Our nation’s local, state and national public health agencies have endured constant attack during the COVID-19 pandemic for doing their job to protect the populace.
Politicians dismiss public health and scientific expertise without rationale and discourage simple, yet effective, public health measures such as distancing and wearing a mask. The effectiveness of federal public health agencies, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC), has been diminished by political manipulations. Widespread misinformation and rejection of COVID-19 public health measures have eroded trust in public health agencies and licensed individuals to put personal freedom above the wellbeing of their fellow citizens. The result — a pandemic that rages out of control.
With inadequate national pandemic guidance, states have cobbled together a hodgepodge of responses to the pandemic with the responsibility falling largely upon local and state health departments. These departments perform many vital services with the goal of safeguarding public health. They face increasing challenges, not only due to the immense burden of COVID-19, but also seasonal flu, vaccine-preventable disease outbreaks, rising obesity, rising rates of STDs, substance misuse, rising suicide rates and much more. Yet, due to politicization of the COVID-19 pandemic, public health offices have been attacked and personnel threatened or driven from their jobs fearing for their safety.
Unfortunately, Americans have become so accustomed to the services of public health agencies that they are taken for granted. Most citizens are unaware of the fragile nature of the public health infrastructure and how perilously close that places them to serious health risks. This ignorance is borne out by the hostile response of many Americans to COVID-19 mitigation. Wearing a mask is cited as an infringement on personal freedom. Yet, our freedom comes with responsibility. The responsible act of wearing a mask prevents those who are asymptomatically infected from infecting someone for whom infection may be deadly.
But imagine if SARS-CoV-2, the virus that causes COVID-19, was more pathogenic. Imagine if it made the majority of those infected fall seriously ill. Imagine that it killed indiscriminately in every age group. Imagine family members, regardless of age, gasping for that last breath. Imagine hospitals so overwhelmed that they were unable to take in the sick. Imagine cold storage trucks driving through neighborhoods, stopping to take away the dead. Imagine the economic collapse that would follow.
This pandemic scenario is not far from reality. There has been one virus outbreak with pandemic potential approximately every 10 years for the last 100 years. The next influenza virus or coronavirus to emerge might spread better than SARS-CoV-2 and be more deadly. We remain woefully underprepared for such a pandemic. COVID-19 has exposed the fault lines in our response and in our ability to unite in a crisis.
COVID-19 has resulted in 13 million total cases in the US, increasing by 150,000 new cases per day. The over 265,000 deaths suffered in the U.S. increases by 2,000 per day. Thanksgiving day saw a record 90,000 hospitalizations. Yet, these staggering numbers seem insufficient to convince the COVID-19 skeptics to practice simple humanitarian gestures to protect one another and control the spread. This pace in COVID-19 cases will result in collapse of the health care infrastructure in many regions of the country resulting in overwhelmed hospitals unable to care for the sick. And, it will get worse as the Thanksgiving holiday surge appears in the coming days.
The data are clear. Countries, like New Zealand, that implemented public health measures early have fared better. Early implementation of the simple public health mitigation procedures of masking, distancing and hygiene would have allowed the U.S. to control the pandemic with fewer closures and lockdowns and fewer deaths. Where masking has been mandated, case numbers have fallen as cloth masks protect both the wearer and others from infection.
The announcement of potential vaccines, by Pfizer and BioNTech and Moderna, has been mistakenly seen by many as a reason to relax mitigation practices. Unfortunately, months of pandemic remain until enough people are vaccinated to slow community spread in the absence of masking and distancing. If the vaccines are effective and safe, the logistical difficulties of manufacturing and distributing enough to vaccinate the global population to approach communal or herd immunity could take years. And this may never happen if large numbers refuse the vaccine.
We must change the course of COVID-19 and prepare for the coming pandemics. In the short term we must comprehend the perilous situation we are facing with a national mandate for masking in public spaces. In the long term, public health initiatives at all levels, including public health education, must be well-funded and organized so that the public is better prepared. Future pandemic threats must be anticipated. The means to detect them and respond early must be established within a permanent federal agency dedicated to pandemic response and global health security. Above all else, these efforts must be impervious to politics.
James Alwine is a virologist and a fellow of the American Academy for Microbiology and the American Association for the Advancement of Science. Felicia Goodrum Sterling is a 2018 Public Voices Fellow of the OpEd Project, a professor and virologist.