Eight Operational Suggestions for a Renewed CDC | Milbank Quarterly

Authored by Sandro Galea, Lawrence O. Gostin, Alan B. Cohen, and Nicole Lurie.

The arrival of the first COVID-19 vaccines and of new Presidential leadership mark important turning points in the pandemic. President-elect Biden announced Rochelle Walensky, an infectious disease expert, as his nominee for CDC director, and policymakers are turning their attention to revitalizing the Centers for Disease Control and Prevention (CDC) as well as the nation’s public health system at the state/tribal/local level. While a comprehensive blueprint for public health reform will take time, we outline eight key operational steps to revitalize the CDC. CDC’s renewal is imperative after a suboptimal performance during the pandemic, while also being politically undermined by the Trump administration.

Taking the Long View, After a Long Year | Boston University School of Public Health

This has been a difficult, unprecedented year. We have faced significant challenges—as a world, as a field, and as a school community. The COVID-19 pandemic has placed the work of public health at the center of the national, and indeed, global, conversation. Recent political, social, and economic developments have all intersected with our core mission of working towards healthier populations by engaging with the broader forces that shape health, with special regard for the vulnerable and marginalized. It has been inspiring indeed to see how the SPH community has pursued this mission in the midst of challenge, working to strengthen the foundations of justice and equity on which a healthy society is based. As we enter the time of reflection the holidays can bring, some thoughts on what the pandemic has taught us about our approach to health, and how these lessons can inform a vision of a healthier future.

In the months since the emergence of COVID-19, the world has been through some previously unimaginable changes. We have changed how we work, live, and play. Stay-at-home orders and guidance and fear of the virus have restricted where we can go and what we can do, the crisis seeming to stretch indefinitely. We are still very much in the thick of this challenge. Cases and deaths continue to rise and the indications are that this winter will be a hard one. However, as we end 2020, all signs suggest that this moment, too, will pass, that the time is coming when the COVID-19 pandemic will be a matter of historical record rather than of daily struggle. The development of safe and effective vaccines and the efforts currently underway to widely distribute them mark a moment when we can finally say that the pandemic not only will not last forever, but that it will likely not even last until the end of summer. At the same time, the incoming Biden administration represents a chance for a political reset, an opportunity to navigate the end of the pandemic in a way that rejects counterproductive approaches and lays the foundations for a healthier world.

Taking the Long View on Covid-19 | Psychology Today

Overnight, the first Covid-19 vaccines in a Western country delivered outside a clinical trial were given to patients in the UK. Today, we can say, to paraphrase a former British Prime Minister, that we are at the beginning of the end of the Covid-19 pandemic.

In the months since the emergence of Covid-19, the world has been through some previously unimaginable changes. We have changed how we work, live, and play. Stay-at-home orders and guidance, and fear of the virus, have restricted where we can go and what we can do, the crisis seeming to stretch indefinitely. We are still very much in the thick of this challenge. Cases and deaths continue to rise and the indications are that this winter will be a hard one. However, as we end 2020, all signs suggest that this moment will, too, pass, that the time is coming when the Covid-19 pandemic will be a matter of historical record rather than daily struggle. The development of safe and effective vaccines and the efforts currently underway to widely distribute them mark a moment when we can finally say that the pandemic not only will not last forever, but that it will likely not even last until the end of summer. At the same time, the incoming Biden administration represents a chance for a political reset, an opportunity to navigate the end of the pandemic in a way that rejects counterproductive approaches and lays the foundations for a healthier world.

The Privilege Gap and Our Response to the COVID Pandemic | KCET

Authored by Sandro Galea and Nason Maani.

The COVID-19 pandemic has come to define 2020 around the world, and perhaps no more so than in the United States. At the time of writing, there have been over 12 million confirmed US COVID-19 cases and almost 260,000 deaths. In parallel, the likely health and equity costs of social distancing measures are in of themselves large and growing. One of the chief pressures facing leadership at local, state and national levels is the nature and timing of ramping up or easing social distancing measures, such as choosing when to open or close schools, for example.

These are not easy decisions for leaders to make. Each is fraught with uncertainty, resource implications and potential liability. Criticism and pressure come from a variety of sources, such as unions, parents, political opposition, trade associations and advocacy groups. And many of the challenges to the decisions that are being made around how to deal with COVID-19 — be they decisions to relax distancing measures or to expand them, to extend additional support measures or not — have been presented as being based on principle or on a pragmatic concern about risk of COVID-19. We acknowledge that it may well be that both principle and concern about risk are informing our collective decision-making. We suggest, however, that an unspoken factor that underlies many such deliberations is privilege.

