The Light at the End of the (Long) Tunnel

November 16, 2020|9:58 a.m.| Marcus Plescia MD, MPH | ASTHO Chief Medical Officer

Marcus PlesciaThere is no question that things feel dark right now. COVID-19 rates are rising in states across the country, the daily case rate has exceeded 100,000, the upcoming winter months and major holidays are a portent of future spread, and the nation is in process of undergoing a challenging political transition. As state and territorial leaders of the nation’s pandemic response, health officials’ focus now is how we can provide effective public health guidance through these next few months. And although there are hopeful new interventions on the horizon, clear direction-setting in every state and territories is vital to assure our planning and implementation is fair and focused on those most at need.

These are not entirely unprecedented times. The 1918 pandemic flu killed almost 700,000 Americans. Even then, despite increasing understanding of respiratory disease transmission, many leaders—including public health leaders—downplayed the pandemic and refused to take effective steps to limit large gatherings and encourage mask wearing.

Changing behavior, or introducing new social norms, was as difficult then as it is now. We have to learn from history if we are to effectively respond to our present reality.

It is increasingly clear that we must listen to, understand, and address the existing fears, misunderstandings, and feelings of helplessness of the public toward COVID-19. We have to also understand the blatant disregard for public health mandates, and the mistrust and perceived threat to liberty that public health orders are eliciting from a vocal minority of our fellow Americans. Our challenge over the next few months and beyond will be to encourage a divided and discouraged country to participate in vaccination and emerging medical treatments, while maintaining physical distance and mask wearing behaviors that will continue to be necessary well into the future.

Dr. Anthony Fauci of the National Institutes of Health has emerged as one the nation’s most visible infectious disease specialist. He is well-schooled in both the science and art of medicine. He is perseverant, speaks to the science, and communicates effectively with the public with empathy and understanding. Many state health officials have been equally effective using these same approaches with their political leaders and the public. ASTHO will continue to share these effective strategies since it’s the most important thing we can do right now to fight pandemic fatigue and encourage the sustained adoption of COVID-19 prevention measures to slow the spread of disease. As state public health leaders continue to lead and communicate their response, we need to find ways to re-frame these conversations about risk reduction and prevention with attention to our collective values as Americans and put the "public"—all of us—back into public health.

There is a light at the end of the tunnel. The recent progress developing a COVID-19 vaccine is encouraging. So is the emergence of new medical treatments and the potential for a more coordinated federal approach to testing, face coverings, and physical distancing. However, administering a vaccine at the scale and speed required will be a challenge for state health departments. We must balance our need for expediency with continued attention to the disparities we have witnessed in COVID-19 infection and outcomes among people of color.

These disparities will become worse if communities are hesitant to participate in vaccination—after all, minority communities have good reason to be hesitant given the legacy of medical injustices they have suffered in the past. Widespread communications campaigns will be important, but public health leaders have tools and relationships we can pull from to engage and inform diverse communities. Despite the rapid timeline and scale of the endeavor, we must find ways now to engage communities that will be most difficult to reach in our planning efforts and as we distribute the vaccine.

As we move through the next few months we will be increasingly challenged by the human consequences of this pandemic and the toll on our workforce. As public health leaders, we are used to dealing with controversy. We are skilled at communicating recommendations and actions based on evidence and emerging science, and we are fortunate to lead a workforce that is sensitive to cultural and historical experience. It is important to remember there is a light at the end of the tunnel and an opportunity to make public health stronger. Thank you for your leadership and perseverance in these difficult times.


Marcus Plescia, MD, MPH, is ASTHO’s chief medical officer