We are in the midst of one of the greatest public health crises of our lifetimes. Years from now, students from numerous disciplines will study the COVID-19 pandemic and our response, and will most likely focus on “what worked” in terms of policy interventions—like school and business closings or border control—and overcoming operational challenges, such as scaling up testing, increasing hospital capacity, and changing clinical workflow to protect patients. They will also, of course, examine the biology of the virus and the epidemiology of the disease. Studying these critically important issues will improve our response to the next pandemic (and there will, of course, be another one).
But to get a truly clear-eyed picture of what went right and what went wrong—and how we can do better next time—there are other, bigger-picture questions we must also address.
One thing we already know: The U.S. federal government—and some state and local governments—were too slow to respond, despite the evidence of the pending crisis and the urging of a majority of experts. So, how can policymakers be prompted to act if evidence and experts are not enough? What are the most effective ways to frame the evidence, and how do we understand the various levers at play? It is one thing to push evidence-informed policymaking for issues when there are months or even years to deliberate. But it’s quite another when days, and even hours, matter.
We must also, of course, better understand how to more effectively engage the general public in embracing self-sacrifice for the collective good. Social distancing is definitely not easy, and many are still refusing to do it, even though the evidence is clear that it will protect the most vulnerable among us. I don’t believe selfish behavior is an inherent part of our culture—just witness the selfless responses to major natural disasters.
These are difficult questions, but there is perhaps an even more complicated one that also demands our attention: How do we balance the immediate health dangers of an infectious disease against the long-term health dangers of restricting economic activity? Consider, for instance, the resulting food insecurity, housing instability, and sharply increased economic stress, all of which can have a very real impact on morbidity and mortality. I’m sure that analysts will count the economic toll of COVID-19, but it’s incumbent upon us to also track the health consequences of the economic impact, separate from the direct effects of the disease. And we desperately need a framework for how to balance these competing needs. The real solution, of course, is the creation of an economic system with a strong social safety net in which no one is insecure from short-term shocks to the system.
Several years ago, I was having a conversation with health policy colleagues from across the world, and the topic was why other industrialized countries could achieve universal health coverage when the United States couldn’t. The general consensus was that the U.S. lacked a sense of social solidarity—a shared feeling that binds us together as a cohesive unit. This is probably true, but as the pandemic demonstrates, public policies like universal health care and paid sick leave can serve self-interest as well as a shared community interest. The lack of these policies has further fueled the pandemic’s spread in the U.S. How many sick individuals went to work because of economic necessity? How many avoided seeking care because of potential costs? We need to know how much our current health care policies have exacerbated this crisis, which might help us get over the hump to universal coverage and access to care.
Before we look too far into the future, it’s important to acknowledge now the heroic work of the health care and public health professionals who are on the frontlines of the crisis, as well as all the human service agencies that are working tirelessly to support the rapidly growing ranks of the needy. I also commend the institutions that took early, decisive (and, at the time, controversial) action to stem the spread of the virus. I’m hopeful that we will eventually emerge from this crisis. Let’s also hope that, when we do, we are wiser and better prepared for the next time.
This commentary first appeared in the spring issue of UHF's Blueprint newsletter.