How American Health Was Broken Before COVID-19 | Psychology Today

Authored by Nason Maani and Sandro Galea

In recent weeks, there has been an increasing conversation, including in prominent medical journals, about the failure of current U.S. political leadership during the COVID-19 pandemic, the preventable deaths it has caused, and that it is time for a change. These contributions reflect the fact that, as Virchow famously said, “Politics is nothing else but medicine on a large scale.”

Building on the challenges posed by this failure for the COVID-19 moment, we suggest that a fuller assessment of the role of leadership must also include an honest and unflinching assessment of longstanding shortcomings in our country’s health, which also contributed enormously to the challenges of the moment, and in which we all have a hand.

Before the pandemic, U.S life expectancy was lagging behind peer countries, and, uniquely, was declining. It suffered from double the chronic disease burden of the OECD average. It lacked universal health coverage. While some have wondered how the US fared so poorly considering its vaunted biomedical industry, world-leading hospitals, and history of medical innovations, the overall population health of the U.S before COVID-19 was far from the envy of its peers. Why?

COVID-19 Has Deepened America’s Depression | Psychology Today

Authored by Sandro Galea and Catherine Ettman.

“Since the earliest days of the Covid-19 pandemic, this crisis has posed challenges for mental health. As of April, 2020, stay-at-home advisories or shelter-in-place policies affected no less than 316 million people in the US—about 96 percent of the population—making sustained social isolation, for perhaps the first time in the country’s history, a ubiquitous experience. We have for months been physically cut off from family and friends. We have had to learn new ways of interacting, new practices for safeguarding health. Many of us now have had personal experience with the virus, either by contracting it ourselves, or knowing someone who has. Some mourn the loss of loved ones, and we all mourn the thousands who have died from this disease in the US and around the world.
These challenges—the virus itself and the policies we have adopted to contain it—have created a perfect storm for poor mental health. This was reflected by a recent report from the Centers for Disease Control and Prevention, which found during June of 2020 adults in the US reported considerably elevated adverse mental health conditions linked with the pandemic. In particular, racial/ethnic minorities, essential workers, unpaid adult caregivers, and younger adults reported disproportionately poorer mental health outcomes, including elevated levels of substance use and suicidal ideation.”

A national mandatory order to wear a mask would keep people from becoming ‘walking weapons’ | STAT News

Authored by: Amy Lauren Fairchild, Cheryl Healton, and Sandro Galea.

Although we don’t yet know what proportion of new infections are the result of transmission from people who are asymptomatic or pre-symptomatic, we know enough to require everyone, unless they have a medical condition like severe asthma that would make mask a health hazard, to wear a mask anytime they are in indoor public spaces or crowded outdoor spaces.
People infected with SARS-CoV-2, the virus that causes Covid-19, most actively shed the virus at the time symptoms begin. Individuals without symptoms who test positive for Covid-19 show viral loads as high as those with symptoms. Individuals who are infected with the virus can feel fine but still transmit virus for days before they develop any symptoms.
A national mask order can be nuanced. Evidence continues to suggest that indoor aerosol or droplet transmission is key to the spread of the epidemic. A mask probably doesn’t need to be worn while jogging or strolling through a park or lightly populated outdoor area if you won’t be close to other people. But they should be worn in urban areas with heavy pedestrian traffic, during protests, or at political rallies.

Moving From The Five Whys To Five Hows: Addressing Racial Inequities In COVID-19 Infection And Death | Health Affairs

In recent months, states and municipalities have begun releasing data on COVID-19 infections and death that reveal profound racial disparities. In Louisiana, Black patients account for 57 percent of COVID-19 deaths, while making up only 33 percent of the total population. In Wisconsin, Hispanic patients constitute 12 percent of confirmed COVID-19 cases, but only 7 percent of the total population. In New York City, the epicenter of the pandemic in the US, age-adjusted mortality rates are more than double for Black and Hispanic patients (243.6 and 237.7 per 100,000) compared to white and Asian patients (121.5 and 109.4 per 100,000).

In the past several weeks, the nation has been further shaken by the murders of George Floyd, Breonna Taylor, and Rayshard Brooks at the hands of police. A National Academy of Sciences study estimates that Black men are 2.5 times more likely to die from police violence than white men, and Black women are 1.4 times more likely to die from police violence than white women.

We argue that these disparities are linked. Indeed, George Floyd himself recovered from COVID-19. The data call for a reckoning with a simple question: Why?

The non-immigrant visa proclamation is the latest step toward self-destructive othering | The Hill

Authored by Sandro Galea and Nason Maani.

The Trump administration’s announcement earlier this week of the extension of a visa ban to cover non-immigrant visas including H-1B, H-2B and some J and L visas resulted in opposition from leaders in science and commerce, who claimed this would make the U.S. less competitive, hampering science, education, economic growth and job creation.

