A clinical study comparing the level of COVID-19 virus RNA in children under five years old with other age cohorts using PCR (polymerase chain reaction, a method to quantify the amount of viral RNA present in a sample) found that the young children under five had significantly higher numbers of viral RNA than older children and adults.[i] While the study did not determine if there were also higher levels of live virus in this group, other research suggests a correlation between the level of viral RNA and live virus. Also, the only source of viral RNA would be the virus itself, so the presence of the viral RNA does indicate exposure to the virus.
These findings are important for the continuing efforts to control the spread of COVID-19, especially in day-care centers, schools, and households. Young children, though they may not become symptomatically ill, may still harbor the virus and spread it to older people. This is significant if the household is multigenerational or if there are older children present who could transmit the virus at school. In such cases, the contacts with people outside the household should be reduced as much as possible to reduce infection risk. It also indicates that mitigation strategies (hand hygiene, surface disinfection, physical distancing, wearing face masks, and isolation if disease symptoms are present) are especially essential for settings where young children congregate. Protecting the adults that take care of young children in day care or school settings should be a community priority and those workers should have access to the full complement of personal protective equipment including N95 masks, and protective garments.
As of July 31, the United States continues to lead the world in the number of COVID-19 cases with over 4.5 million and the number of deaths with over 150,000. Additionally, the number and rate of new infections in the United States continues to rise. Controlling the spread of COVID -19 is critical to the safe re-opening of the economy.
[i] Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19). JAMA Pediatr. Published online July 30, 2020. doi:10.1001/jamapediatrics.2020.3651
The rate of COVID-19 positive cases per 100,000 population continued its precipitous rise through July 25, 2020. As of July 19, 2020, the United States remains one of the three most severely affected countries for COVID-19 in the world. Based on data compiled by the Johns Hopkins University, thirty two of fifty one jurisdictions (50 states plus the District of Columbia) experienced a more than 5 percent rise in the number of positive COVID-19 tests (either diagnostic or antibody compared to the previous week. Data from the U.S. Centers for Disease Control and Prevention shows a doubling in the seven day average of newly detected cases nationwide between June 24 and July 17, when the number increased from 31,244 to 65,339.
There are a variety of factors that explain the surge in COVID cases. Many states began reducing “stay at home” restrictions and many large gatherings were documented after that policy change. Also, some states have not required the use of face masks in public; the scientific consensus advocates face mask use to reduce virus transmission. Asymptomatic and pre-symptomatic disease transmission, which was confirmed by the analysis of COVID-19 epidemiological data, also played a role after the “stay at home” restrictions were lifted and people interacted with large groups
A continued steep escalation in cases may cause a second shutdown. To avoid a second shutdown there must be more rapid results reporting and better case finding. This requires a significant increase in diagnostic testing to find people who are actively infected and can spread the disease to others. COVID-19 surveillance is essential; this requires antibody testing of a representative sample of the entire population to determine who was exposed and infected with COVID-19 in the past. Studies to date have indicated a significant number of asymptomatic cases and antibody testing would provide a more accurate measure of the total number of persons who have been affected by the disease. Controlling the spread of COVID-19 to others requires effective enforcement of precautions such as mask use and social distancing; they are among the limited number of available tools to disrupt virus transmission. Although COVID can be transmitted by asymptomatic or pre-symptomatic people, symptom screening can play a role in reducing the spread of disease by removing infected people from group or public settings. Mitigation strategies to protect people who have occupational contact with large numbers of people include installation of transparent barriers, use of medical grade N95 masks, enhanced disinfection of surfaces and upgraded ventilation equipment to increase air exchange. Notably, some of these mitigations will improve the ability of public facing employees to avoid seasonal influenza, which has significant health impacts every year.
Recent epidemiological investigations indicate younger people, especially school age children over 10 years old, are susceptible to COVID-19 infection and can transmit the disease to others without showing symptoms. This presents a major infection control challenge for schools resuming in-person instruction at the end of the summer. If schools are to re-open safely, younger people must practice the same precautions as older people and mitigation measures must be implemented to prevent the spread of disease. Such actions will help protect vulnerable older family members and teachers as well as the wider community.
Until there is a vaccine, there is no shortcut to reducing the circulation of the SARS-CoV-2 virus.
