For Everything That Comes Next, Public Health Will Be Critical
April 20, 2020
By Ana V. Diez Roux, MD, PhD, MPH
Dear Dornsife faculty, staff, students, and friends:
It has now been five weeks since we at the Dornsife School of Public Health (DSPH) and all of Drexel have been working remotely. Classes (all remote) started two weeks ago. Research and administrative activities are ongoing remotely as well. We are all adapting to these unprecedented circumstances as is much of the country (and the world). We are all working hard to keep engaged and connected with our classes, our research, or the many other activities that we need to keep our School running.
The pandemic has raised and will continue to raise many important questions about population health, public health practice, and even about our society. There is much that we need to do, but at the same time, there is so much that we need to reflect on because it has implications for the future, not just for how we respond to the pandemic, but for how we think of our society and our health.
One major issue that has emerged is the importance, and at the same time the challenge, of having accurate data to inform public health practice and policy. There is still considerable uncertainty about the incidence of infection and about what proportion of cases are asymptomatic (or have very mild symptoms). The lack of easily available and rapid testing has been a major challenge in obtaining this kind of information. Having a good understanding of the number of people who have been infected is also very important to estimate the case fatality rate of COVID-19. This type of information is critical to any effort to predict the number of deaths or estimate the impact of various measures, including implementing or relaxing social distancing measures. Efforts are underway to improve this information so that we can have a better understanding of what our strategy should be going forward, including when and how social distancing measures can be relaxed.
A second major issue that has emerged, is the way in which the pandemic is making even more visible the inequities in our society. It is no surprise that as the pandemic advances (and as better data becomes available) we are increasingly seeing COVID cases, severe cases, and deaths emerge as more frequent in social, groups that have traditionally been disadvantaged and discriminated: the poor and the working class, Black Americans, immigrants among others. There are many reasons for this: living conditions and types of jobs that make social distancing impossible, greater vulnerability to infection because of stressors, more severe disease because of socially patterned underlying health conditions. This just one more reflection of how the social determinants of health drive virtually every health outcome. A silver lining is that COVID-19 is promoting public discussion of health inequities (including their causes and the imperative to act to reduce them) like never before.
Last but not least, the unprecedented and radical response to the pandemic shows us that a different way of living (and organizing) our society so that it is healthier, better for the environment, and more equitable is possible. Just witness what our cities feel and look like with fewer cars and less air pollution, imagine a world where we routinely provide accessible health care for all, where fewer people are incarcerated, where we have social safety nets in place that protect the most vulnerable always, not just when disaster strikes, where we systematically address the social determinants of health. This is also something that the pandemic is teaching us.
There is still much uncertainty and much to do. The good news is that there is growing evidence that social distancing seems to be working. We are not yet sure what the next steps in controlling the pandemic will be and we have to move forward thoughtfully and based on evidence. There will be many discussions on the next steps over the coming days, but they will likely involve a combination of relaxing social distancing in a thoughtful and measured way, enhancing surveillance, intensifying case identification, contact tracing, and protecting the most vulnerable.
There will be questions about data, about ethics and about society. We will also have to address the consequences of the pandemic for lower and middle-income countries who have not felt the full brunt of it yet but who will be highly vulnerable to its many effects. We will have to work across the globe together with other countries and supporting international initiatives and organizations (like WHO among others) that connect us, now more than ever. These are things that we will all be actively engaged in.
For everything that comes next, both the challenges and opportunities, public health will be critical. Our School is actively engaged in many activities including getting information out through our webinar series, supporting the health department in any way we can, participating in national and global discussions about the pandemic and its effects, analyzing data to characterize how the pandemic is evolving and who it is affecting, and advocating for the core public health and equity-oriented approach. You can see some of our activities on the Coronavirus Updates webpage or in the Dean's Weekly and Monthly Newsletters. Additional activities are forthcoming so stay tuned!
These are hard times for all of us, for students taking classes remotely, for faculty teaching remotely, for research teams to continue to engage at a distance, for staff to continue to run so many activities fundamental to our mission remotely as well, all while supporting families and friends all over the country and the world. We should all take care of ourselves and seek balance, also finding times to recover and relax so that we have the energy we need.
But we are here to support you, and we are still moving forward, and we have a lot to learn, and a lot to think about and a lot to do. Our focus and expertise are necessary today like never before. (And all the other public health problems we know about are still out there!)
If you have ideas about how the School can help please don’t hesitate to reach out. And last but not least, a big thank you to all of you for continuing to be public health ambassadors, for all your work and patience, dedication and flexibility as we navigate these unprecedented times together.
Ana V. Diez Roux, MD, PhD, MPH
Dean and Distinguished Professor of Epidemiology
Dornsife School of Public Health