The presidential proclamation, entitled “Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak,” claims that to allow such “aliens” to enter the country would be “detrimental to the interests of the United States.” This is in contrast to the opinion of most experts, including the editorial pages of reliably business-friendly newspapers like the Wall Street Journal, who suggest that this proclamation would in itself be harmful to the U.S. economy. We agree that this move is self-defeating for a U.S. economy already in dire straits.

The COVID Conversation | Inference

THE ENTIRE WORLD has experienced the COVID-19 pandemic, and within three months of the first recorded case, more than half of the global population was undergoing some form of quarantine. Scientists struggled to make sense of a new, poorly understood disease, and decision-makers scrambled to find data that could help them guide policy. From roughly January 2020 to the present, scientific papers devoted to COVID-19 doubled every fourteen days, for a total of more than 100,000 papers. As the pressure for information increased, the health sciences embraced preprint publication—work that was uploaded to the web without scrutiny.

The global media has been galvanized by the COVID-19 pandemic, with print, video, and audio outlets scrambling for news. This followed a decade-long change in the media landscape. Once dominated by a small number of high-profile outlets, it has become fractured: sound bites, headlines, and video fragments now a part of the public conversation. The new media landscape did not scrupulously distinguish among peer-reviewed papers, preprint uploads, and opinion pieces. A preprint study on COVID-19 seroprevalence in Santa Clara County, California, quickly hit the front pages following its publication on the preprint site medRxiv.1 News outlets reported that the virus had spread “50 to 85 times more than confirmed cases”2 before epidemiologists had the chance to comment on the paper’s many flaws.3 Other stories promoted drugs such as hydroxychloroquine,4 and still others were devoted to predictions from various infectious disease models.5 “2.2 Million People Could Die in US,” claimed one news site, citing a controversial model released by the Imperial College in London.6 Politicians reacted to the rapidly evolving narratives, using fragmentary stories of complicated scientific observations to inform policies that ultimately influenced the lives of millions.

2020: The Great American Trauma | BU Today

“It has been a hard year. We are living through a global pandemic unlike any since 1918, an economic collapse unlike any since 1933, civil unrest unlike any since 1968, and the greatest unexpected loss of life since 9/11. The entire country is living, collectively, through four events that, each in isolation, would suffice to make the year darkly memorable. That the four events are being experienced together represents nothing short of a remarkable collective traumatic experience, one with immediate, short-term, and long-term consequences for millions of Americans.
And yet it’s important to remember. There was a 1919. A 1934. A 1969. A 2002. There will be sun after the dark of 2020.”

Cutting ties with the World Health Organization, Trump endangers global public health | STAT News

“President Trump’s announcement on Friday that the United States will cut ties with the World Health Organization was, he said, aimed at punishing China, which he claimed influenced the WHO to “mislead the world” about the Covid-19 pandemic. Cutting ties with the WHO is exactly the wrong move, at the wrong time. It adds fuel to the public health fire we have been collectively dealing with over the past several months.

The president’s announcement came just a few days after the U.S. had passed the 100,000 mark in Covid-19 deaths. The road to this grim milestone was paved with failures at the federal level to adequately prepare for such a crisis by underfunding the public health organizations tasked with pandemic response followed by the administration’s slipshod efforts to quickly deal with the outbreak when it reached the U.S.”

How conspiracies theories hurt vaccination numbers | Oxford University Press Blog

“Near the end of 2018, 1data released by the Centers for Disease Control and Prevention showed that a small, but growing, number of children in the United States were not getting recommended vaccinations. One in 77 infants born in 2017 did not receive any vaccination. That’s more than four times as many unvaccinated children as the country had at the turn of the century. Some of this may be due to lack of access to vaccines; populations without insurance and those living in rural areas have greater rates of nonvaccination. But part of it is also likely due to the rise of conspiracy theories and the willful dismissal of scientific evidence when it comes to vaccines.

Vaccinations have always provoked anxiety. But the data on vaccines that are in widespread use are now clear: vaccines are safe and save lives. Nonetheless, conspiracism insists that we don’t know all the facts, that things about vaccines are not as they seem. Conspiracism fuels the anti-vaccine movement, nudging people to accept anecdotes (e.g., “I heard about one child who got a measles vaccine and developed autism”) over statistics.”

The coronavirus pandemic will turn into a poverty pandemic unless we act now | The Washington Post

“Discussions about the covid-19 pandemic’s effects tend to focus either on public health or the economy, as if they were two separate matters. But they are linked, and not just by data about the disease’s disproportionate impact on poor and minority populations. The worldwide economic devastation from lockdown policies is sending millions into poverty — increasing their exposure to potential covid-19 infection as well as to the deadly threat that comes simply from being poor.

As challenging — and vitally important — as fighting the pandemic has been, the long-term health costs of an economic depression could ultimately far eclipse what covid-19 has wrought.”

