for links to POSTS 1-235 in chronological order highlight and click on
July 26, 2021
“The stark reality of the COVID-19 pandemic challenged the very systems established to ensure the nation’s safety and quality. The pandemic resurfaced long-endemic challenges within the health care quality and standards ecosystem and identified novel challenges that cannot be ignored…
The pandemic demonstrated the stark divide between our public health and clinical care systems. For decades, public health has been underfunded at all levels of the government, which hampered U.S. pandemic preparedness and response. In addition, the quality and safety focus areas for public health and clinical care have been poorly aligned, with health systems focused more on specific clinical areas such as treatment for acute cardiac conditions and avoidance of localized nosocomial infections; public health systems are traditionally more focused on communicable disease control and prevention of chronic disease and injuries. There was no existing data infrastructure across these systems that included key variables and metrics around readiness to inform preparedness and the response capacity of the health care system. As a result, most health systems did not have data or systems for collecting and sharing information about personal protective equipment (PPE), essential staffing, or ventilator shortages at the start of the crisis. The locus of control between the federal, state, and local governments was not always clear, with emergency response responsibilities resting in multiple federal government agencies and varying forms of state-local governance structures for public health, which can generally be described as centralized, decentralized (or home rule), mixed, and shared state and local governance. Each model presents its unique coordination challenges. The state-local mixed models are described in more detail in Public Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs .
Within the health care sector, multiple organizations and systems compete for business in a market-based system, with little guidance, much less metrics, for cooperation and collaboration during a public health emergency .
The broad quality frameworks for payers and providers have created a large infrastructure and set of resources that focus on tackling dissimilar requirements and metrics across markets and providers, supporting the disparate data and reporting systems. The resources devoted to this enterprise generate revenue and enable provider incentives—but this “teaching to the test” does not contribute enough to the health of individuals, and activities such as support for SDoH are not always rewarded.
The complex and layered measurement system was largely built through federal and state legislation. Measurement currently serves multiple agendas. The wide-ranging focus and cumbersome data capture and reporting system leave the health sector unable to tackle novel or emerging specific issues, particularly crises such as COVID-19, which required such comprehensive cross-sector collaboration. Without an overarching strategy or direction, the current system is one in which no outcomes are prioritized—there is no ability to create consistent directional change for the health of a population.”…(A)
February 17, 2022
“Since the Covid-19 pandemic began, however, many indicators make it clear that health care safety has declined. The public health emergency has put enormous stress on the health care system and disrupted many normal activities in hospitals and other facilities. Unfortunately, these stressors have caused safety problems for both patients and staff. Managing the competing priorities of providing care for large numbers of patients with Covid, as well as for the patients without Covid who need care every day, and of maintaining safety efforts such as robust infection-control practices is both difficult and essential…
We have observed substantial deterioration on multiple patient-safety metrics since the beginning of the pandemic, despite decades of attention to complications of care.2-4 Central-line–associated bloodstream infections in U.S. hospitals had decreased by 31% in the 5 years preceding the pandemic; this promising trend was almost totally reversed by a 28% increase in the second quarter of 2020 (as compared with the second quarter of 2019).3 There were also increases in catheter-associated urinary tract infections, ventilator-associated events, and methicillin-resistant Staphylococcus aureus bacteremia. Safety has also worsened for patients receiving postacute care, according to data submitted to the Centers for Medicare and Medicaid Services (CMS) Quality Reporting Programs: during the second quarter of 2020, skilled nursing facilities saw rates of falls causing major injury increase by 17.4% and rates of pressure ulcers increase by 41.8%. The surges of the delta and omicron variants of SARS-CoV-2 in late 2021 and early 2022 do not bode well for a return to prepandemic levels for any of these indicators…
Over time, the U.S. health care sector has implemented various pieces of the safety-assessment-and-improvement puzzle, but it has not instituted a thorough system of safety that reaches from the boardroom to the front lines and that can be maintained during times of crisis. For example, it is important to have sufficient resources such as staff and personal protective equipment for times of stress. The United States deserves breakthrough thinking about systems built on foundational principles of safety, akin to those used in other industries in which safety is embedded in every step of a process, with clear metrics that are aggregated, assessed, and acted on. We also need renewed national goals of harm elimination throughout the health care system and a core safety strategy that includes promoting radical transparency, addressing workforce shortages, and continuing to strive for safety while being sensitive to such trade-offs as reporting burden and costs. This effort should extend across the continuum of care, beyond the traditional hospital-based safety indicators, and include attention to diagnostic errors and outpatient care.” (B)
February 10, 2022
“As the Omicron wave recedes in the United States, public health officials are faced with a new round of decision-making on the best way for the country to move forward.
It’s a critical moment to rebuild the trust that has been lost among weary Americans over the past two years, said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.
But the best way to gain that trust — offering a transparent, metric-based approach — is challenged by a fractured and undervalued health data infrastructure. It’s problem that has long plagued the United States and one that has hindered the ability to respond swiftly and pointedly to the Covid-19 pandemic since the beginning.
