Public health policy amid the COVID-19 pandemic

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By Philip Smith, assistant professor of kinesiology and health, and Shavon Anderson, university communications and marketing


Philip Smith, assistant professor of kinesiology and health.

As COVID-19 continues to spread across the United States and the world, many communities have lingering questions about the deadly virus and its impact. To help address concerns, Miami’s office of university news and communications connected with Philip Smith, assistant professor of kinesiology and health. Smith has expertise in psychology, epidemiology, health policy, community health and health behavior. In part 3 of a 4-part series, Smith talks health policy in a way that’s easy to understand, in his own words.

With stories of overcrowded hospitals, lack of supplies and health care workers battling sickness on the frontlines of the coronavirus crisis, state and federal officials are not only working to stop the current spread but learning how to prepare for a scenario like this in the future.

It’s going to be incredibly important for policymakers to assess how our health care system can be both efficient – in that we do not have extra capacity and personnel sitting around – while being flexible enough to prepare for possible future epidemics. Whether or not changes to state or federal policy will follow the COVID-19 crisis is difficult to determine, since this is the first major outbreak of its kind in current times.

Of course we’ve known it was a possibility, and there have been people in healthcare and public health sounding warnings – we weren’t ready for something like this, whether it was a massive bird flu pandemic or a severe coronavirus pandemic. However, we tend to react rather than prevent.

Health policy changes

To think of a pandemic on a similar scale, you would have to think all the way back to the 1918 influenza pandemic. That pandemic caused more loss of life than COVID-19 is likely to cause – around 50 million people worldwide and 675,000 people in the U.S. Thinking about policy changes is hard because it was so long ago, and so different. We did not have the CDC, or much else in terms of our Department of Health and Human Services back then – that all happened after the 1950s. Health insurance, and especially public health insurance like Medicaid and Medicare, was barely a thing. Our hospital system was minuscule compared to what it is now. 

We don’t really have a good example of how much policy tends to change when you have a pandemic like this.

There are clear policy changes that could happen that would help. For example, creating or more efficiently using national and local stockpiles of medical supplies and equipment, such as masks and other protective gear, and ICU supplies that can be deployed in the case of emergency. Having an emergency plan and dedicated budget that would allow healthcare providers to rapidly and efficiently scale up in case of an epidemic would make a huge difference. These policies would need to happen at the national, state and local levels. 

Making sure people have access to health care so they have a provider to call when they start to get sick, rather than just showing up at the ER, would make a difference. We could also look at better use of existing policies, like more quickly using the Defense Production Act to require companies to make ventilators. We also clearly have existing policy tools to encourage social distancing, like stay-in-place orders and shut-downs, that some states are using more than others and that some states enacted earlier compared to others. 

If a pandemic like this happens again in the future, hopefully we will have learned lessons and can make better use of the policies that exist, and then create new policies that make our healthcare system better prepared to massively scale-up when needed.

Easing the burden on health care workers

The models and predictions that experts with state governments and the Centers for Disease Control are using to predict numbers of cases, hospitalizations and deaths are getting more and more accurate by the day as we have more data and know more about the particular strains of coronavirus that are causing COVID-19. We’re rapidly learning, and because of that fact, we’re making more accurate predictions. 

Unfortunately, the data and predictions we’re making now are consistent with what people feared from the start. The virus is spreading very fast, and the number of people who are sick and dying is staggering. Even with relatively extreme measures in place, we are likely going to see an increased number of people get sick and die in a short amount of time. With extreme measures in place, there will be fewer severely sick people and deaths than if we did nothing. With this said, these are still predictions, with error, and something could change in a day that makes the predictions change.

The federal government can do more to help people social distance by subsidizing income to an extent that is more consistent with other countries. It can also ensure adequate testing and medical supplies. In the meantime, while there are such shortages of protection for our health care workers, and as we start to see shortages in ICU capacity, the absolute most important thing to do is for people to wash hands and engage in social distancing. This is why federal, state and local efforts to enact policy and support people in doing this are so important. 

Mobilizing healthcare volunteers, like we see in New York City, can help fill gaps when health care workers start to get sick. However, as heartwarming as it is to see this altruistic spirit, this puts more people at risk in an already terrible situation. The more we can do to prevent the need for more people to be at risk, the better off we will be. 

Of course, if novel treatments are developed, or if we eventually have an effective vaccine, fewer people will get sick and people will stay sick for shorter periods of time, lowering demand on the system and saving lives. We have innovators who are working around the clock to try to make this happen, so we will see. It’s not something we can depend on right now. 


Join Philip Smith for an upcoming May 8 webinar: Miami Presents: Surviving COVID-19 - Making informed decisions during a global pandemic. Smith will teach basic skills for staying informed during the COVID-19 pandemic, empowering the audience to make informed decisions during this unprecedented time of uncertainty. The webinar is intended for a general audience and does not require any prior knowledge of public health or epidemiology.