Americans Want Health. Will Leaders Listen? | Thrive Global

Authored by Sandro Galea and Karestan Koenen.

On March 11, 2020 the World Health Organization declared COVID-19 a global pandemic. In the days that followed, schools across the country closed, businesses declared non-essential shut their doors, and Americans were told to stay at home. American citizens met the challenge, altering their entire way of life within days and continuing to uphold these changes 10 weeks and counting. Collectively, citizens changed their behavior for the good of the nation’s health. In remarkably short order, Americans were asked to change their behavior, and we did so, quickly and effectively flattening the curve.

Anyone who has made a New Year resolution knows that changing one’s behavior to improve one’s health is difficult at best. Public health slogans focused on individual behavior change such as “eat less, move more” have not bent the curve for obesity, heart disease, or diabetes. The dramatic declines in motor vehicle-related mortality over the past several decades have not been attributed to better driving behavior, but to seatbelt use, airbags, shatterproof glass, and laws monitoring driving while under the influence of alcohol. In other words, when we have improved health, it has seldom been because we chose to behave differently. This moment is, therefore, particularly important because so many in the past months have changed their behaviors.

Preventing the next pandemic through investment in academic public health | The Hill

Authored by Laura Magaña and Sandro Galea.

“The novel coronavirus pandemic is a public health emergency not seen in our lifetimes. And while we fully endorse calls to redouble our nation’s investment in public health infrastructure, investments in academic public health are just as crucial to ending this crisis and ensuring that we are better prepared for the next one.

Public health schools and programs, which train the workers dedicated to advancing the health of our communities and serve as incubators for innovative public health efforts, have stepped up in meaningful and visible ways during this difficult moment. Epidemiologists, immunologists, virologists and social scientists from public health schools and programs are building our knowledge base about COVID-19, showing time and time again that public health research is more important than ever.”

Uncomfortable conversations about COVID-19 | The Hill

“The relationship between health and income is remarkably clear. Those who are fortunate enough to have higher incomes live longer, healthier lives. The richest among us have life expectancies of more than a dozen years beyond the poorest. The COVID-19 pandemic has laid bare our class divides and points to the imperative of prioritizing health equity as we get past these terrible weeks and months.  

As we describe in “Pained: Uncomfortable Conversations About The Public’s Health,” poverty is a public health problem. The COVID-19 crisis only clarifies the mechanisms by which a new health threat makes the poorest among us the most vulnerable.

The coronavirus highlights three questions: Who gets exposed? Who needs critical care? Who receives care?”

Anxiety as a Public Health Issue | Harvard Business Review

As the Covid-19 pandemic unfolds, many of us are feeling the strain on our mental health. Some people feel anxiety about getting laid off; others have to continue to work at grocery stores and delivery companies, or perform other essential services, sometimes without the protections they need to stay safe. Families are trying to balance caregiving with remote work. We all worry about someone we love getting sick or about getting sick ourselves. There’s also the sudden instability of it all, as the pandemic upends global systems that many took for granted. Meanwhile, the social distancing measures we are taking to slow the spread of the disease have meant weeks of confinement, which brings its own anxieties.

In our concern for the physical risks of this pandemic, it is easy to overlook the mental health burden many of us feel. We may even be inclined to minimize our anxiety, thinking that, compared with what Covid-19 can do to our bodies, its effect on our minds is a lesser concern.

Covid-19 is bad for all, but devastating for the poor | Psychology Today

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Authored by Sandro Galea and Neil Schluger
”Do you want to know your chance of surviving an episode of coronavirus infection? Check the median income of people living in your county. The coronavirus epidemic is providing a dramatic example of the devastation that serious infectious diseases can wreak on large urban populations. Our medical systems are overwhelmed with the sick and dying. As more and more data become available however it becomes clearer that what is really happening is an epidemic of a serious infection layered on top of health disparities that mirror structural inequalities in our society. The consequences of this epidemic are bad for all, but devastating for the poor. We spent recent weeks looking at patients who presented at the Columbia Presbyterian ICU. They painted a striking picture of these health disparities.”

Read the full piece on Psychology Today.

Social scientists can play a key role in stopping the coronavirus | Times Higher Education

“The Covid-19 pandemic has created deep uncertainty about nearly all aspects of daily life. Into the breach of this uncertainty has stepped science. As the crisis has unfolded, scientific groups all over the world have worked quickly to offer their best analysis of the virus. How might it behave? How can we stop it? Can we safely resume our work, and how might we balance the risks from the virus with the pressing needs of our economy? This work has been the lifeblood of policy decisions worldwide.
All aspects of science have been relevant to the current moment, from natural sciences that explore the mechanics of the virus, to social sciences that look at how populations are responding to stay-at-home orders, to the political science that reflects the intersection of policymaking and public health.”

This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.