leading to a significant difference in the impact of the pandemic on life expectancy . As the CDC noted , the reasons are related to many factors , particularly the conditions in which people live , work , and socialize , as well as overcrowded home conditions . Tackling these issues is important to dealing with underlying vulnerability in our social structures for the severity of infectious disease .”
Sharfstein continued , “ We ’ d also like to see improvements in access to care . Hospital care was not evenly distributed during the pandemic , and many people were not able to get the same and necessary hospital care that others , even in their same communities , sometimes were able to get and vaccination was not evenly distributed even within the priority groups that were established . There were significant racial disparities , particularly initially , and it was a situation where in the chaos of trying to find vaccines , people who were able to navigate through all these different challenges and systems were much more likely to get vaccinated .”
Sharfstein also indicated the desire to see improved investment in public health .
“ We ’ ve learned the lesson in the U . S . that we are llowing up again . Perhaps my emails are going to spam ? underfunding public health at our own peril ,” he commented . “ It can be seen in the challenges associated with COVID reporting and the problems of getting the data as well as weaknesses around contact tracing , isolation , and quarantine — pretty much every step of the public health response has been challenged by underlying weaknesses in public health infrastructure . Maybe there ’ s a little bit of extra funding with the pandemic , but that ultimately , public health itself is not invested in to be successful in handling a crisis .”
Sharfstein pointed to the role of telehealth access after the pandemic . “ Telemedicine might ease ER crowding . You see pictures of crowded ERs and how crazy is it that we put all these sick people so close together so that they can make each other sick ? We need better solutions for healthcare that reduce infectious disease , and telemedicine can play an important role .”
He continued , “ So , are we going to get the changes that we need in this country as a result of the pandemic ? Are we going to see the massive legislation paths that can change the frontiers of public health , or are we going to be frustrated and unhappy , public health-wise , such as after the swine flu affair in the 1970s ? What will happen next ? While I would like to say that crises do motivate a lot of positive change , that ’ s not true in every case , and I think that there are some reasons for pessimism . One reason is that people urgently want to go back to normal . This is a common response that after a crisis , people want to go back to normal and the desire to make changes competes with the desire to want to return to normal . They don ’ t want to think about all the things that need to be fixed . They don ’ t want to wear masks when they need to . How are we going to get people to pay attention to the changes that need to happen ?”
Sharfstein added , “ There are dwindling sources of authority to lead change . When you look at the history of crises , the people who are seen as the heroes of a crisis are the ones who can help set the agenda for the post-crisis response and for change . However , the public health field at the national , state , and local levels has had it tough , as has the infectious diseases field . Many have left the profession . There is all kinds of misinformation about the fields of public health and infectious disease , and there ’ s no clear source of authority to say ‘ Here is what we need to do ,’ and I think that is a serious weakness . However , I do think there are some reasons for hope . The first is that crises make the impossible possible , with the changes that crises bring about . Crises can suspend