From the Editor: Public Health Surveillance of Infectious Disease Attention to COVID-19
by Lloyd F. Novick, MD, MPH
The November-December issue of the Journal of Public Health Management and Practice focuses on surveillance of infectious disease attention to COVID-19. As this issue goes to press, the presidential election is on the near horizon. The decision of the electorate on choosing the next president has public health implications. This is reflected in the lead scientific article of this issue: “Surveillance to Monitor the Impact of the Trump Administration on the Health of New York City Residents” by Gould and co-authors. These authors write of the many policies enacted or proposed by the Trump administration with adverse public health consequences. Examples include attempts to repeal the Patient Protection and Affordable Care Act (ACA), restricting funding for women’s health care, and removing environmental regulations. A public health surveillance system was designed to measure the public health impacts of the Trump administration. Twenty-five indicators are distributed over 5 domains: access to care; food insecurity; reproductive health; environmental health; and general physical and mental health. This surveillance system can be applied to the next presidential administration, whatever the outcome, chosen by the electorate. Jurisdictions other than New York City will find also find this system useful.
“Deaths, Hospitalizations, and Emergency Department Visits from Food-Related Anaphylaxis, New York City, 2000-2014” by Poirot and co-authors is important because of its implications for fatality prevention. Food-induced anaphylaxis is potentially fatal but preventable by allergy avoidance and immediate treatment. The epidemiology of this condition is described over a 15 year period, coupled with recommendations for public health initiatives to prevent deaths. Prevention efforts among children with peanut allergies are detailed as are those for adults with known crustacean allergies.
Sakamoto authors an article describing using liaison public health nurses in Los Angeles hospitals to combat infectious disease. This project uses 5 nurses who interface with hospitals to improve reporting of infectious diseases and strengthen surveillance infrastructure. Substantial improvements in infectious disease reporting occurred. Articles in this issue demonstrate improvements in surveillance, including one from Arizona and another from New York City, that focus on the advantages of utilizing electronic reporting of laboratory results. The issue also contains articles on public health interventions aimed at addressing chlamydia; HIV/STD prevention among gay, bisexual men and transgender persons; and the 2015 West Ebola outbreak.
As the opening editorial by Lenaway and Beitsch asserts, strengthening public health infrastructure is an essential prerequisite for improved public health outcomes. During the current COVID-19 pandemic, basic public health functions such as surveillance, laboratory testing, and contact tracing have been overwhelmed. This issue contains commentaries and scientific articles that highlight this problem and make recommendations. Gracia points to the disproportionate impact of COVID-19 on communities of color. The COVID-19 pandemic spotlights deeply rooted inequities in our nation with higher rates of death among people of color.
Volkin’s commentary on maternal mortality and COVID-19 also refers to the dis-proportionate impact of COVID-19 on communities of color. Black Americans are 3 times more likely to die of COVID-19 than White Americans. This report points out that there is no national standard for collecting data on pregnancy status during disease outbreaks. This is a serious flaw in public health surveillance systems. Race and ethnicity are frequently missing from local data reports and are not linked to social determinants of health such as housing and food insecurity.
Homeless individuals are particularly vulnerable to the COVID-19 pandemic. Duber describes case identification, community testing, and efforts to prevent disease transmission in King County, Washington. This region has the third-largest homeless population in the nation with more than 11,000 homeless individuals at any one time. The most difficult issue faced by public health officials was arranging for quarantine and appropriate isolation once there was an outbreak of COVID-19. Seattle and King County established a number of isolation and quarantine centers for individuals with pending and positive tests. These isolation and quarantine sites were motels that were leased or purchased by the local government. Wraparound social and medical services had to be provided to this vulnerable population. If these individuals left these sites prematurely, they would place the community at risk.
Stay-at-home orders have been issued by states during the pandemic to increase social distancing. Gigliotti and Martin evaluated political versus public health predictors of stay-at-home order adoption among US states. They also examined association between order enactment and resident’s mobility. They found while popular media suggest that adoption of stay-home orders was primarily political, public health considerations were also important in decision making. Another finding was that these orders significantly reduced mobility of residents in states adopting these orders.
The January-February issue of JPHMP will be accompanied by a special supplemental issue on COVID-19. This supplement is sponsored by the Association of State and Territorial Health Officials (ASTHO), the Big Cities Health Coalition (BCHC), and the de Beaumont Foundation. Articles will be included on racial and ethnic disparities, epidemiology, contact tracing, homelessness, and LBGTQ communities.
For more information about the November-December 2020 issue, listen to the latest edition of The Editor’s Podcast at https://wp.me/p7l72S-6gS.
Lloyd F. Novick, MD, MPH is Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Previously, he was chair of this Department. He has served as the Commissioner of Health and Secretary for Human Services of Vermont, Director of Health Services for Arizona, and Director of the Office of Public Health for New York State. Previous academic positions include Professor and Director of the Preventive Medicine Program for SUNY Upstate Medical University, Professor and Chair of Epidemiology at the University of Albany School of Public Health, and Clinical Professor and Director of the Teaching Program in Epidemiology and Public Health at the University of Vermont, College of Medicine. [Full bio]