COVID-19: Why it could affect public health for years to come

Vacines notwithstanding, health care experts expect major long-term consequences
Credit: (AP Photo/Matt Rourke)
Feb. 12, 2021: On the boardwalk in Atlantic City

A year after officials reported the first case of COVID-19 in New Jersey, the numbers of cases, deaths and hospitalizations tied to the virus are declining. Demand continues to outpace supply for coronavirus vaccines, but hundreds of thousands of doses are expected to ship in coming weeks and the state’s goal of immunizing 4.7 million people by this summer seems possible.

Gov. Phil Murphy said on Wednesday that by Easter, on April 4, “We will be in a dramatically, quantum different place” adding that, “One year in, we can finally see the light of a new day beginning to break on the horizon. We cannot yet bask in that light, but make no mistake, we will.”

But reaching that new day will take time and further commitment, according to many experts, who stress that other actions will be needed in the months and years to come to effectively protect New Jerseyans, and residents nationwide, from the novel coronavirus.

They also worry about the psychological damage the pandemic has inflicted on some groups — including frontline health care workers and communities of color — and underscore the need for more investment in public health systems so we are better protected from future possible pandemics.

The next epidemic?

“There will be another epidemic within ten years,” said Stephen Crystal, a research professor, aging expert and director of Rutgers University’s Center for Health Services. While the next outbreak might not be as lethal, society needs to be better prepared, he said.

More than 800,000 COVID-19 cases have been diagnosed in New Jersey since last March, according to state data, including nearly 23,500 fatalities, and the crisis has caused widespread personal and economic loss. The state has so far administered nearly 2.3 million doses of the COVID-19 vaccine; almost 800,000 people have received the recommended two shots of Moderna and Pfizer-BioNTech vaccines, with the one-shot Johnson & Johnson vaccine now also being distributed; the Murphy administration’s aim is to immunize 70% of the eligible adult population.

COVID-19 shots will likely become the norm, with clinicians recommending a booster shot every year or so, experts agree. Some anticipate proof-of-vaccine cards will become a routine part of things like airline travel, but that with widespread inoculations, natural immunity and other public health protections, society can safely reopen.

Credit: (AP Photo/Jeff Chiu)
File photo: A nurse prepares a dose of Moderna COVID-19 vaccine.

“I would lean on the optimistic side [when considering the future]. But the optimistic side doesn’t mean COVID will go away immediately. It’s going to be endemic,” Crystal said.

Vaccines alone not enough

Vaccines alone will not be enough to protect society, public health leaders stress. Not everyone can be immunized and mutations in the virus create new challenges, they note. Face masks, regular hand-washing, social distancing and other time-tested practices must be part of the strategy to contain COVID-19 and other infections for months, if not years.

Dr. Antony Fauci, the nation’s COVID-19 tsar, recently suggested the U.S. could see a “significant degree of normality” in social life by the fall but mask-wearing should probably continue into 2022. Some states, like Texas, have started to lift mask mandates, decisions Murphy called “stunning” in his press conference Wednesday.

“The whole social norm should change” when it comes to masks, Crystal said. Not only would this help to protect against COVID-19, he said, but it would also curb the spread of flu virus, which has had limited impact during the pandemic — something scientists attribute to the coronavirus-related protocols in place.

“We shouldn’t go back to where we were, ever. We should normalize wearing masks when we’re in public places,” Crystal said.

The state and national public health infrastructure also needs additional and sustained support, experts stressed. Years of underinvestment have left local and county offices short-staffed and technologically outdated, issues the pandemic exposed.

Overhauling public health infrastructure

“I think we have really bolstered up our public health infrastructure” as part of the pandemic response, state health commissioner Judy Persichilli told NJ Spotlight News in a recent interview. “That, in my opinion, is the best thing that’s come out of this.” State and federal leaders have committed millions of dollars over the past year to hire and train contact tracers, expand disease tracking and reporting systems, enhance laboratory capacity and take other steps to fill the gaps.

Persichilli said these pandemic-related investments allow the state to “be prepared if this ever happens again,” but will also prove useful with smaller, more localized outbreaks. “Public health infrastructure has been so decimated over the years, nationally and certainly in New Jersey, and we have really bolstered up what happens closer to the public,” she said.

Credit: (Rich Hundley III, the Trentonian)
File photo: Health Commissioner Judith Persichilli at a state briefing on the coronavirus pandemic in May, 2020

A critical part of that infrastructure is the health care workforce itself, which has experienced significant trauma battling the deadly virus, a situation that many say was compounded by a lack of critical resources. In New Jersey and nationwide, health care facilities of all kinds were faced with unprecedented staff shortages and a dangerous lack of masks, gloves and other protective gear — something Persichilli, a longtime hospital administrator, called “unimaginable, especially in the richest country on earth.”

Initial studies suggest that at least half — and possibly far more — of these frontline caregivers are now suffering post-traumatic stress disorder, anxiety or other mental health issues. “The stress on staff has been toxic from the beginning,” according to Dr. Shereef Elnahal, president and CEO of Newark’s University Hospital, a regional hub for COVID-19 care, and former state health commissioner.

The sickness, death and economic hardship generated by the pandemic have also resulted in behavioral health challenges for members of the community, experts note. Elnahal said this shows up in the unprecedented need for one-to-one monitoring at the hospital, in which someone is assigned around-the-clock to track a patient who is suicidal or violent toward others.

“We’ve had to step up and really invest in people’s health and well-being,” Elnahal said, with things like free counseling sessions, but also by providing child care and hot meals. Programs designed to address mental health needs among health care workers and the population at large must continue to be prioritized in the years to come, he said.

Long-standing inequities

The public and private sector both need to direct additional resources to programs that address long-standing inequities in health care, experts agree. This includes spending on chronic conditions that have an outsize impact on underserved communities, like certain cancers, and working to reduce disparities in insurance coverage and access to primary care doctors and other preventive medical care.

“The underinvestment in public health in general and in the social safety net in particular … is not practical even from a financial point,” Rutgers’ Crystal said, since keeping people healthy reduces future medical costs and benefits communities in economic and other ways.

Many hope that the racial gaps exposed by the pandemic, and magnified by the social justice struggles following the death of George Floyd last summer, highlight the need for additional focus on the social determinants of health — underlying factors like poverty, housing and education. Some advocates are working to translate the empathy generated for essential workers, like those stocking store shelves and delivering food, into policy actions that provide lasting change.

“I think for the first time, people (in more affluent communities) are starting to understand the health and well-being of people of color in urban communities has a direct effect on their own health,” Elnahal said. “We’re all better off if the general population is healthier — and that includes the most vulnerable.”

“It’s much easier to connect that bridge than it was before,” Elnahal added. “That’s one silver lining of all this.”

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