Has public health failed us? Or have we failed public health?

These two questions are the subtitle for Gregg Gonsalves’ newly published article in The Nation (Pandemic Year 3: Who’s Got the Power?). In addition to being an eye-catching subtitle, these two questions perfectly encapsulate how the politicization of public health (and almost anything that potentially restricts personal autonomy) has led to our current state— 1,085,150 dead and counting.

Both Dr. Gonsalves’ lecture and article have allowed for personal reflection. I have a vivid recollection of the first few months of the Covid-19 pandemic. But when I try to recall the later months of 2020 and 2021, I come up short. I don’t know when the weeks began to bleed together, no longer holding frequent, impactful memories that would never leave. I think this is the case for most people. It’s also what I think has strengthened the ability to change the narrative and politicize this pandemic.

Masking is a great example where the societal ‘we’ have asked public health to defend their actions instead of setting the agenda. The mask fatigue and calls from some of our most vocal political leaders must have been a huge reason why the CDC changed their masking guidelines a couple of months ago. Scientific data and common sense took a back seat. I mentioned this in class so I do apologize for the repetition, but this infuriated me. Not because I knew it would lead to increased Covid-19 spread and infection (though that is still incredibly important), but because this decision was released right at the start of respiratory season, when healthcare systems were already reporting higher rates of flu and RSV infections and admissions than normally expected for this time of year. Unlike Covid-19, these viruses are transmitted through droplets. Therefore, simple surgical masks are very effective. As hospitals, including even non-pediatric beds, reach full capacity, I wonder how many infections could have been avoided if the masking guidelines and requirements were still in place?

Dr. Gonsalves writes, until we address “sovereign state actors, who are openly antagonistic toward science and public health, and other entities with vested interests that disseminate false information,” public health will not hold the power to set the policies and practices. Until this no longer remains the case, we will keep adding more lives to the 1,085,150 who have died from Covid-19.

Burnout in health care is often characterized as a state of emotional exhaustion with degrees of depersonalization, detachment from patients, and apathy regarding work. The U.S. Surgeon General released an advisory on health worker burnout earlier this year. While this is not a new phenomenon, the rates of burnout have massively increased since the start of the pandemic. This is particularly significant because, according to a 2019 report from the U.S. Census Bureau, healthcare workers make up 14% of the U.S. labor force, making it one of the largest sectors. Before the pandemic, the healthcare industry already had a supply and demand problem. This has only worsened over the last few years. While burnout cannot be solely attributed to this problem, it is a significant factor. Hospitals and organizations are trying to implement supportive programs or initiatives to mitigate the levels of burnout. To an extent, usually on an individual level, some of these are very helpful. But overall, there does not appear to be a plateau anywhere in site.

We know from Dr. Dittmann and Dr. Bianchi’s presentations the covid-19 pandemic was not “the great equalizer” early reports hoped it might be in 2020. In fact, I would argue the pandemic shined a brighter light on the inherent inequalities and lack of social services in the U.S. For healthcare workers, this became something we could no longer compartmentalize away. My first covid patient who died most likely contracted the virus while working overtime in an Amazon warehouse because his family could not afford for him to stay home. I cared for more children in the ICU who attempted suicide in 2021 than I did for my previous five years combined. We had to wear our N95 masks for eight 12-hour shifts before getting new ones, knowing they were no longer effective by the end of the first shift. These experiences were too numerous and impactful to accept as the status quo. Practically three years in, there are still very few resolutions, and I believe that is one of the main drivers in healthcare worker burnout. We can’t alter the past, but we can’t ignore it either. I don’t know what the answer is to addressing burnout or other issues in the healthcare workforce. Maybe reflecting back as we do for this class will provide some insight. Regardless, change is inevitable, and I hope we remember and reflect on these impactful patients and co-workers and all of the unfortunate things covid-19 highlighted.