Don’t be lulled by the waning of COVID-19 — emergency preparedness is as crucial as ever
July 10, 2023
By Syra Madad, DHSc, MSc, CHEP, David Silvestri, MD, MBA, MHS
Even though the worst of the COVID-19 pandemic is behind us, we cannot go back to the way things were pre-pandemic.
Recent news may give the impression that COVID-19 is done with us. The United States ended its national COVID-19 public health emergency on May 11. A week earlier, the World Health Organization (WHO) declared(opens in new tab/window) the virus is no longer a public health emergency of international concern, and on the same day, the director of the Centers for Disease Control and Prevention (CDC) submitted her resignation, citing the waning of COVID-19 in her transition.
While like a grand finale, these cascading events can suggest the end to COVID-19, it is important to note that the end of the public health emergency declaration does not mean the pandemic is over, nor that vigilance about COVID-19 or other emerging infectious disease threats is no longer needed. In fact, COVID-19 remains one of the leading causes of death in the US, contributing to over 500 weekly deaths according to latest CDC data(opens in new tab/window).
Nevertheless, the situation is thankfully far less dire than it was during the height of the pandemic, when the nation hit a record high of 23,000 weekly deaths(opens in new tab/window) from COVID-19 in January 2021 and record-high COVID-19 hospitalizations during the initial Omicron variant surge in January 2022. Moreover, the overall severity of disease caused by COVID-19, as measured both by risk of hospitalization and death, has significantly declined over the last three years, thanks in large part to more immunity from vaccines and prior infections, and the advent of highly-effective therapeutics.
Therefore, given our emergence from the worst phases of the pandemic, we, as emergency managers, support the US and WHO decisions to end the emergency declarations made last month, but recognize and emphasize that we cannot — indeed, must not — simply go back to the way things were pre-pandemic.
Even as this generational emergency is now declared “behind us,” we cannot ignore nor revert to deprioritizing the continued potential threat to us posed by infectious pathogens, be it a resurgence of COVID-19 or another emerging health threat, of which there are many. It is this “pre-pandemic” complacency — uncharacteristic of our nation’s vigilance toward other national security threats, where we spend nearly 300 to 500 times(opens in new tab/window) more on our military defense(opens in new tab/window) than we do on our health defense(opens in new tab/window)— that set us up for one of highest per capita deaths rates(opens in new tab/window) from COVID-19 among all nations worldwide, and which will keep us vulnerable unless we prioritize and strengthen our health defenses.
If we are to take anything away at this moment of closure, it is that health system preparedness is critically important but not a given. Whether firsthand or in the news, we have borne witness in the last three years to the devastating consequences of under-preparedness, be it from shortages of personal protective equipment (PPE), runs on medications, or overwhelmed hospitals. These consequences did not happen without reason, nor in hindsight were they unforeseeable. They were the natural outpourings of our market-driven, just-in-time national healthcare system routinely operating at the margins, where success can be measured by competitive advantage, and costs of preparedness can feel like deadweight.
What do we need to be prepared?
For us to emerge from this public health emergency as a nation prepared, we need an all-hazards, holistic and structural approach that addresses this major market failure of our US healthcare system by fundamentally incentivizing hospitals and healthcare systems to invest in a range of preparedness strategies and activities. These include routine and comprehensive risk assessment and mitigation; infrastructural planning and resource management, including scalable diagnostic and therapeutic capabilities; emergency compensation and contracting; strategies to strengthen workforce training and exercising; and upgrades to health communication strategies and technology, among others. These strategies and activities do not come without cost, but their vitalness is the lesson of the last three years.
Take, for example, the costs in sourcing and stockpiling personal protective equipment (PPE) for healthcare workers and patient safety prior to the pandemic. The costs of procurement and storage, limited shelf-life, and low expectation of PPE usage prior to the pandemic created little incentive for individual hospitals and health systems to maintain deep PPE stockpiles. As such, they were underprepared for the surge in consumption and bidding wars that ensued with the pandemic, which one analysis(opens in new tab/window) found to cause nearly a threefold increase in spending on PPE by hospitals nationwide during the first year of the pandemic.
Or take infrastructural preparedness. Given the large price tag of capital projects, hospitals and health systems have little incentive to create or upgrade space and facility capabilities to accommodate for what may be perceived as otherwise low-likelihood shocks. As such, across the nation, our Emergency Departments and Intensive Care Units are scaled to today’s demand, not tomorrow’s potential pandemic. The costs of maintaining and upgrading excess capacity to “be ready” are high, and so as a nation, our hospitals largely remain vulnerable to surge events — even post-pandemic.
The hard truth is that under-preparedness is not a hospital or health system fault alone but rather the fault of the market-driven health system. Under-preparedness is exactly what we would expect from such a system. And the role of government is to provide public goods where the market cannot or is not. While the federal government has ended the public health emergency for COVID-19, the investments in preparedness must continue, even intensify.
The COVID-19 pandemic has been a defining moment in our history, and as we’ve emerged out of its emergency phase, we must not disregard its continued presence among us, nor ignore the lessons we have learned from it that bear impact on our actions as a nation after the emergency. Hospital and health system preparedness is vital; federal, state and local government must continue playing a heavy role in creating incentives for such preparedness where markets fall short. And all of us have an obligation to remember these years and not take preparedness for granted.
Dr Syra Madad(opens in new tab/window) is on the faculty at Boston University's Center for Emerging Infectious Diseases Policy & Research, a fellow at the Harvard Belfer Center for Science and International Affairs and Senior Director of the System-wide Special Pathogens Program at NYC Health + Hospitals(opens in new tab/window).
Dr David Silvestri(opens in new tab/window) is Senior Assistant Vice President of Emergency Management; Attending Emergency Physician, and Medical Director of Utilization Management & Transitional Care at NYC Health + Hospitals(opens in new tab/window).