“It’s difficult not just during pandemic times, but even more difficult during the pandemic,” Freeman said. “Our data modernization infrastructure for governmental public health is just really nonexistent. So when you think about having to pivot quickly with new metrics and how that data gets collected and reported and accumulated, aggregated, de-aggregated, it can be daunting.”
The data failings of America’s public health system are many and varied, tainting nearly every decision-driving metric in one way or another.
“Lack of accurate, real-time information was one of the greatest failures of the US response to the Covid-19 pandemic,” Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention, said at a hearing before the House Energy and Commerce Committee in March 2021.
Nearly a year later, these issues persist.
States have led the way in public dissemination of Covid-19 data, but experts say the federal government — particularly the CDC — could have offered more leadership and guidance on priorities. The CDC did not respond to CNN’s request for comment for this story.
Holding on to what progress has been made will require states to keep up their own efforts, as well as federal commitment to the investment of resources, but signals are mixed…
One of the most glaring issues throughout the pandemic has been the lack of clear definitions of what is even meant to be measured…
Some states report only PCR tests, while others include positive antigen tests, too.
Covid-19 hospitalization data, often viewed as one of the most stable metrics, has also come under scrutiny recently, with questions raised about how to differentiate between patients who are specifically admitted for treatment of Covid-19 and those who test positive incidentally while being treated for something else.
The US Department of Health and Human Services has outlined guidance for hospital reporting of Covid-19 data in a 50-plus-page document that is regularly reviewed and updated. And although there was intent to capture hospitalizations caused by Covid-19, the process can vary in practice, according to an agency spokesperson.
If disease severity or hospitalization data becomes a trigger metric for decision-makers going forward, having this distinction in the data will be critical, said NACCHO’s Freeman.
“We need to get that data correct, and we need to do it quickly,” she said…
“Our nation had a patchwork of underfunded, understaffed, poorly coordinated health departments and decades out-of-date data systems, none of which were equipped to handle a modern-day public health crisis,” said Frieden, who is now president and CEO of Resolve to Save Lives.
Building the national public health data infrastructure will be a “long, difficult and expensive process,” he said — but it’s critical to prevent another pandemic.” (C)
“A leading health expert said the largely more mild symptoms reported by vaccinated people against the coronavirus proves the inoculation is the best way to protect yourself from being seriously sick or dying from the disease and that a surge in case numbers should no longer be the central metric by which to measure the pandemic.
“For two years, infections always preceded hospitalizations which preceded deaths, so you could look at infections and know what was coming,” Ashish K. Jha, dean of Brown University and a former Harvard health expert said during an appearance on ABC’s “This Week” on Sunday. “Omicron changes that. This is the shift we’ve been waiting for in many ways.”
The country has shifted, Jha said, to a place where people who are vaccinated and especially those who have received a booster shot “are gonna bounce back” if they become infected with the coronavirus.
“That’s very different than what we have seen in the past,” he said. “So I no longer think infections, generally, should be the major metric.” ..
“But we really need to focus on hospitalizations and deaths now,” he said. (D)
“There are two paths world leaders can take.
It’s a little like Aesop’s fable, The Ant and the Grasshopper – a story about the virtues of planning for the future. Like the ants in the fable, we could learn from Covid-19, stock-up, prepare and keep watch as a global community.
Or policymakers could breathe a sigh of relief, hope nothing like this happens again, and carry on much as before.
Governments cannot make the same mistakes again.
They must do better.
And they must work together to strengthen global health systems to better prevent, prepare for and respond to the next pandemic.
1. Improve global coordination and leadership…
2. Provide a sound financial footing for pandemic preparedness and response…
3. Invest in the gaps in infrastructure to monitor and respond to threats…
At the start of the Covid-19 pandemic, very little was known about the virus, even less how to diagnose, treat and prevent it. Thankfully, scientists could build on existing research on other coronaviruses, such as vaccines for MERS and new mRNA technology. As a result, multiple vaccines were developed, approved and manufactured in record time.
Next time, the world may not be so lucky.
Consider our response to Ebola, where failures to continue key areas of research between outbreaks led to a delay in the development of usable diagnostics, treatments and vaccines when the next outbreak hit.
There are still no WHO-approved diagnostic tests for six out of the WHO’s 10 priority diseases. “ (E)
“Preparing for the next pandemic implies that policymakers will have to understand and address the cited failures. Here, it’s imperative that policymakers develop a long-term pandemic preparedness strategy that is evidence-based, educates the population, and strives for what the former WHO Director-General Dr. Margaret Chan calls “health security.” Chan posits that “respiratory pathogens with pandemic potential pose an existential threat as serious as climate change, environmental degradation and nuclear war.” Underscoring Chan’s point, Dr. Maria Van Kerkhove, Technical Lead of the WHO’s Covid-19 Response, warned that “pandemic preparedness and readiness is a constant. It doesn’t begin, it doesn’t end. There is no peacetime.”
