Underfunded and under threat

‘At least 29 US states have passed laws, enacted other initiatives, or succeeded in lawsuits that permanently weaken state and local government authority to protect public health, and similar efforts are pending in multiple other states. The analysis was published by Kaiser Health News and the Associated Press as part of their ongoing series “Underfunded and Under Threat,” which examines how US public health systems were unprepared to confront the COVID-19 pandemic and face ongoing politicization, funding cuts, and other hindrances. Legislators in at least 16 states have limited public health authorities’ ability to issue mask mandates or quarantines or isolation orders, and in some cases, legislatures gave themselves that authority or shifted it to other elected officials. In at least 17 states, lawmakers passed legislation banning SARS-CoV-2 vaccine mandates or passports or facilitated opt-out options. And in at least 14 states, new laws, executive orders, or court rulings ban or limit mask mandates. 

‘Proponents of the new measures argue that they are a necessary check on executive powers, particularly for appointed officials, and give lawmakers a voice in public health emergencies. Public health officials and experts have expressed frustration with these efforts and warned that the consequences of these actions will extend far beyond the current pandemic. These new limits could also impact public health officials’ ability to prevent and contain future outbreaks for any number of communicable diseases. At least 303 state and local public health department leaders have resigned, retired, or been fired during the pandemic, according to the analysis.’ Johns Hopkins Center for Health Security e-newsletter 

• Public health officials face wave of threats, pressure amid coronavirus response (June 12, 2020). Read here
• Pandemic backlash jeopardises public health powers, leaders (Dec 15, 2020). Read here
• Hollowed-out public health system faces more cuts amid virus (July 1, 2020). Read here
• Politics slows flow of US pandemic relief funds to public health agencies (August 17, 2020). Read here

Read here (KHN & AP, as at Sept 17, 2021)  

Equity in vaccination: A plan to work with communities of colour toward Covid-19 recovery and beyond -- Introduction

‘The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. The number of cases, hospitalizations, and deaths related to this disease is significantly higher in these groups. Additionally, members of BIPOC communities are among those hit the hardest by the economic and social upheavals caused by the pandemic.

‘As the COVID-19 vaccination campaign begins, it is critical that vaccines be delivered fairly and equitably—so that everyone has the same level of access to this lifesaving technology. Just as pressing is the need to address longstanding disparities that have created the unequal situation that BIPOC communities are now in.

‘This plan provides elected and appointed officials with the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts, prevent even more health burdens, lay the foundation for unbiased healthcare delivery, and enable broader social change and durable community-level opportunities.

‘The 5 key principles and their associated action items in the plan are:

‘Iteration: Repeated engagement with BIPOC communities is necessary. There is a race to get as many people vaccinated as soon as possible, and this urgency must be balanced with the need to build real trust in BIPOC communities. In many areas, this trust is low or nonexistent, which means that building trust will take time. It will require committing to engaging with BIPOC communities, including organizing productive “listen-and-plan” sessions in which community members have the opportunity to explain their thoughts on COVID-19 vaccination and where officials have the opportunity to listen and hear what is being said, and in partnership, put these ideas into action.

 ‘Involvement: Moving forward, BIPOC community representatives and advocates must become active collaborators in the public health process. This will involve implementing mechanisms for 2-way communication (particularly with trusted leaders, influencers, and pillar institutions in local BIPOC communities) and engaging with these key representatives as partners, not as audiences to persuade or subordinates to command. One way this can be done is by encouraging BIPOC individuals and community organizers to actively participate in the COVID-19 vaccination campaign in ways that respect their self-determination and strengthen their self-reliance. A longer-term approach is to ensure BIPOC individuals are in positions of power in government and public health.