During the seven day period ending July 5, 2020, ten states individually reported more than 9800 new cases of COVID-19. These states were: Tennessee, North Carolina, South Carolina, Alabama, Georgia, Florida, Louisiana, Texas, Arizona, and California. The case counts represent a significant increase in the number of new cases. During the period of June 1 to July 5, all ten states also had an increased rate of COVID-19 cases per 100,000 people; the case rate rose at least 60 percent for all of the specified states. These two measures, the number of new cases for the last seven days and the rate of new COVID-19 cases per 100,000 people, indicate increased disease transmission within the specified states.
For the ten states reporting a surge in the number of COVID-19 cases during the seven day period ending July 5, six states reported more than 70 percent of the intensive care unit (ICU) beds were occupied on July 3. The states with ICU high occupancy were: Tennessee, North Carolina, South Carolina, Georgia, Alabama, and Arizona. If the current trends of increases in the number of new cases and the rate of new cases for COVID-19 were to continue, it is likely existing hospital resources could be overwhelmed. We know from the U.S. Centers for Disease Control and Prevention data that 2,866,267 cases were diagnosed and 129,811 deaths were recorded as of July 6 for COVID-19. The percentage of fatal cases among diagnosed cases is approximately 4.5 percent. While the number of asymptomatic cases is undetermined, among those who became ill or had reason to believe they had been exposed to the SARS-CoV-2 virus and were tested, 4.5 percent of those people became seriously ill and died.
The future of the pandemic is unknown. If efforts to reduce transmission are not effective, it is likely the number of cases will continue to rise. Many restrictions implemented during the early days of the pandemic have been relaxed and increased unprotected interactions will lead to more new cases and more disruption.
U.S. Centers for Disease Control and Prevention data is available at https://www.cdc.gov/covid-data-tracker/index.html#caseson July 6, 2020.
During the seven day period ending on June 17, ten states reported a spike in the number of reported COVID-19 cases in the United States. These states were North Carolina, South Carolina, Georgia, Florida, Alabama, Wisconsin, Illinois, Texas, Arizona, and California. Six of these states: North Carolina, Georgia, Florida, Illinois, Texas, and California, have large populations of African Americans. African Americans Latinos, and indigenous Americans experience a variety of health disparities that have made the impact of COVID-19 much worse for them on a population basis than for Caucasians. While all of the reasons why these states have experienced significant increases in the number of COVID-19 cases are not known, increased interactions among people after various states reduced stay-at-home restrictions, and decreased adherence to social distancing and mask wearing are likely to have played a role. Additionally, clinical research indicates some disease transmission occurs when no symptoms are present, so people spread the virus without knowing they are infected. The current challenge is to reduce disease spread, especially among African Americans, and other people of color, who have been shown to be more vulnerable to severe disease. Data from the U.S. Department of Health and Human Services report 55.5 percent of non-Hispanic blacks in comparison to 75.4 percent of non-Hispanic Caucasians used private health insurance during 2017;[i]9.9 percent of non-Hispanic blacks in comparison to 5.9 percent of non-Hispanic Caucasians were uninsured.[ii]Access to health insurance and, by extension healthcare, is one of several significant health disparities that contribute to a higher rate of chronic disease among African Americans. Chronic diseases are associated with more severe COVID-19 outcomes. Similar disparities exist for other marginalized groups.
The SARS-CoV-2 virus will not be eliminated in the near-term. Even if a successful vaccine is developed it requires protection of more than 70 percent of the world’s population to eliminate the disease. Producing enough vaccine doses for more than seven billion people will likely cause bottlenecks which will take time to resolve; perhaps the most significant of these will be the limited vaccine production capacity. Universally applied mitigation strategies that should be implemented to minimize the adverse effects on disadvantaged communities include more diagnostic testing to identify cases and quarantine of newly infected persons to interrupt transmission within populations. Antibody testing in specific geographic areas is needed to determine and understand the how prevalent COVID-19 disease is in specific communities. Improved healthcare access is needed to reduce health conditions that adversely affect the course of disease and provide early treatment to limit health deterioration if infection occurs. Also, more personal protection equipment (PPE) is needed for all workers who have essential and public facing jobs that place them at greater risk for virus exposure.
In the absence of continuation of the strict lockdown measures that allowed the trajectory of the COVID-19 pandemic to be reduced, we can expect that the number of infected persons will continue to increase. While the lockdown prevented the U.S. health system from being overwhelmed, it did not alter the infectiousness of the virus and thus, it continues to spread. The maintenance of social distancing and mask wearing can curb virus exposure and transmission. These measures, especially in those areas having a spike in the number of cases, along with the mitigation strategies mentioned above, and research to find effective treatments and vaccines will improve outcomes for everyone.
