For most of the world, everything changed one year ago when the World Health Organization declared the coronavirus a pandemic. In March 2020, in a matter of days, the size and scope of the pandemic was crystallized. The NBA suspended its season. Actor Tom Hanks announced he had tested positive for the virus, and then-President Donald Trump suspended travel between the U.S. and Europe.
Millions of cases and hundreds of thousands of deaths later, we are now seeing optimistic numbers, in the millions of vaccinations being administered into the arms of beleaguered Americans. There’s cautious hope that this spring will be a true rebirth. The concept of herd immunity is closer, and the Centers for Disease Control and Prevention have updated guidance to even allow (in limited circumstances) for unvaccinated individuals and vaccinated individuals to gather safely without masks and social distancing.
But as the past year drifts further into the rearview mirror, there are three areas that must continue to be prioritized for policymakers and leaders, including the Biden administration.
Public health infrastructure
President Joe Biden’s Covid-19 stimulus bill includes tens of billions of dollars for the public health workforce, but this will be largely swallowed up by the incredible deficit created by decades of underfunding the very infrastructure now responsible for dealing with the pandemic. It’s more or less equivalent to using a very strong garden hose to put out a sprawling wildfire.
To prevent future pandemics, we need to increase both the levels of funding and the integration of public health leadership in nontraditional areas: education, transportation and energy, to name a few. Not one sector was spared from being laid bare by the little virus with red spikes. Covid-19 has acted as a tracer condition in this sense, something that exposes inequities but can be traced to one condition or diagnosis.
Any leader running a state or federal department, or even a private company, would be wise to consider how best to integrate key principles of public health into their organizations, including scenario-planning and the ability to adapt to acute needs for data and technology. Former Surgeon General C. Everett Koop put it best when he said, “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.”
Mental health services
There has been much discussion and research about the toll of the pandemic, from an increase in depression to a possible rise in deaths from suicide — but frankly very few tangible solutions. From persistent issues regarding the stigma of mental illness to the shortage of professionals who can help, there is no question that the true “twindemic” of 2020 was not Covid-19 and the influenza virus, but Covid-19 and mental health diseases.
Even simple processes such as the SF-86 form, which is required for government positions with security clearance, asks a number of questions about disclosure of mental health conditions that have often resulted in a tangible barrier in seeking treatment, despite changes to the questionnaire over the years.
Children are more likely to be screened for fevers than they are for depression or anxiety, yet we know they can present with signs and symptoms at 5 years old or younger. Structural policies that remove barriers must be prioritized, from insurance benefit design to local availability of high-quality professionals who can help children and adults survive and thrive in their diagnoses.
This past year we saw the polarization and politicization of science — not just misinformation about masks or vaccines, but the science of racism, the science of disparities, the science of the impact of the coronavirus on women, children and families. Many of us, myself included, have been doing research on health disparities for decades that allows us to predict that Black people are diagnosed with Covid-19 later or with less frequency than their white counterparts but die at higher rates.
While disparities, masks and science communication may not seem like they’re related, they are. Science, especially high-quality peer-reviewed research, must be given value and made accessible in all aspects including different languages and for different literacy levels.
This needs to start upstream, with pushing for clear language that conveys the message from emerging data, scientific meetings and expert consensus. Campaigns to promote vaccination should be seen as successful only if they can bleed into other aspects of scientific communication, such as screening for cancer, describing the tangible benefits of health insurance access and the science of discrimination.
In addition to these three areas of focus, we must continue to fight for spaces to publicly and privately grieve. We need to grieve our losses and our sickness but also feel the grief that does not have a name or a diagnosis: the loss of seeing a smile, the loss of the touch of others, the loss of hearing laughter on a playground. Our world should not ever be the same, not because of the devastation of the past year but because of the work ahead and the possibility of a better future.