Predicting U.S. public health impacts of COVID-19

We’re all living through an unprecedented moment as everyone works to navigate through the COVID-19 crisis. For the U.S. federal government, the stakes are incredibly high. Agencies are working to justify where to focus both in the short- and long-term in order to mitigate further spread of the virus and better prepare the nation for future pandemics. 

And while it’s difficult to truly predict what the future will hold given the rapidly evolving situation and how volatile COVID-19 is, there are observations we can make drawing from our experiences and the government’s response to past national disasters. 

What we see now 

Now and over the next few months, the U.S. government’s mandate is clear. We have already started to see resources, funding, and focus being put towards: 

Surveillance and analytics

Better understanding of COVID-19’s prevalence, transmission, and treatment is the only way to truly fight the virus. Improvements to syndromic surveillance through the incorporation of lab-testing data will need to be made in the short term. In fact, the CDC’s Emergency Operations Center has already started to optimize the performance of BioSense—the CDC’s platform for nationwide syndromic surveillance—in order to maximize throughput, harden security measures, and expand the infrastructure to absorb the surge in nationwide usage. 

Additionally, agencies are beginning to analyze the impact the pandemic and physical distancing is having on other aspects of well-being such as mental health, suicide prevention programs, access to care for non-COVID-19 illnesses, addictive behaviors (drinking, smoking, vaping, drug abuse), domestic violence, child welfare, food/housing assistance, and more.

Communications efforts and information dissemination

Right now, there’s a significant amount of misinformation being shared about what to do and what not to do to stop the spread of COVID-19. Agencies are focused on the best way to get the right information to the right audiences through the sharing of evidence-based communications recommendations to state and local government officials, doctors and nurses, and other healthcare workers. For example, the U.S. National Institute of Health just launched a new site that details how doctors should care for COVID-19 patients. 

IT systems and modernization efforts

Federal CIOs continue to partner with mission leaders to deliver advanced surveillance, analytics, and communication platforms in response to COVID-19. Meeting user expectations, keeping sensitive data and systems secure, and ensuring responsive, multi-channel access to services are new mandates. To achieve this kind of transformation—at scale—agencies are moving from outdated legacy IT platforms to agile environments with cloud computing at the core. 

Global response

COVID-19 is just beginning to take hold in places like Africa and Latin America where countries lack capacity to track and treat such pandemics. The U.S. Agency for International Development has been implementing the Demographic and Health Surveys Program for 30+ years, which provides the data needed to inform public health decisions in developing countries, including tracking the spread of infectious diseases. For example, the USAID Infectious Disease Detection and Surveillance (IDDS) Program supports health systems strengthening and the cross-border interoperability of disease detection systems in developing countries to track and mitigate the continued global spread of COVID-19. We have already started to see an increase in support for these efforts.

Community response resources

In March, the president issued an emergency declaration under the Robert T. Stafford Disaster Relief and Emergency Assistance Act in response to the ongoing pandemic. COVID-19 is different than a natural disaster—there are no floods, fires, or hurricanes—but the Federal Emergency Management Agency (FEMA) remains the coordinator of federal assistance. Under the Public Assistance Program, FEMA provides supplemental aid to states, communities, and certain private nonprofit organizations for emergency medical care and the distribution of food, water, medicine, and other supplies such as personal protective equipment. We will likely continue to see flexible and innovative use of FEMA funds to ensure citizens are protected. 

Additionally, the Department of Health and Human Services’ Assistant Secretary for Preparedness and Response has quickly curated 6,000+ readily available COVID-19 resources for federal, state, and local governments to immediately share and implement via the Technical Resources, Assistance Center and Information Exchange (TRACIE). These include the best and most promising practices on COVID-19 patient management, hospital surge, allocation of scarce resources, and other pandemic management strategies. 

Long-term impacts 

While the immediate challenges are glaring and undeniable, the long-term impacts of COVID-19 are harder to predict. How will health and medical research be impacted? Will there be long-term health effects?

We can expect a major emphasis on health surveillance modernization. This is already a priority area for the CDC as there was line-item funding for it in the most recent federal budget. Additionally, more funding was provided via the COVID-19 stimulus package, so we can reasonably expect funding and attention to increase.

Some areas that are not so certain, but are entirely plausible are:

Streamlining data collection

The way we collect information on notifiable diseases and what diseases are even considered notifiable in the U.S. varies. Hospitals, laboratories, and healthcare providers currently send data to local and state public health departments, who then voluntarily submit data to the CDC. Each reporting jurisdiction determines how to manage its priority health issues and resources and whether a surveillance system for a given notifiable disease in its state or territory should be active or passive in nature, and state-wide or localized to a specific region of the state or territory. Streamlining the collection of data provides faster access to positive COVID-19 test results and improves the process of contact tracing. 

Creating a new health surveillance agency

Considering the experience and outcomes following the September 11th terrorist attacks, it’s possible the federal government could form a new agency to oversee health surveillance the way the Department of Homeland Security was created to oversee counter-terrorism intelligence. Such an agency could better bring together disease research, disease control and prevention, and drugs/vaccines for disease treatment, to help connect the dots and improve our preparedness and response.

Challenges

But regardless of the specific long-term approach the government will take in response to COVID-19, there are universal issues and challenges that will need to be considered, including:

• Identifying and governing federal, state, and local governments and healthcare provider responsibilities in response to pandemics. 
• Creating national stockpile requirements for vaccines, medical equipment, and supplies. 
• Managing surge capacity in hospitals and for healthcare workers as pandemics spread. 
• Using the Defense Production Act to mandate the production of health equipment and supplies. 
• Improve the testing and surveillance of emerging threats. 
• Regulating private employers’ operations during a pandemic, particularly if they are deemed essential and employees continue to work on-site. 

We may not be able to predict exactly what they are, but COVID-19 will have long-term impacts on our ways of working, on the broader economy, on our system of public health, and on global cooperation for future pandemics. That means we must not only deal with the immediate problems in front of us, but also support rebuilding and resilience to the next global pandemic.