In an op-ed in Health Affairs, Oxiris Barbot, New York City Health Commissioner and member of the CUNY SPH Dean’s Advisory Council, writes that not only do public health departments need access to widespread, ongoing testing for COVID-19, but that it can only happen with federal support.
In The Fight Against COVID-19, It’s Not Too Late to Fix America’s Public Health System
May 12, 2020
For weeks, Americans have dutifully followed the guidance of public health experts and stayed indoors to slow the spread of COVID-19 and protect the health of their communities.
But with some leaders urging restrictions to be eased—often against the advice of public health authorities—our national public health infrastructure may be tested as never before.
During this unprecedented crisis, we are learning many lessons, and one has become painfully clear: the federal government’s investment in America’s public health system is not keeping pace with our urgent health needs.
The Path Forward
As states plan to reopen in the coming days, I am terrified that local health departments lack the resources to quickly identify and extinguish remaining embers of COVID-19 that could easily spark an accelerated transmission.
To protect communities across the country, we need to make sure public health early warning systems are sensitive enough to detect local microclusters of potential COVID-19, rapidly isolate infected individuals, and appropriately quarantine their identified contacts.
This requires a comprehensive technology infrastructure for real-time data surveillance at the local level to monitor emergency department volume, as well as hospital admissions and deaths for those with COVID-19 or COVID-like illness. Robust data streams that include race and ethnicity are critical for us to better track the populations who are most affected and set in motion aggressive ongoing responses centered on equity. Collecting data on race and ethnicity is an imperative—it should be viewed as essential as monitoring ventilator supply.
The surveillance infrastructure in New York City has matured significantly since the tragedy of 9/11, and we were able to adapt to the new demands presented by COVID-19, such as analyzing near real-time data on race and ethnicity, in a relatively short amount of time. This technology capacity, along with the high level of expertise of our epidemiologic staff, is unparalleled in this country. In times of unprecedented public health crisis, local health departments are our front line. They need the tools to keep us all safe.
In this crisis, data and technology is only half of the story. Establishing effective, humane and ethical systems for safe isolation and quarantine requires equitable solutions—such as alternative housing options—that acknowledge generations of systemic disinvestments in Black, Latino, immigrant, Native American, and low-income communities that are being ravaged by COVID-19.
New York City is ensuring that equity is central in our response in the suppression phase of this pandemic.
For example, as we expand testing, we are focusing on community-based sites and public hospitals—by next week, more than 14,000 people per week in the hardest hit neighborhoods will have access to testing. As we expand contact tracing, we are recruiting applicants to do this important work who reflect the diversity of groups most affected. And as clinical providers reopen, we will provide technical support for community-based care via telemedicine services, including standing up a call center to do wellness checks for people with poorly controlled chronic illnesses in these hard hit communities.
Federal Government Support
Every crisis builds on lessons from the past. If there was ever a moment to make a full and honest change to our public health infrastructure, it’s now. But we must have support from the federal government.
Local health departments have been chronically underfunded, forcing jurisdictions across the country to eliminate more than 55,000 jobs since 2008. This includes disease detectives, public health laboratory scientists, risk communication experts, and emergency managers. Cuts to federal programs for emergency response have stretched local and state budgets, impacting our ability to prepare for threats like COVID-19. Today, state public health spending is actually lower than it was a decade ago mainly because funding from federal, state and local has not increased or been cut.
The public health system cannot just be turned on and off in between crises. We urge the federal government to increase funding for health departments across the country, not only during this crisis, but even more importantly, once it’s behind us.
It should be abundantly clear that public health departments need access to widespread, ongoing testing for COVID-19. That can only happen with federal support. It is inexcusable that there is still no national policy and funding in place to expand testing for COVID-19—a request New York City made back in January and every week since. Before states can safely ease social distancing measures, public health departments need lab capacity for widespread testing. We’re not there yet and we won’t get there without adequate federal attention and support.
The best action we can take to confront a public health emergency is to build essential infrastructure before it strikes. If the federal government invests sufficiently in both emergency preparedness programs and the everyday programs that combat chronic disease, address underlying health inequities, and promote community health, we will be more than ready to tackle the next crisis that comes along, and better protected from its ravages.
It shouldn’t take mass casualties for the federal government to commit to safeguarding the public’s health. The cost of inaction is so clear. When public health systems are willing but unable to address developing threats, families, communities, and the economy suffer unimaginable losses. That should never be a risk we are willing to take.