Lately, there have been a number of discussions about protecting healthcare workers, bolstering the ranks with volunteerism, and utilizing alternative care sites and providers. There have been call-ups of retired clinicians of all stripes, field promotions of health sciences students, and alternative venues for care like telemedicine. However, one group that does not seem to be as considered or fully addressed is that of home health workers. Although they are often tangentially referenced in healthcare environment conversations, this unique, variable, and incompletely accounted landscape is potentially an area of increased risk for providers, patients, public spread, and mortality.
To help with the increasing surge of COVID-19 patients, there have been a number of calls to re-enlist retired physicians and nurses in the healthcare setting. These calls from those within the government and the clinical setting are understandable on the surface. However, some elements are not being fully considered and could actually have harmful effects if not implemented effectively.
SARS, H1N1, Ebola, Zika, and now the COVID-19 pandemic blindsided U.S. public health officials and the world at large. Although this is a newsworthy headline, it is not entirely accurate. Hyperbole may sell newspapers, but has ignored the great progress that has been made in national public health emergency preparedness. This narrative downplays the lessons learned, many which resulted in improvements in preparedness. Preparedness for well understood threats and expert knowledge of how to respond to those threats – from a scientific, medical, and logistics perspective – is already established. Addressing the many lurking yet unknown threats is more challenging.
This year marks 20 years since Congress established the Strategic National Stockpile (SNS), originally named the National Pharmaceutical Stockpile, in preparation for the year 2000. The intent was to arm the country against possible terrorist threats that could disrupt the U.S. medical supply chain. With a $51 million appropriation and a handful of public health staff based at the Centers for Disease Control and Prevention, the stockpile began in 1999 with a sole focus to protect the American people from biological and chemical attacks.
Conditions of squalor, which may be found in a refugee settlement or on the streets of a third world country, appear to be rapidly increasing in certain places in the United States over the past several years. This phenomenon is evident not only in a growing number of cities in California – including San Francisco, Oakland, San Jose, Los Angeles, and San Diego – but in cities in Oregon, Washington State, Colorado, and elsewhere. During the past several years, similar signs of deteriorating conditions have also become increasingly evident in New York City and Washington, D.C.
While the mission of the Strategic National Stockpile (SNS) has not changed since Congress established this national repository of emergency medicines and supplies, public health events in the United States during the past 20 years have led to a dramatic expansion of the scope of the stockpile’s capabilities. Originally focused on protecting Americans from bioterrorist threats surrounding the year 2000, or Y2K, the stockpile has grown and evolved to a greater than $8 billion enterprise that contains more than just medical countermeasures (MCMs) for biological and chemical threats. The mission authorized is broad enough to encompass virtually any threat to national health security, and the progress SNS has made operationally lends it to encompassing a continually evolving landscape of risks that might be mitigated.
In any disaster, there is a cost beyond the immediate mortality figures following a disaster due to a lack of proper medical supplies and treatment in mass care shelters. The Centers for Disease Control and Prevention publishes a weekly “Morbidity and Mortality Weekly Report,” which serves as a clearinghouse for epidemiological reports submitted by state health departments. However, a public health method must go beyond the death tolls and rates and estimate the years of life lost for people who were without medications and treatments (like dialysis) for extended periods of time during and following disasters.
Transitioning from public sector emergency management for a large city to emergency management for a private sector hospital is not easy. The fundamentals of emergency preparedness are the same, but the hospital setting has unique challenges. Each day, there are different numbers of people within the hospital. Some days, the occupants exceed hospital capacity during normal operating conditions. There is no set vulnerable population as the demographics of the population changes hourly. Having a large turnover of people in the hospital because of appointments, outpatient surgeries, visitors, and vendors makes preparedness efforts more challenging.
In today’s emergency response landscape, public health jurisdictions across the United States rely on the Strategic National Stockpile (SNS) when incidents prove large enough or severe enough to deplete medicines and supplies needed to protect communities. In just 20 years, the SNS – now managed by the U.S. Department of Health and Human Services’ (HHS) Assistant Secretary for Preparedness and Response (ASPR) – has grown to a $7 billion enterprise poised to respond to a variety of public health threats. These threats include anthrax, botulism, smallpox, plague, tularemia and viral hemorrhagic fevers, as well as emerging infectious diseases, pandemic influenza, natural disasters, and other chemical, biological, radiological, and nuclear incidents. Although predicting the future of any program is challenging, the SNS has evolved from humble beginnings to a formidable component of national security.
In 2017, the U.S. Department of Health and Human Services declared a public health emergency related to the opioid crisis. Indeed, overdoses and deaths from opioids have skyrocketed over the past decade. In 2017, deaths from opioids were six times higher than in 1999. Opioids impact the quality of life and longevity, as well as have tremendous social and economic impacts on communities throughout the United States. The Centers for Disease Control and Prevention has stated that the total economic burden of prescription opioid misuse costs over $78 billion per year.