After Pandemic Missteps: Senators Seek Lessons for Future Emergencies

Members of the Senate Health, Education, Labor and Pensions (HELP) Committee played the blame game for false steps during the pandemic.

At a hearing on Tuesday, HELP committee chair Patty Murray (D-Wash.) said the nation was ill-equipped to respond to the COVID-19 pandemic because of a weak and underfunded public health infrastructure. She called for an end to the pattern of “crisis and complacency” in public health funding.

But ranking member Richard Burr (R-N.C.) called out the CDC for the country’s pandemic response missteps.

Beyond the finger-pointing, the HELP committee heard about caregiver support, next-generation face masks, and interoperability.

She Said, He Said

Murray pointed out that public health systems have been understaffed and underfunded for over a decade, noting that spending for public health has dropped by 16% since 2010, and funding seems to always dip whenever there is a lull in emergencies. As for staffing, outside of large cities, one in five public health workers earns less than $35,000 per year, she said.

Murray touted her bill, “The Public Health Infrastructure Saves Lives Act” that would establish a Core Public Health Infrastructure program at the CDC. The goal would be to help the agency provide states and local health departments with sustained funding for the tools, well-trained staff, and systems necessary to respond to emerging health threats.

Burr held that the CDC lacked adequate surveillance to track the virus’s spread in “near real-time”; had not hired the right experts to conduct biosurveillance; and early in the pandemic, bungled the delivery of coronavirus tests to public health labs, delaying testing and costing American lives.

Despite being “two steps behind the science,” the CDC was reluctant to speak with innovators offering to help, Burr stated.

“We need to make sure they know what their mission is, and focus the CDC on the right priorities,” Burr said. “Business as usual has to be over.”

Later in the hearing, Burr defended the Trump administration for not following a pandemic management playbook set out by the Obama administration. But he also stated that “Congress deserves as much criticism as any administration out there, period, end of sentence — doesn’t have to be that way going forward.”

HELP asked expert witnesses to highlight gaps and challenges in pandemic preparedness and responses, explaining that their insights will aid in the development of targeted legislation for introduction in the fall.

Caring for Caregivers

Besides public health measures, the success of any pandemic response depends on the ability to address “hospital strain,” or the “excessive demand on the resources or abilities of a hospital,” emphasized David Janz, MD, MSc, director of medical care services at the University Medical Center New Orleans.

Not surprisingly, hospital strain can negatively affect patient outcomes, he stated. For example, how does a hospital or health system respond when critically ill patients arrive and intensive care units are full? At his medical center, critical care services for COVID-19 were boosted, and supplemental healthcare staffing were added. In turn, they were supported with evidence-based patient-care tools, Janz explained, adding that those best practices were shared with other health systems in Louisiana and nationally.

Janz said he worries that hospitals will be faced with a severe shortage of healthcare workers, and nurses in particular, in the face of another public health crisis. He reported that 43% of nurses said they are considering leaving the profession this year, and that more than one in three healthcare workers say they are experiencing depression or anxiety. In addition, roughly one in four healthcare workers report symptoms of post-traumatic stress disorder.

“Nurses are perhaps the most vital responders to this pandemic,” he said. “We have too few of them, and we’re not supporting them enough.”

When asked about the 10% pay cut for doctors in the 2021 physician fee schedule, Janz again expressed concern for nurses, noting that “all healthcare professionals right now need help, especially our nursing colleagues, who … are shouldering the heaviest load in response to this pandemic. And we need to think of ways to help bolster them, not things that we can take away from them.”

Better Masks, Better Communication

Anita Cicero, deputy director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health in Baltimore, discussed “commonsense, attainable” measures that could be implemented to save lives, such as incentivizing industry to develop better masks — “next-generation masks and respirators” — for healthcare workers and other essential workers.

The Biomedical Advanced Research and Development Authority (BARDA) recently held a “mask innovation challenge. That’s a good thing,” she said. According to the Department of Health and Human Services website, there were over 1,400 submissions, with 10 companies, including Amazon and Levi Strauss, winning phase I of the challenge.

The public should also have access to higher quality masks, and “the government could establish standards around breathability, wearability, and effectiveness of masks to ensure more reliable protection,” Cicero said.

She proposed a face-mask certification process. “I think when people buy masks in CVS, they should know, first of all, they’re available, and secondly, they’re … certified, and so they’re effective at reducing the risk of infection,” she said.

Finally, Les Becker, MBA, PMP, deputy secretary of innovation for the Washington State Department of Health, emphasized the critical need for interoperability between public health data systems, hospitals, and health systems. He also stressed the importance of public-private partnership.

Becker described WA Health, a partnership between Microsoft and the state health department, that shared real-time statistics about Washington’s hospital systems’ staffing levels, emergency department availability, and access to personal protective equipment.

“We need to incentivize private partners to stay the course post-pandemic,” he said.