What Happened to Public Health?
Author: Shoshana Benjamin, MPH
Keywords: public health, pandemic, COVID-19
I was in my second semester of my master’s of public health in New York City when the COVID-19 pandemic started. And aside from all of the fear and anxiety I was experiencing because of the pandemic, I remember feeling so proud that I had chosen the field of public health. While many of us would agree that the early response to COVID-19, especially with 20-20 hindsight (no pun intended….) was severely lacking, I was excited that the major tenets of public health—prevention and promotion—were taking center stage.
For my summer practicum that year, I worked for the New York City Department of Health and Mental Hygiene, helping to craft messaging about COVID-19 and equity. It was inspiring to be a part of an organization dedicated to protecting my city. During a zoom happy hour with friends, I darkly joked that the one upside of the pandemic was that at least people now knew what public health was…
But things have changed. Since the first waves of the pandemic, we’ve seen a terrifying about-face from health professionals—or health professionals portraying themselves as expert in public health who do not have that training. You know that we are in crisis when medical doctors who are ostensibly public health focused are calling for a return to “normal” and minimizing the risk of COVID. The Centers for Disease Control and Prevention (CDC) is barely calling for any COVID-19 POPULATION-level mitigation measures, focusing only on reducing severe disease through vaccination and treatment (though barely doing any messaging about the updated, bivalent boosters) and especially focusing on INDIVIDUAL risk assessment and reduction. The CDC has forgotten its name and its mandate: to control and prevent disease.
During orientation for grad school, a professor told us the classic public health parable about people in the river. Basically, someone sees that there are people drowning in a river and immediately starts scooping them out. Another person runs upstream to see why there are all these people in the river, only to find a broken bridge. Obviously, it’s critical to get the people out of the river, but it’s more efficient (and less traumatizing for the people) to fix the bridge and keep them from getting in the river in the first place. That’s what public health is about: preventing people from getting into the river; preventing people from getting sick in the first place.
We have the tools to prevent people from getting COVID in the first place: increasing indoor ventilation, masking (with high-quality masks) indoors, mandating boosters, making testing free and easily available, etc. And we need to use everything in our arsenal to prevent COVID infection in the first place, not just severe disease as a complication. Long COVID is a clear and present risk that we know about, data suggests that between 20-30% of people who are infected with COVID develop long COVID. And that is what we know. What we don’t know is what will happen to people who’ve gotten COVID in a year, 5 years, a decade, or longer. It can take HIV years to turn into AIDS, chicken pox can flare as shingles after decades, and EBV can lead to multiple sclerosis. In addition to the mass disabling that is occurring due to Long COVID, what potential horror awaits us down the road? HPV turns into multiple types of cancer (cervical, head/neck, and anal )—will COVID lead to nothing or another terrible disease? Already, evidence demonstrates that COVID is a vascular disease and can lead to cardiac and neurologic complications. The truth is, we don’t know, and because of that we must be careful. We must prevent every infection we can.
When I go on Twitter and see medical professionals downplaying the risk of COVID and advocating against masks or other protective measures, or when the CDC opts to let millions of Americans die or become disabled, I feel betrayed. As someone who is still taking COVID fairly seriously: I always wear a KN95 or N95 when inside public spaces, I don’t eat indoors at restaurants, and only hang out unmasked, inside with friends if we’ve all take rapids or gotten PCRs. I feel gaslit by the government and medical pundits. The pandemic is still happening, with hundreds of Americans dying everyday, but sometimes it feels like there is an ever-shrinking minority who both acknowledges that or thinks we should do something about it.
We need to return to public health, to thinking about how to protect populations instead of relying on people’s individual choices. We need to go upstream and keep people from ending up in the river in the first place.
About the author: Shoshana Benjamin received her master’s in public health from Columbia University’s Mailman School of Public Health, where should focused on the social determinants of health and sexual and reproductive health. She currently works as a research assistant and project administrator with the Social Intervention Group at Columbia University’s School of Social Work. (Twitter: @shoshal_network)