 ‘Information: Effective communication with BIPOC community members is essential in the ongoing COVID-19 vaccination effort. Applying best practices for communication during this time will be useful for moving forward. As a starting point, it is important to recognize that vaccination messages must be tailored to address the specific concerns of local BIPOC communities. This can be done in one of the following ways (or through a combination of these approaches): identify and support trusted BIPOC individuals and organizations who can relay information and help set community norms related to COVID-19 vaccination, apply learning from “listen-and-plan” sessions to frame COVID-19 vaccination in the communities’ own terms, and enlist allies to blanket BIPOC communities with accurate information that can drown out misinformation.

 ‘Investment: All of the efforts described above will require investments of time, attention, and funding. At the same time, the vaccination process itself can be viewed as an opportunity for economic revitalization, with the potential to lead communities out of the pandemic and its economic hardships. This type of revitalization is particularly important to BIPOC communities that historically, and presently, are often economically challenged. Practical suggestions for investment include: pull together the necessary resources to ensure COVID-19 vaccination is equitable (meaning, easily available to the most marginalized individuals in the community) and then fight to keep these resources in place moving forward; creatively finance nonprofit and for-profit entities with BIPOC community roots to strengthen the vaccination enterprise; and enlist the help of private capital to support vaccination, for example, by getting transportation companies to commit to providing free rides to and from vaccination sites or by having a local grocery store sponsor a “get vaccinated” poster contest for schoolchildren.

 ‘Integration: Looking forward to the end of the pandemic, it is important to recognize that recovery will take time. COVID-19 will have long-lasting physical, psychological, and financial effects, especially in BIPOC communities. Because of this, the COVID-19 vaccination campaign cannot be viewed as a final step in returning to “normalcy.” Instead, it needs to be seen as a step toward a more complete recovery that can, and should, include meaningful social change. This can take place as the recommendations outlined above—including “listen-and-plan” sessions, empowering BIPOC individuals and communities, and investing in equitable public health—are integrated into ongoing community initiatives and as government and public health officials commit to ensuring durable social change and community benefits that include adequate housing, food security, living wages, and leadership opportunities.

‘This approach will be challenging. Some may argue that a lack of time or funding or interest are barriers that make such an approach unrealistic, especially in the middle of a pandemic that is challenging on every front. However, it is important to keep in mind that challenges like the one we are currently facing often stem from social inequity and provide opportunities to change and improve. Some actions may be more appropriate to prioritize in the near term, but many actions that are crucial for the long term will have more of an overall impact if those efforts are initiated now.

‘COVID-19 vaccination is the most likely way out of the current pandemic. It is also an opening to create equity and durable benefits for BIPOC communities, who have been devalued and too often cut out of opportunities in the United States. We hope that you consider this and the specific recommendations made in this report as you begin to implement COVID-19 vaccination campaigns in your own towns, cities, and states.’

Download PDF here (John Hopkins Center for Health Security, Feb 09, 2021) 

CommuniVax: A coalition to strengthen the community’s involvement in an equitable vaccination rollout

‘CommuniVax is a national alliance of social scientists, public health experts, and community advocates who seek lasting solutions to a serious problem: in the United States, historically underserved Black, Indigenous, and Latino populations have endured negative health and economic impacts from the COVID-19 pandemic at tragic and disproportionate rates. While these communities could benefit greatly from safe and effective COVID-19 vaccines, longstanding biases and barriers hinder their access to and acceptance of vaccination.

‘The coalition is strengthening national and local COVID-19 vaccination efforts in the United States by putting communities of color at the center of those endeavors. The coalition is listening to Black, Indigenous, and Latino/Latinx individuals on how best to promote awareness of, access to, and acceptability of COVID-19 vaccines in their respective communities; and developing longstanding, local governance systems that enable underserved groups to exercise collective agency over their own health and wellness, during this pandemic and going forward. Funding for CommuniVax is provided by the Chan Zuckerberg Initiative.

‘CommuniVax relies on efforts from 3 groups: local teams, a central working group, and national stakeholders.

