In Summary:

• Like health care workers, Michigan’s public health workforce is exhausted.
• The advent of a vaccine to protect against COVID-19 is monumental, but it will not provide immediate relief from the pandemic.
• Michigan is likely still in for a long winter of masks, physical distancing, and other public health protocols.

As the pandemic continues to wear on, many people are experiencing “pandemic fatigue” and have become tired of taking precautions for COVID-19. In part because of waning compliance with public health recommendations, Michigan’s hospitals have been inundated with COVID-19 patients, leaving health care workers weary and overwhelmed. Yet, lost in this discussion is the fact that Michigan’s public health capacity is also stretched too thinly, and that public health leaders and personnel are themselves exhausted and desperate.

Public Health in Turmoil

The pandemic has put Michigan’s public health systems to the test. Core public health functions, like disease surveillance, contact tracing, laboratory diagnostics, and data collection, analysis, and dissemination (not to mention the expertise and authority to issue public recommendations and/or orders), have all been marginalized by resource and capacity constraints. In fact, Michigan has, in some cases, turned to private contractors (and even volunteers) to perform these essential governmental functions.

Public health plays an essential role in keeping people healthy and preventing the need for hospitalization or other health care interventions, and yet, while concerns over health care capacity have been voiced widely since the start of the pandemic, very few have expressed the same concern for public health capacity. It is this latter public health capacity that makes it possible to do things like “flatten the curve” and prevent hospitals from becoming overwhelmed.

“I wasn’t prepared to understand how little investment had been made in the core capabilities of public health…There’s a huge lack of investment, which I hope this pandemic will change.”

– Dr. Robert Redfield, CDC Director

Part of the challenge facing our public health workers, systems, and infrastructure is simply long-term lack of investment. The Citizens Research Council highlighted this vulnerability in 2018.

Dr. Robert Redfield, Director of the U.S. Centers for Disease Control and Prevention (CDC), recently told attendees of a U.S. Chamber of Commerce event: “I wasn’t prepared to understand how little investment had been made in the core capabilities of public health…There’s a huge lack of investment, which I hope this pandemic will change.”

Redfield also warned that the coming months could be “the most difficult in the public health history of this nation.”

Funding and capacity aren’t the only impediments to the effective delivery of public health services and implementation of public health policies. Even prior to the onset of pandemic fatigue, politicization of public health policies and recommendations created another (unfortunate) dimension of complexity, turning even the most mundane recommendations (such as mask wearing) into a flashpoint for some people. 

No one chooses the public health profession to win popularity contests; however, few (if any) public health professionals expected to be rewarded with vitriol and death threats for doing a job intended to keep everyone safe and healthy during a pandemic. This vilification has caused public health officials around the nation to quit their jobs just when we need them most.

Public health professionals make decisions, recommendations, and, indeed, mandates, based on science, evidence, and historical best-practices. We would all do well to heed this expertise, rather than dismiss, undermine, or attack it.

People may argue ad nauseam over the idea that one person’s social contract is another’s tyranny, but they should do so while wearing masks, maintaining physical distance, and ensuring adequate ventilation.

The Long-awaited Vaccine

Health care workers in Michigan began receiving the first doses of a vaccine to protect against COVID-19 earlier this week. While this is certainly a cause for optimism, it doesn’t mean that we can give in to pandemic fatigue just yet; it will still be quite a while until any sort of “normal” is restored.

Numerous logistical challenges impede the ability to provide vaccines to the entire population. Unfortunately, the diffusion of vaccine hesitancy is also a domestic and global problem that continues to threaten public health. While support for COVID-19 vaccines appears to be increasing in the U.S., 27 percent of the public remains vaccine hesitant, saying they probably or definitely would not get a COVID-19 vaccine even if it were available for free and deemed safe by scientists.

For better or worse, immunization is just one tool in a broader public health toolbox for preventing infectious diseases by breaking the chains of transmission. Michigan is in for a long winter of mask wearing, physical distancing, and cooking at home.