[i]See: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61
[ii] Op.cit at 1.
Over 5 million people (estimated cases as of May 21) have suffered COVID-19 infections since the disease emerged in late 2019.[i] During the course of the pandemic, evidence emerged COVID-19 can be spread before the appearance of symptoms and some people have no symptoms at all.[ii] This circumstance complicates efforts to control this highly contagious disease as some countries begin to loosen pandemic restrictions. Diagnostic testing for suspected cases, surveillance to detect asymptomatic cases, continuing research on identifying previously unrecognized symptoms and pathology, and research on the development of immunity in recovered patients will be key components of effectively controlling COVID-19.
It is especially difficult to control an infectious disease if infected persons cannot be identified and continue to spread the infection to others. As of mid-May in the United States, diagnostic testing is focused on persons having symptoms or persons who have been exposed to the pathogen. As a result, persons who are not symptomatic are not widely tested. Some estimates are that as many as 25 percent of COVID-19 infections are asymptomatic.[iii] Without maintaining social distancing and other preventive measures, the coronavirus will likely continue to be spread by people who do not know they are infected.
The accuracy of the diagnostic tests is another challenge to controlling the disease. The first diagnostic tests for COVID-19 were based on the genetic composition of the virus and require significant technology and time to perform, but the results are highly accurate. This diagnostic test is considered to be the “gold standard” of diagnostic tests. When the rapid test was developed, the accuracy was measured by comparing rapid test results to the ‘gold standard” test results using the same clinical sample. On May 14, the U.S. Food and Drug Administration, the regulatory authority for approving medical tests, raised questions about the accuracy of the Abbott rapid test.[iv] The immediate concern arising from uncertainty about rapid test accuracy is people with false negative test results interacting with people who are susceptible to infection. In the case of health care workers, this is especially important.
During the course of the pandemic, health professionals have recognized signs and symptoms of COVID-19 that were not associated with the disease during the earliest phases of the pandemic. This is important for two reasons. First, persons who did not display the expected symptoms may not have been tested or counted among COVID cases. Second, the epidemiological analysis that monitored the spread of COVID-19 was incomplete because it did not capture all transmission events. Thus, the effectiveness of control efforts was diminished. More information about all of the clinical symptoms caused by COVID-19 will modify the case definition and improve diagnosis. It can also improve patient outcomes by allowing doctors to mitigate potentially life threatening symptoms, such as blood clots, that emerge later in the course of disease.
The question of whether recovered patients develop long-term immunity to COVID-19 has become prominent as government authorities seek methods of resuming economic activity. Vaccination or recovery from some diseases, such as smallpox and measles, induces long-term immunity against re-infection. As of mid-May 2020, there is no definitive evidence that COVID-19 falls in that category. Long-term immunity typically develops after infection and recovery from viral disease. While the development of short-term immunity has been observed, the passage of time, measured in weeks, is necessary to prove long-term immunity. This is why it cannot be assumed that recovered patients do not need to follow infection control precautions and they should be tested if COVID symptoms recur.
COVID-19 will remain a public health crisis at least as long as there is no effective vaccine or treatment. To date, the only measures that have slowed disease transmission are those that reduce exposure to the virus. As economic activity resumes, only reducing disease transmission will prevent a resurgence of disease and death.
[i]Johns Hopkins University and medicine Resource Center, available at https://coronavirus.jhu.edu/map.html on May 19,2020.
[ii]Furukawa NW, Brooks JT, Sobel J. Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis. 2020 Jul [date cited]. https://doi.org/10.3201/eid2607.201595DOI: 10.3201/eid2607.201595, Original Publication Date: May 04, 2020 and Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:377–381. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e1external icon, both available on May 20,2020.
[iii] See University of Oxford (U.K.), The Centre for Evidence-Based Medicine, available at https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/ on May 20, 2020.
[iv]U.S. Department of Health and Human Services, Food and Drug Administration, Press Release - Coronavirus (COVID-19) Update: FDA Informs Public About Possible Accuracy Concerns with Abbott ID NOW Point-of-Care Test, May 14, 2020 available at https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-informs-public-about-possible-accuracy-concerns-abbott-id-now-pointon May 20,2020.
