Skolnik: Should COVID Still Be A Priority?

By RICHARD SKOLNIK
White Rock

How much priority should public health put on COVID these days? Aren’t the risks of COVID so diminished that we don’t have to worry about it anymore?

In public health, as in other fields, there are well known principles for setting priorities, that largely have to do with:

• The impact of the disease on illness, disabilities, and deaths.
• The availability of cost-effective, doable, and sustainable approaches to addressing the problem.
• Fairness/equity.

When it comes to the burden of COVID disease:

• Provisional CDC data has COVID as the 10th leading cause of death in the US in 2023, taking account of all ages.
• Based on that same data, COVID appears to have been the 8th leading cause of death in the US in 2023 among those over 65 years of age.
• COVID continues to cause an enormous amount of “illness and disability” and there are many unknowns about “long-Covid”.

These impacts are substantially less than they were each year from 2020 to 2022. However, they are still very significant and we don’t know if or when a more virulent COVID variant will emerge.

Much has been learned in the fight against COVID about what works, and at what social, economic, and political cost. Disease surveillance is at the core of public health but is challenging for COVID in the absence of information about the number of infections. The vaccines against COVID are imperfect but still provide important protection against severe illness and death particularly among older people. In addition, we still want people who are infected to know they have COVID and avoid spreading the disease to others. We also want people to have the information they need to make choices about how to prevent infection or severe illness.

In terms of ethics and fairness, COVID took a disproportionate toll on those who work in non-technical and non-professional jobs. It also took a disproportionate toll on Native, Black, and Hispanic people. In addition, COVID hurt older people more than others, with 88% of all COVID deaths in 2023 being among those over 65. Our approach to COVID must keep these factors in mind.

In light of the above, it is important that New Mexico continue to pay careful attention to COVID and take the following steps to address it:

• Maintain a robust statewide wastewater monitoring program for COVID. This can provide nearly real time information about the spread of the virus.
• Engage as needed in locally appropriate health education programs about COVID, its risks, to whom, and how to address it through personal, family, and community action. This can be enhanced as one starts to see the likelihood of “surges”.
• Strongly promote vaccination among those most at risk: health workers, pregnant women, older people, people with significant co-morbidities, and people with immunocompromising conditions.

These measures are cost-effective. They are also at the core of what every public health department in the US should be able to do.

Sadly, the US is failing to prepare adequately for “the next pandemic”. This should be a matter of concern and political action for all of us. Given the downside risks of COVID and the risks of a future pandemic, it is important for New Mexico to also strengthen pandemic preparedness at the state level, and work with the federal government to do the same.

Richard Skolnik is the former Director for Health, Nutrition, and Population for South Asia at the World Bank. He was a Lecturer in the public health schools at The George Washington University and Yale and the Executive Director of a Harvard AIDS treatment program for three countries in Africa. He is the author of Global Health 101, Fourth Edition and the Instructor for the Yale/Coursera online course Essentials of Global Health.

This article is published to GGEDC with permission and originally published here.