Public Health Workforce Continues All-Hands Approach to Coronavirus, Risk to Public Low

February 06, 2020 | Jim Blumenstock

Now weeks into this large-scale response, the 2019 novel coronavirus outbreak (2019-nCoV) continues to be a global public health threat. The Johns Hopkins University dashboard reports 28,344 cases and 565 deaths worldwide as of early February 6.

First reported in Wuhan, China on Dec. 31, 2019, most cases are in mainland China, but 28 countries are affected—this includes the US, where the 12th case was reported Wednesday in Wisconsin. Limited human-to-human transmission has been seen. The dashboard also indicates that 1,339 of these cases have recovered, though the number of cases and countries impacted continue to grow. On January 30, the World Health Organization (WHO) declared the 2019-nCoV outbreak to be a Public Health Emergency of International Concern (PHEIC) under the authority of the 2005 International Health Regulations; then on January 31, Health and Human Services Secretary Alex M. Azar II declared a public health emergency for the entire United States to aid the nation in responding to this outbreak.

Under the technical and scientific leadership of the Centers for Disease Control and Prevention (CDC), an aggressive layered approach is being implemented in strong partnership with state, local, and territorial public health departments to delay the entry and slow the spread of the virus. This containment strategy is driven by prudence, not panic. The temporary measures put in place provide precious time to allow us to enhance and mobilize our readiness efforts and, as of now, this virus is not spreading in the community in the United States and the vast majority of Americans have a low risk of exposure.

In an ever-changing environment of complexity and some scientific uncertainty, response efforts are underway following an evidence-based risk assessment model. This includes:

• Conducting enhanced screening of arriving travelers.
• Implementing necessary quarantine and isolation measures.
• Identifying and ensuring proper clinical care of confirmed cases.
• Following up with contacts of cases to stop further spread.
• Working with hospitals to ensure proper infection control measures are in place.
• Expanding disease surveillance and in-state laboratory diagnostic capacity.
• Modifying existing pandemic plans specific to nCoV that were initially developed for influenza.
• Providing helpful and needed public education and risk communications messages.

The level and duration of this response does take additional resources as agencies continue to reprioritize and divert as much of their assets as possible from other important public health programs to address this immediate and, yes, long haul mission. As such, our collective response will benefit from the ongoing consideration and support of federal decisionmakers in the following areas:

• Affording flexibility to reallocate and temporarily reassign, within reason, resources made available to jurisdictions through various public health categorical grant and cooperative agreement funds as an immediate gap-filling measure to provide surge capacity.
• Prompting disbursing dollars presently in the Infectious Disease Rapid Response Reserve Fund to state, territorial, and local health departments.
• Providing sufficient all-hazards preparedness funding via the appropriations process and a potential emergency supplemental bill to HHS and to state, territorial, and local health departments. This includes proven successful programs like Public Health Emergency Preparedness (PHEP) and Epidemiology and Laboratory Capacity (ELC) cooperative agreements—administered by the CDC—and the Hospital Preparedness Cooperative Agreement, administered by the HHS Assistant Secretary for Preparedness and Response. Finally, adequate replenishing of the Infectious Diseases Rapid Response Reserve Fund, so it will be ready to use for the “next one”.

Aptly summarized by Mike Fraser, ASTHO’s Chief Executive Officer: “State and territorial health officials are prepared to face the challenge of preparing and responding to the current novel coronavirus (2019-nCoV). The unprecedented pace of the public health response to 2019-nCoV has only been possible because of prior investments in public health preparedness. Governmental public health agencies share a unique and important mission: they work to keep America healthy 24-hours a day, seven days a week. Outbreaks like the 2019-nCoV are critical reminders of the significance of public health readiness and the need for continued strengthening of public health agencies’ core response capabilities.”

While what our governmental public health is doing and must continue to do is vital, it also important to mention what the public can and must do as well. First, as is always recommended, maintain proper hand hygiene and cough etiquette measures, keep a distance from others if you have symptoms of respiratory illness, and if symptoms worsen-especially if you were at increased risk of exposure to nCoV—seek prompt medical attention.

I have heard federal experts say, albeit too many times, that an infectious disease outbreak can often spawn outbreaks of fear, misinformation/rumor, and stigma. This is so true. The best advice I can share is to rely on information provided by authoritative sources such CDC and state and local health departments. Fear is understandable but reviewing information from a credible source or speaking with a public health professional can allay fears and reduce stigma and misinformation.

In a press statement this week from the Trust for America’s Health (TFAH) Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, John Auerbach, TFAH President and CEO, said: “The increasing number of threats to Americans’ health in 2019, from floods to wildfires to vaping, demonstrate the critical importance of a robust public health system. Being prepared is often the difference between harm or no harm during health emergencies and requires four things: planning, dedicated funding, interagency and jurisdictional cooperation, and a skilled public health workforce.” This is a perfect closing thought, and so well-said.