COVID-19 has sparked the most profound economic crisis unrelated to armed conflict since the 1918 influenza pandemic. Fortunately, there is now far more scientific understanding of disease dynamics to inform the best practices for returning to normal activity. Following are some important considerations for a return to the interactions that underpin the economy.
· Implementing comprehensive disease surveillance. This includes adequate clinical testing to provide an accurate knowledge of who and where newly infected persons are and tracing the contacts of confirmed cases. In the United States, this required level of testing has not been reached. Additionally, it is critical to know who has immunity by testing for antibodies. Anecdotal data suggests there is a significant percentage of infections that are not accompanied by symptoms of disease. Antibody tests are essential for anyone returning to a work situation that precludes the possibility of social distancing.
· Collecting and analyzing virus samples over time. This includes genetic analysis of samples both within communities as well as samples from distant places to provide an understanding of how the virus is mutating. The SARS CoV-2 is a pathogen that can mutate quickly and some mutations directly affect whether a recovered person can effectively fight a new exposure to the virus. This is the reason why health officials monitor new influenza virus strains every year. As with seasonal influenza, if the virus mutates in specific ways, it is possible to acquire a new infection even though one has suffered a previous infection.
· Analyzing clinical data to ascertain why certain characteristics predispose some people to more severe disease. Based on the case reporting, we know that African Americans, Hispanics, and those with pre-existing chronic diseases have much higher rates of death and severe illness than others. A comprehensive analysis of patient health status will help protect those who are most vulnerable to serious disease after exposure to COVID-19.
The consequences of the COVID-19 pandemic have caused more economic dislocation than any event other than war since the beginning of industrial age. However, a failure to thoughtfully and adequately plan for a return to economic production will ultimately be more costly in both lives and treasure.
COVID-19 has sparked the most profound economic crisis unrelated to armed conflict since the 1918 influenza pandemic. Fortunately, there is now far more scientific understanding of disease dynamics to inform the best practices for returning to normal activity. Following are some important considerations for a return to the interactions that underpin the economy.
· Implementing comprehensive disease surveillance. This includes adequate clinical testing to provide an accurate knowledge of who and where newly infected persons are and tracing the contacts of confirmed cases. In the United States, this required level of testing has not been reached. Additionally, it is critical to know who has immunity by testing for antibodies. Anecdotal data suggests there is a significant percentage of infections that are not accompanied by symptoms of disease. Antibody tests are essential for anyone returning to a work situation that precludes the possibility of social distancing.
· Collecting and analyzing virus samples over time. This includes genetic analysis of samples both within communities as well as samples from distant places to provide an understanding of how the virus is mutating. The SARS CoV-2 is a pathogen that can mutate quickly and some mutations directly affect whether a recovered person can effectively fight a new exposure to the virus. This is the reason why health officials monitor new influenza virus strains every year. As with seasonal influenza, if the virus mutates in specific ways, it is possible to acquire a new infection even though one has suffered a previous infection.
· Analyzing clinical data to ascertain why certain characteristics predispose some people to more severe disease. Based on the case reporting, we know that African Americans, Hispanics, and those with pre-existing chronic diseases have much higher rates of death and severe illness than others. A comprehensive analysis of patient health status will help protect those who are most vulnerable to serious disease after exposure to COVID-19.
The consequences of the COVID-19 pandemic have caused more economic dislocation than any event other than war since the beginning of industrial age. However, a failure to thoughtfully and adequately plan for a return to economic production will ultimately be more costly in both lives and treasure.
One of the greatest challenges of the COVID-19 pandemic has been the fact it is a new disease and the first information about its pathology and epidemiology was collected as the outbreak was emerging. Although the virus is related to other coronaviruses that cause human disease, it is proving different in how it spreads and its clinical manifestations. The initial COVID-19 data that was collected in China during the winter of 2019-20 indicated transmission was attributable to symptomatic patients. As the pandemic grew and more data was collected, however, additional data suggested some patients did not display symptoms and therefore transmitted the disease unknowingly.
The change in the U.S. Centers for Disease Control and Prevention public health guidance is the result of this new data. Unlike the early stages of the pandemic when the recommendation was to mask patients only if they exhibited symptoms, the current guidance is for everyone who can tolerate a mask to wear one when in close proximity (less than six feet separation) to others. The new guidance was issued to reduce the transmission from asymptomatic patients, who may represent as much as 25 percent of those who are infected with SARS CoV-2.
