Weaknesses in our public health system have become apparent in the COVID-19 pandemic and must be addressed before the next pandemic[25]. Grant-based funding, and limited ongoing funding makes operating a long-term sustained public health infrastructure difficult. Lack of consistent national messaging and the lack of infrastructure, systems and inconsistent standards/methods for data collection/reporting limit effectiveness.
ED-focused data collection misses changes that have occurred in healthcare delivery. More and more people are not going to the ED and turning instead to urgent care centers, retail “convenience clinics” (e.g. CVS Minute Clinic) and on-line “direct-to-consumer telemedicine” as a matter of convenience and cost. Furthermore, in the COVID-19 pandemic, people are avoiding going to the ED. (Example: Use of “direct to consumer telemedicine” jumped 700-1000% in 2020. Telemedicine CMS claims jumped 12,000%[26]) Public health information gathering has to change to take into consideration rapid changes in the delivery of care.
Covid 19 presents a unique problem: understanding risk at a community level and understanding risk at a personal level in an emergency that impacts the resources of every part of the nation at once. We have experience and understanding of storms and other regional events.. We know what to do, what to bring in, what to tie down, and what to buy. For example, we have both institutional and personal memories of what wind or water do to your living environment and community. So choices are easier, and communities act more in concert with appropriate behavior (not everyone but most). With Covid there was no institutional memory at the community or personal level. It has been that lack of experience and lack of sound guidance, that has prompted frequent inaction or wrong action. That makes planning even more essential as plans capture institutional knowledge and pans to act.
An essential function of public health is to provide for community communications, accurate information, training and guidance. This was severely complicated in the COVID-19 pandemic by conflicting messages occurring at the national and local levels, the promotion of conspiracy theories and unproven/non-scientific claims and pronouncements. All these things were encouraged by the vacuum caused by a lack of a clear direction and planning. The situation has become dangerous with the politicization of messages and claims. This further deteriorated into social media information wars, protests, disruption of public health meetings and threats against public health officials, employees and their families.
Other public health considerations must address safe housing for vulnerable populations to reduce infection spread and provide care and quarantine when needed.
Ideas:
- Provide direct community outreach/communications by locally driven communication public health providers.
- Inform citizen about the availability and advantages of telemedicine
- Provide vetted, nationally sourced, information (see Critical Issue #1).
- Coordinate information from the experts – public health and local providers.
- Establish communication channels through local clinical providers to deliver vetted public health guidance (i.e. patients trust their providers).
- Offer a system/application to deliver vetted public health guidance through local providers. Keep it local through local providers who have the confidence of the community.
- Consider using local social platforms as a distribution channel to reach certain populations.
- Collect mapping and surveillance data for reporting. Include other care entry points (see Critical Issues# 5 , 6, 7, 9 above)
- Provide shelter and care to reduce infection in vulnerable populations.
- Ensure plans and resources to provide shelter for homeless people, including sufficient structures, isolation and quarantine facilities.
- Transition homeless to medical home and away from reliance on emergency care.
- Consider developing telehealth space and resources for use within homeless housing/shelters (e.g. dedicated private space, internet, computer, camera, HIPAA compliant).
- Provide counseling and behavioral health via telemedicine.
- Protect students and schools.
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- Consider schools as potentially significant infection transmission environments and plan accordingly.
- Understand and compensate for the effect of students going in and out of the classroom and carry the investigation to friends and family in their homes and wherever they have activities.
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