Op-Ed: An ER Doctor’s Perspective on How to Safely Reopen and to Prepare for the Next Health Threat

Key to recovery is understanding — and balancing — community context, economics, education, physical environment and health care systems
Dr. Novneet Sahu

New Jersey has the highest population density in the country, but that’s only part of our COVID-19 story.

The road to recovery must be paved with a holistic understanding of the five key areas of social determinants of health: community context, economics, education, physical environment, and health care systems. Our leaders must balance all these factors in order to produce COVID recovery plans.

To address the first social determinant, community context, we need to evaluate how resilient our communities were in the face of this challenge, so that we can prepare for a second wave — or a new pandemic. COVID-19 will not be the last pandemic we see in our lifetimes. We need to start preparing for a new threat now.

At the outset, New Jersey responded quickly by emphasizing social distancing, enacting a stay-at-home order, and closing nonessential businesses.

Although “quarantine” has weighed heavily on society, Gov. Murphy made the right decision — our high population density necessitated this response and countless lives have been saved as result of these actions. However, we need to continue to pursue robust contact tracing, a necessary and lifesaving protocol that will help us slow the spread of the virus. Gov. Murphy is starting to ramp up these efforts, but there’s still much work to do in order to pursue robust contact tracing.

Moving forward, our leaders must consider the social determinant of economics by addressing the significant impact COVID-19 has had on our workforce. More than 1.1 million New Jersey residents have filed for unemployment since March.

Balancing the risks

Providing adequate financial support for those who have lost their jobs is essential. We need to ensure our current economic disparities are not widened as a result of this public health crisis. However, the state needs to balance the risk of reopening businesses with the risk of increased transmission of COVID-19.

More and more people are speaking out against the restrictions that are meant to keep us safe. That’s why education, the third key social determinant, must be integral as New Jersey reopens.

Holding daily press briefings may no longer be the best way for elected officials to inform the public on how to protect themselves from COVID-19. People need to be able to access and apply this information rapidly, so health communication and education should be community-based.

The state should make a more concerted effort to partner with municipal leaders to ensure that we are reaching people across the Garden State, in a language and format they can access and understand.

New Jersey’s housing infrastructure also plays a significant role in the transmission of COVID-19. A person’s physical environment, another key social determinant, can have a huge impact on their level of exposure to this virus. For example, people who are homeless or reside in a long-term care facility account for more than 40% of all COVID-19 deaths statewide.

Increasing the availability of quality housing and improving environmental conditions in long-term care facilities can reduce the impact of the current pandemic and prevent a future crisis.

To further protect New Jersey’s most vulnerable, we also need to consider the fifth and final social determinant, health care systems, and how they are functioning to meet patients’ needs.

No more crowded clinics

Prior to COVID-19, patients primarily accessed routine care in a hospital or clinic. Going forward, people will need to continue to be able to utilize telemedicine and local place-based care initiatives, rather than crowding into clinics where the threat of disease transmission is greater.

As an emergency room doctor at University Hospital in Newark, I have seen firsthand the impact COVID-19 has had on disadvantaged communities. I also serve as a primary care physician in Newark, so I understand the long-term implications a crisis like this can have on urban community health as a whole. That being said, I have hope that if we utilize scientific data to plan effectively, we can prevent another outbreak of this magnitude.

During COVID-19, I’ve seen the widening of health inequities due to social determinants of health barriers. The long-term impact is that we may not be able to resolve these gaps, which will worsen our health care disparities.

I’ve seen the COVID-positive service worker who faced two pressures: first as an essential employee unable to work from home and second as an undocumented immigrant who must keep working in order to feed his family because he was ineligible for employment assistance programs.

I’ve seen the many patients, often arriving three to four at a time from nursing homes, with COVID symptoms that are so severe that they required immediate critical care interventions upon coming to the emergency department.

During the height of the pandemic, each shift, I took about 10 to 15 calls from paramedics out in the field for people pronounced dead. These patients were people we knew as homeless and/or chronic-disease patients with diabetes, heart failure, lung disease, mental health issues, etc., who were unable to connect with timely health care during COVID. These are patients who historically have suffered health inequities due to their social determinants of health and COVID-19 amplified that problem.

Our leaders must use these five social determinants — community context, economics, education, physical environment, and health care systems — to inform the next steps on the road to recovery. It’s the only way we can confidently reopen New Jersey.