As the pandemic continues to grow, there may be other changes in health recommendations for the public. The assessment and analysis of new data improves the public health response and reduces risk of infection for everyone.
The COVID-19 virus has spread widely, both inside China and to the rest of the world. One possible transmission pathway that should be considered as part of the ongoing epidemiological investigation is the clandestine movement of wildlife and people across international borders.
Illicit international wildlife trade has been documented to occur and China is actively involved in the sale of wildlife in its live animal markets. Other coronavirus outbreaks, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were traced to a wildlife source when those diseases “jumped” to infect humans. A second possibility is the undocumented movement of persons across borders through human trafficking, the illicit drug trade, or other criminal activity. Human trafficking is recognized as a serious problem with many victims being trafficked to provide labor. The illicit drug trade and trade in other controlled products continues to occur because it is highly profitable.
COVID-19 infection has become a significant issue of international concern, both due to its impact on public health as well as on international economics. Investigating how the virus is moving from its source in China should include all possibilities because a thorough understanding of transmission dynamics is essential to controlling the disease.
The exposure to a novel coronavirus in Wuhan, China triggered an outbreak of human disease during December 2019. As of February 10, 2020 there were over 40,000 confirmed cases with over 900 deaths.[i]Genetic sequencing of the novel coronavirus shows it is related to both the severe acute respiratory syndrome (SARS) virus and the Middle East respiratory syndrome (MERS) virus,[ii]which caused human outbreaks in China during 2002 and in the Middle East during 2012. All three coronaviruses have a zoonotic origin. Coronaviruses exist in a variety of wildlife species and the current outbreak is believed to have jumped from animals to humans. In light of the current situation and a history of other coronavirus diseases jumping to humans, the Chinese government ordered the temporary closure of live wildlife markets as a disease control measure. Such markets pose an identifiable risk to human health and the permanent closure of live wildlife markets should be considered.
Close proximity interactions between non-domestic animals of varying species in live markets pose significant human health risks. They provide an opportunity for the spread of infectious diseases between the caged animals and humans who visit the markets. Among the post-outbreak findings from the SARS and MERS outbreaks was that the viruses adapted to humans once it spread within communities. Although much remains uncertain about the current coronavirus outbreak, previous experience suggests a similar human adaptation is possible. Additionally, the fact that the outbreak emerged in a densely populated city such as Wuhan and has spread among people who have not had direct contact with the live wildlife markets raises concerns about its epidemic potential.
Placing several Chinese cities under quarantine, as the government has ordered, could reduce the spread of the novel coronavirus disease outside the most severely affected areas. However, the effectiveness of a quarantine as a control measure is questionable as time passes for logistic (supporting the quarantined population with food and other essential goods) and social/political (the willingness of the population to suspend their usual activities) reasons.
Although it may too late to affect the course of the current outbreak, the permanent closure of live wildlife markets should be considered as a public health policy intervention. Eliminating close interactions among wildlife species and the subsequent exposure of the animals to humans could reduce the risk of another novel disease emerging. History suggests there may be other coronavirus outbreaks with similar characteristics and consequences in the future if no preventive action is taken.
[i]Case counts provided by World Health Organization, available at www.who.inton on February 10, 2020.
[ii]Roujian Lu and others, “Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding,” The Lancet, Published online January 29, 2020 https://doi.org/10.1016/S0140-6736(20)30251-8
The Constitution requires the federal government to conduct a census every ten years. Among the reasons are to realign congressional representation in the U.S. House of Representatives, apportion funds to pay for federal government functions and infrastructure, and to provide baseline population data for disaster and crisis response.[i] The decennial census is designed to count every person living in the United States without regard to citizenship status. These counts are updated regularly with data collected from the American Community Survey, a statistical estimate of population changes from year to year. All of the above mentioned uses of the census data are critical but none have the same immediate impact as having accurate data when the federal government is asked to respond to a natural disaster or a health emergency. Without accurate data on the number and location of people who are affected by an emergency, the crisis cannot be addressed effectively. Any policy that may encourage people not to respond to the census questions is inconsistent with the requirement specified in the U.S. Constitution and the best interest of the people of the United States.