Echoing the warnings issued by Chan and Van Kerkhove, Dr. Scott Gottlieb writes in his book, Uncontrolled Spread, why we must view public health preparedness through the lens of national security. Here, the U.S. has an indispensable role to play, given the influence it exerts as the world’s largest economy, along with having several public health agencies the world has traditionally looked up to, including the Centers for Disease Control and Prevention.
But, public health preparedness in the U.S. faces enormous challenges. For one thing, it appears that already U.S. legislators are no longer prioritizing efforts to prepare for the next pandemic. Some might be shocked by this, in light of what has transpired over the last 20 months. But, the apathy displayed by many lawmakers is consistent with decades of neglect of public health, which has led to chronic underfunding, at the local, state, and federal levels.
Essential public health components are even an afterthought in the Biden Administration’s $65 billion pandemic preparedness initiative. Missing in this plan are, for example, comprehensive plans on how to equitably distribute and provide access to developed and procured medical technologies, as well as ways to improve outreach and information campaigns, and properly fund local public health authorities.
At a bare minimum, public health departments at the local, state, and federal levels ought to be revitalized. But, this will be a difficult undertaking in the face of entrenched opposition to public health interventions. Twenty-six states have curtailed public health powers amid the Covid-19 pandemic. In these states, legislators have rolled back the capacities which state and local officials use to protect the public against infectious diseases…
Preparing for the next pandemic will be difficult under any circumstances. But, it’s made harder by a persistent lack of resources and the rise of anti-science attitudes. Accordingly, making preparations for future infectious disease outbreaks will involve more than just resource deployment. Public health officials will also need to work on improving messaging, specifically to explain science-based decisions to the public in a nuanced way that allays fears of government overreach. Here, policymakers will have to walk a fine line when rebutting the narrative of disinformation campaigns, as run, for example, by the anti-vaccine community.” (F)
“U.S. health officials said on Wednesday they are preparing for the next phase of the COVID-19 pandemic as Omicron-related cases decline, including updating CDC guidance on mask-wearing and shoring up U.S. testing capacity.
The plans come as a growing number of U.S. states have begun to ease COVID-19 restrictions as cases decline. The seven-day average of daily cases dropped 40% from the previous week, while the daily hospital admission average dropped 28% and the average daily deaths dropped 9%, according to CDC data.
“We’re moving toward a time when COVID isn’t a crisis, but is something we can protect against and treat. The president and our COVID team are actively planning for the future,” White House COVID-19 Response Coordinator Jeff Zients told reporters.
“Our highest, first priority is fighting Omicron,” Zients said. “At the same time, we are preparing for the future.”
The U.S. Centers for Disease Control and Prevention is weighing new COVID-19 guidance, including on when to wear face masks, CDC Director Rochelle Walensky said at the same briefing, adding that hospital capacity will be a key metric.
The CDC expects many of the revised guidelines will be issued in late February or early March, around the same time mask mandates in several states are lifted, she said.
“We want to give people a break from things like mask- wearing when these metrics are better, and then have the ability to reach for them again should things worsen,” said Walensky.
Walensky cautioned that people will still have to wear masks in certain situations such as when experiencing COVID-19 symptoms, during the ten days following a COVID-19 diagnosis, or following exposure to someone with COVID-19.” (G)
- A.Quality, Safety, and Standards Organizations COVID-19 Impact Assessment: Lessons Learned and Compelling Needs, By Carolyn Clancy, Kate Goodrich, Jean Moody-Williams, Karen Dorsey Sheares, Margaret O’Kane, Stephen Cha, and Shantanu Agrawal, https://nam.edu/quality-safety-and-standards-organizations-covid-19-impact-assessment-lessons-learned-and-compelling-needs/
- B.Health Care Safety during the Pandemic and Beyond — Building a System That Ensures Resilience, by Lee A. Fleisher, M.D., Michelle Schreiber, M.D., Denise Cardo, M.D., and Arjun Srinivasan, M.D., https://www.nejm.org/doi/full/10.1056/NEJMp2118285
- C.The US still isn’t getting Covid-19 data right, By Deidre McPhillips, https://www.cnn.com/2022/02/10/health/covid-data-problems/index.html
- D.Health expert: Surge in COVID-19 cases should no longer be ‘major metric’ of pandemic, BY DOMINICK MASTRANGELO, https://thehill.com/homenews/587329-health-expert-surge-in-covid19-cases-should-no-longer-be-major-metric-of-pandemic
- E.How to prevent another major pandemic,https://wellcome.org/news/how-prevent-another-major-pandemic#:~:text=Explainer-,How%20to%20prevent%20another%20major%20pandemic,-The%20world%C2%A0could
- F.Preparing For The Next Pandemic: Guarding Against Anti-Science, by Joshua Cohen, https://www.forbes.com/sites/joshuacohen/2021/11/01/preparing-for-the-next-pandemic-guarding-against-anti-science/?sh=136539682485
- G.U.S. officials prepare for pandemic’s next phase as Omicron wanes, By Susan Heavey and Ahmed Aboulenein, https://www.reuters.com/business/healthcare-pharmaceuticals/us-cdc-weighs-new-guidance-masks-still-key-some-cases-chief-says-2022-02-16/