What Have We Learned from COVID-19? Apparently Not Much

Furthermore, public health workers left the field in large numbers during the pandemic, citing burnout and public abuse related to COVID-19 rules and economic downturn. Though $3 billion is expected to come to state and local departments this month to help support building a public health workforce, another one-off lump sum is not enough, especially after thousands like those hired by CDC Foundation will have already had to move on with their lives.

Today, at least 1,072,285 people in the US have lost their lives to COVID-19, with 555 of those reported yesterday alone. COVID-19 is the third leading cause of death in the US, behind two noncommunicable diseases-heart disease and cancer. Even if it were true that COVID-19 is no longer a major part of our lives, the fact still remains that these numbers are as high as they are because of how poorly the US responded to the pandemic. This boom and bust funding cycle clearly does not work for public health. Consistent, yearly, secure funding is needed to make sure we have a competent, stable public health workforce that is well-supplied and able to handle whatever we have to deal with next. Dr. Katie Schenk, who served as a Senior Epidemiologist on CDC Foundation COVID-19 emergency fund contracts at the Illinois and District of Columbia Health Departments, was quoted by KHN on this subject, saying “How do you explain that there is no funding for employment in our field when there is clearly so much work to be done?” she asked. “It’s to the detriment of the public health system, which is shedding staff like there’s no tomorrow.”

Tossing a bucket of water towards the neglected, dry, wooden house that is already engulfed in flames is never going to work. Pre-COVID-19, just 3% of healthcare expenditures in the United States were for public health. In 2019, US the National Health Expenditure sat at $3.8 trillion, or $11,582 per capita, accounting for 17.7 percent of GDP. That number grew nearly 10 percent in 2020 to $4.1 trillion, or $12,530 per person, accounting for 19.7 percent of GDP. Of course, in the middle of surging hospital occupation and the rush to find a vaccine, the US spent a lot on health care and related activities like research and insurance. And, to be fair, public health funding accounted for 5.4 percent of NHE in 2020, but it was in the middle of a pandemic.

Furthermore, in August, Brookings estimated that around 16 million working-age Americans have long COVID. In a longitudinal survey conducted by the US Federal Reserve Bank of Minneapolis, 24.1 percent of people who contracted COVID-19 experienced symptoms for three months or longer. At that point, 70 percent of Americans had contracted COVID-19, meaning if that 24.1 percent holds roughly true in the broader population, about 34 million working-age Americans had long COVID at some point. As many as 4 million workers are likely out of work because of long COVID too, according to Brookings. The annual cost of those lost wages is estimated to be between $170 and $230 billion annually and it is likely to rise in absence of substantial policy changes like expanded sick leave, improved employer accommodations, and wider access to disability insurance in addition to improved prevention. To be sure, this all costs a lot of money. However, it would not have cost nearly as much if we had invested more in things like public health way before COVID-19 even emerged.

This highlights two very important points: 1) Americans spend much more than comparable countries on healthcare, but they have poorer outcomes, and 2) much like it is cheaper to invest in preventative care and social services that improve quality of life rather than pay for medical care down the line when someone is seriously sick, it is cheaper to invest in public health way before a crisis comes. In fact, Academy Health found in 2018 that “Every $1 invested in public health yields improved health outcomes equivalent to as much as $88 in expenditures saved by county public health departments.” One study found that other OECD country spent on average about $2 on social services for every $1 of health care spending, compared to the United States 55¢. The US spends nearly twice as much as the average OECD country on health care as a share of the economy, yet it has a lower life expectancy than comparable high-income countries like Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The US also has among the highest chronic disease burden in the OECD, and its obesity rate is two times higher than the OECD average. Finally, according to the Commonwealth Fund, the US has the highest rate of avoidable mortality among its peers because Americans do not receive timely, high-quality care. All this points not only to problems in efficiency and delivery in healthcare, but also to major risk factors that make the US much more vulnerable to health security threats.

Tackling healthcare spending, insurance issues, and broadening access to care are objectively difficult to accomplish in the current US political environment. Public health has similarly suffered from partisan politics over the course of the pandemic, from the national level all the way to rural county commissions. However, at the end of the day, this is national security at stake. The US is suffering major economic hardships because of the impacts of COVID-19, including the loss of millions from the workforce on top of global inflation. Lack of equitable access to quality, timely care, lack of funding for community and state-level public health, and an overall reactionary system create a population that is bogged down by high chronic disease burden and slim options for healthcare. That population by definition is not secure. Patchwork and crisis-dependent funding is not cutting it and if we do not do something about it now, we will be in a similar or much worse situation not long from now when the next global health crisis strikes.

This article is published courtesy of the Pandora Report.