When a natural disaster strikes a community, immediate assistance is required to save lives and protect property. First responders must have accurate information about how many people could be affected and where they live to do their jobs. A census undercount could result in insufficient resource deployment, leaving some people without appropriate assistance. A public health crisis, such as a severe influenza outbreak, could result in some affected people not receiving treatment if public health responders do not know the total number of people who are at risk of becoming sick due to inaccurate or incomplete census information. Such a circumstance would negatively affect efforts to control the outbreak and limit illness and mortality. Even during an average year, more than 30,000 people die from influenza infection, so the potential for harm is significant. Citizenship status is not important to responding to a natural disaster or controlling a disease outbreak; what authorities really need to know is how many people may need help.
A census undercount has numerous negative effects, maldistribution of federal resources for representation, infrastructure, and social programs as well as an inadequate response to natural disasters and public health crises. Anything that impedes a full count of every person living within the United States will harm the entire country. Every possible effort should be made to accurately count each person resident in the United States and universal participation is critical.
[i]See U.S. Bureau of the Census, https://www.census.gov/about/what.html
Revitalizing infrastructure remains an important imperative for the federal government. Legislation to support the rehabilitation and improvement in transportation, power generation, telecommunications and other nationwide systems could facilitate economic growth and improve population welfare. Although health infrastructure does not receive as much attention in discussion of national infrastructure priorities, it is an essential component that will support the national economy and also improve lives. Any policy proposal to fund infrastructure improvements should include health infrastructure, especially in the areas of workforce, data systems, and crisis response; these areas were identified by a federal study as being critical parts of the national health infrastructure.[i]
While the United States spends about one sixth of its GDP on health related expenses, it still does not reap the same level of tangible benefits as other peer developed countries that spend much less on a per capita basis. Additionally, the emergence of climate change and exotic zoonotic diseases challenges to U.S. heath infrastructure in novel ways. A modern U.S. health infrastructure will need to develop capabilities across human and animal health to optimize benefits to the U.S. economy and residents.
Currently, there are workforce shortages in a variety of health fields including physicians[ii]and veterinarians[iii]. As the U.S. population ages, there is increased demands for health services. Also, for reasons that are not yet clear, the health status of younger Americans is worse that it was for previous generations of Americans at the same age and may be an additional cause of increased health service demand. [iv]Climate change has resulted in changes in disease patterns among animal populations. Previously unknown pathogens will likely increase the demand for veterinary clinical services including animal disease surveillance and outbreak management. Further integration of human and animal health, or “one health” infrastructure, will be essential for building additional health capacity.
Modernization and improvements of health systems, particularly in the areas of telecommunications and cybersecurity will support the needs of health infrastructure by improving medical record keeping and information access when patients are treated. Disease patterns will be identified and outbreak response can be occur more quickly. The recent approval for the merger of CVS Pharmacy and Aetna health insurance suggest a shift from large medical practices to retail health settings for routine healthcare. If stand-alone clinics become an increasingly popular source of preventive and well-being health services, more reliable and comprehensive access to individual medical records will facilitate optimal care.
Effective crisis response to health emergencies requires support from other critical infrastructures because the immediate requirement is to deploy resources as quickly as possible for rescue and recovery. Depending on the nature of the health emergency, such as hurricane response for example, rescue workers may need to get to disaster areas quickly to restore basic health services. Affected health infrastructure may require transportation, telecommunications, and electrical power systems as well as possibly erecting temporary clinical facilities to resume operations. A different health crisis may require specialized clinical isolation and treatment facilities be created to contain a widespread infectious disease outbreak. To the extent that a rapid and efficient response will minimize deaths and more severe health consequences, collaborations between various infrastructure stakeholders would ideally include exercise for a variety of health crisis scenarios.
Health systems and infrastructure are an important area of the overall U.S. infrastructure and must be an integral part of planning nationwide updates and modernization.
[i]See Healthy People 2020, Public Health Infrastructure, https://www.healthypeople.gov/2020/topics-objectives/topic/public-health-infrastructure, accessed on June 9, 2019.
[ii]Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physicians and Surgeons,
on the Internet at https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm (visited June 06, 2019). See U.S. Department of Health and Human Services, Health Resources and Services Administration, https://data.hrsa.gov/topics/health-workforce/shortage-areas, accessed on June 9, 2019.
[iii]See Journal of the American Veterinary Medical Association, https://www.avma.org/News/JAVMANews/Pages/181215e.aspx?PF=1, accessed on June 9, 2019
[iv] See Blue Cross Blue Shield, “The Health of Millennials,” https://www.bcbs.com/the-health-of-america/reports/the-health-of-millennials accessed June 9, 2019.