COVID‐19 and Underinvestment in the Public Health Infrastructure of the United States

Abstract

severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has spread globally, leading to more than 2 million confirmed cases (with the true prevalence of infection unknown but certainly much higher) and nearly 200,000 deaths. 1 In the early stages of the pandemic, cases were largely concentrated in the Wuhan province of China, and subsequently northern Italy, with the World Health Organization (WHO) labelling Europe as the epicenter of the pandemic as recently as March 13th. 2 However, as the pandemic progressed, the epicenter moved to the United States, with case numbers surpassing those in China by March 26th, and at the time of writing, standing at nearly four times the total confirmed cases of any other country. 1 It seems clear that the United States was not only ill-prepared and poorly positioned to deal with COVID-19, 3 but also uniquely susceptible to the spread of this illness. The rapid increase in cases, the escalating pressures on hospitals, and the latest modelling estimates suggest that the United States will bear the brunt of COVID-19 related harm as compared to many other high-income nations. It is prudent that we ask why this might be the case, particularly considering the status of the United States as the world's wealthiest country. While the predominant focus of public debate has been on political decision-making as the pandemic unfolded, this narrative fails to acknowledge additional longstanding exacerbating features in the United States that laid the ground for greater spread and slower containment of SARS-CoV-2. As with any such event, assessing the precise causes is a complex issue, but there are two important trends that we consider central to the United States'

Community Pharmacists’ Contributions to Disease Management During the COVID-19 Pandemic

“…Now is the time for community pharmacy organizations to prepare for this critical public health role. Additionally, the community pharmacist's role in providing accurate health information about COVID-19 and the safety and appropriateness of vaccines will continue (41).…”

50 policies, 1 pandemic, 500,000 deaths: Associations between state-level COVID-19 testing recommendations, tests per capita, undercounted deaths, vaccination policies, and doses per capita in the United States

“…Improving surveillance and data quality during the first months of the COVID-19 pandemic has been challenging for state health departments, many of which have struggled with staffing, funding, and even threats to public-facing employees. 16,17 However, messaging around the utility of testing has been inconsistent at both the federal and state level, [18][19][20] with three states actively recommending against testing asymptomatic people and then reversing this policy to encourage all residents to get tested. [21][22][23] Consistent messaging from public health authorities would be beneficial, particularly in light of the continuing problem of misinformation during the COVID-19 pandemic.…”

Health and human rights are inextricably linked in the COVID-19 response

“…Many countries such as the UK, Italy, Spain and the USA are struggling to respond, partly due to years of budget cuts under austerity measures. [46][47][48][49][50][51] As a result, they have struggled to source adequate diagnostic testing and personal protective equipment (PPE) to prevent disease transmission. 52 53 Compounded by discrimination in healthcare settings, marginalised groups such as migrants and displaced persons, racial and ethnic minorities, women, sexual minorities, older persons, incarcerated populations and those living with HIV are particularly vulnerable to violations of the right to health.…”