• Local Teams are composed of resident researchers, grassroots leaders, and public health implementers. They will engage local communities of color to identify improvements needed to vaccine delivery and communication strategies in their communities.
• The Central Working Group includes experts in public health, public policy, medical science, anthropology, and public involvement. With input from diverse stakeholders, the working group will coordinate the local research processes and ensure the implementation of findings nationwide
• National Stakeholders represent groups with political, technical, cultural, and social justice perspectives on vaccine delivery and uptake. These associations will amplify information generated from local teams within their networks and provide feedback to the central working group.

Read here (John Hopkins Center for Health Security, Feb 2021)

Crisis standards of care: Lessons from New York City hospitals’ Covid-19 experience

‘The purpose of this project was to convene a forum in which critical care physicians from a number of hospitals across New York City could frankly discuss their experiences with implementation of crisis standards of care (CSC). The Johns Hopkins Center for Health Security, in collaboration with New York City Health + Hospitals, convened a virtual working group in October 2020 consisting of 15 New York City intensive care unit (ICU) directors.’

Major themes discussed and suggestions moving forward are contained in the 23-page report.

Read here (The Johns Hopkins Center for Health Security, Nov 24, 2020) 

WHO head has singled out one developing country for its success in managing the coronavirus pandemic

‘Thailand’s numbers “speak for themselves,” said Tedros Adhanom Ghebreyesus in closing remarks to the World Health Assembly, which took place this week. Thailand was the first country outside China to report a case of COVID-19, but to date it has counted fewer than 4,000 cases and just 60 fatalities, despite having a population of 70 million and one of the world’s biggest and most tightly packed cities in Bangkok. By comparison, the U.K., with a population of about 68 million, has had 1.3 million cases and 51,396 fatalities, according to data aggregated by Johns Hopkins University.’

Read here (Market Watch, Nov 23, 2020)

Johns Hopkins calls for papers on Covid-19 and systemic racism

‘The Johns Hopkins Center for Health Security’s journal, Health Security, issued a call for papers for an upcoming Special Feature on systemic racism in the context of the COVID-19 pandemic (scheduled for May/June 2021). The COVID-19 pandemic’s impacts on health, economies, and social structures have disproportionately impacted racially marginalized populations. Racial and ethnic minority communities are experiencing elevated COVID-19 morbidity and mortality, stemming in part from ineffective response efforts and longstanding barriers to accessing healthcare and public health programs and services. Evidence-based and peer-reviewed research is urgently needed to examine the root causes and impacts of systemic and pervasive racial and ethnic inequities in the context of COVID-19 as well as how systemic racism manifests in the practice of health security, including in preparedness for, response to, and recovery from COVID-19. The journal is actively encouraging submissions from women, underrepresented minority scholars in health security, and scholars with disabilities.’

Read here (Johns Hopkins Center for Health Security, Oct 23, 2020)

Tamil Nadu and Andhra Pradesh study: (1) 8% of the detected Covid-19 cases accounted for 60% of the transmission (2) Transmission among individuals of approximately the same age was highest among children under 15 years old and adults 65 years and older

‘A study published in Science analyzed surveillance and contact tracing data from two South Indian states, Tamil Nadu and Andhra Pradesh, collected through August 1. This is one of the few studies that captures the epidemiology of COVID-19 in low- or middle-income countries on a large scale. Together, these states account for approximately 10% (127.8 million) of India’s national population, and they contain the most robust healthcare workforces and public health infrastructure in the country. The study provides a detailed look at the timeline and growth of the COVID-19 epidemics in these states, including incidence and mortality.

‘The researchers found that the majority of cases (71%) did not result in secondary transmission to any of their contacts identified through contact tracing efforts. Based on data collected from more than 600,000 cases and contacts, the researchers estimate that 8% of the detected COVID-19 cases accounted for 60% of the transmission, providing further evidence that super-spreading events play a major role in the COVID-19 pandemic. The researchers also identified that transmission among individuals of approximately the same age was highest among children under 15 years old and adults 65 years and older. While the researchers were not able to determine the degree of transmission from children to adults, the study results support that pediatric cases do play a role in the ongoing pandemic. Overall, the case fatality ratio was 2.06%, and generally increased with age; however, unlike the US, mortality tended to plateau rather than increase in individuals 75 years and older. The reasons for this trend are uncertain. Additionally, the median hospital admission time before death was 6 days.’

Read here (John Hopkins Newsletter, Science, Sept 30, 2020)

Johns Hopkins and Bloomberg Philanthropies, with New York State, launch online course to train army of contact tracers to slow spread of COVID-19

‘To support the effort, the Johns Hopkins Bloomberg School of Public Health has developed the contact tracing course that is available for registration on the Coursera platform starting Monday, May 11, 2020. It is open to anyone in the world, whether they are interested in becoming a contact tracer or just want to understand the process. Applicants in New York state will be invited to take the course after their application is reviewed and they pass an initial interview. The interview, followed by taking the course and passing the final assessment within 72 hours, will be required to be hired into the New York state program.’

Read here (John Hopkins, May 11, 2020)

National action plan for expanding and adapting the healthcare system for the duration of the Covid pandemic

This 24-page report by the Johns Hopkins Center for Health Security offers answers and recommendations related to the following problems, for which there are tractable solutions:

• How can we improve infection prevention in hospitals and maintain a robust supply chain for personal protective equipment (PPE)?
• What approach should we take to restarting deferred healthcare services?
• What financial support is needed for hospitals and healthcare providers?
• How should the healthcare workforce be sustained and augmented?
• How can we provide mental health support for healthcare workers in this crisis?
• How can we provide medical care and sick leave for all people in the United States?
• How can we make telemedicine a new normal?
• How can we reduce the number of undiagnosed infectious diseases in our hospitals?
• How can we better protect emergency medical services (EMS) personnel from infectious diseases?
• How can we better coordinate the healthcare response to COVID and the next pandemic?

Read and download here (Johns Hopkins Center for Health Security, May 5, 2020)

Developing a National Strategy for Serology (antibody testing) in the United States: Publication by John Hopkins

‘Serology tests will be an important tool for public health workers to estimate the prevalence of disease. These tests will be in high demand by individuals who hope to assess their risks of immunity to SARS-CoV-2. Serology testing, among other nonpharmaceutical interventions, can help to bridge the time before a vaccine is available. However, validated, accurate tests are currently in short supply. In this report, we seek to draw attention to the options for expanding access so that the potential benefits of serology tests can be realised as soon as practicable.’

Download here (John Hopkins Center for Health and Security, April 22, 2020)

Public health principles for a phased reopening during COVID-19: Guidance for US governors

‘This document provides an assessment of the risk of SARS-CoV-2 transmission in a variety of organisations and settings that have been closed. We outline steps to reduce potential transmission during the reopening of these organisations and settings, building on the proposed phased approach from the National Coronavirus Response: A Road Map to Reopening. Reopening businesses and other sectors represents one of many steps that will need to be taken to revitalise communities recovering from the pandemic, restore economic activity, and mitigate the unintended public health impact of the distancing measures that were necessary to confront the epidemic of COVID-19. A discussion of larger community-wide considerations for holistically enhancing recovery can be found in the Appendix.’

Download here (John Hopkins Center for Health and Security, April 17, 2020)

John Hopkins produces a 15-page ‘national plan to enable comprehensive COVID-19 case finding and contact tracing in the US’

It says ‘to manage COVID-19 epidemics going forward, communities in the United States need:

1. Ready access to rapid diagnostic tests for all symptomatic cases or those with a reasonable suspicion of COVID-19 exposure;
2. Widespread serological testing to understand underlying rates of infection and identify those who have developed immunity and could potentially return to work or school without fear of becoming infected; and
3. The ability to trace all contacts of reported cases.’

Download here (John Hopkins Center for Health and Security, April 10, 2020)