Lessons Learned From the Public Health Workforce's Experiences With the COVID-19 Response.

Limited research is available on the COVID-19 response experiences of local, state, and federal public health workers in the United States. Although the response to COVID-19 is still presenting challenges to the public health workforce, public health systems must also begin to consider lessons learned that can be applied to future disasters. During July and August 2021, a random sample of participants from a cross-sectional study of the public health workforce was invited to participate in interviews to obtain information on the current state of public health operations, the ongoing response to the COVID-19 crisis, and takeaways for improving future preparedness and response planning. Interviews were transcribed and inductively coded to identify themes. Twenty-four initial interview invitations were sent, and random substitutions were made until thematic saturation was reached when 17 interviews were completed. Four thematic categories were identified, including challenges related to (1) ongoing lack of political support or policy guidance; (2) fluctuations in, and uncertainty about, future funding and associated requirements; (3) job expectations, including remote work and data-sharing capabilities; and (4) the mental health toll of sustained response and related burnout. As the public health response to the COVID-19 pandemic continues in its third year, it is crucial to identify lessons learned that can inform future investment in order to sustain a public health workforce and a public health preparedness and response system that is resilient to future disasters.

Implementing public health control measures

Early in response to the COVID-19 pandemic, before vaccines and other therapeutics were available, individual- and community-level nonpharmaceutical interventions (NPI) were the only option available to public health officials to prevent or slow transmission. Because the use of these control measures was the only approach available at the time—and a clearer understanding of COVID-19 transmission was needed—a wide array of NPIs was implemented or recommended. These included social distancing, travel bans, stay-at-home orders, school, office, and nonessential business closures, and cancellation of events, as well as hand washing, frequent cleaning, and other enhanced hygiene practices. While these measures work best with a layered, additive approach, limited federal guidance and different jurisdictional approaches to the use of control measures led to vastly different implementation of NPIs across the USA. With the introduction of pharmaceutical interventions, including convalescent plasma, antivirals, and vaccines, confusion about the need for, and use of NPIs especially face coverings, grew. The COVID-19 pandemic has brought to light the importance of utilizing NPIs as part of the approach to reduce the risk of infection and control population-level spread of diseases like seasonal influenza and respiratory syncytial virus. However, it has also highlighted the importance of clear public messaging and authentic community engagement around NPI use.

Equity and disproportionate impacts of COVID-19

The COVID-19 pandemic has had disproportionate impacts on racial and ethnic minorities and other vulnerable groups. The direct inequities—higher risks for infection, hospitalization, and death among racial and ethnic minorities in the U.S.—tell only part of the story. Social determinants of health, including access to and quality of housing, employment, education, and healthcare, also contributed to the inequitable impacts of COVID-19. This is particularly pronounced among groups like essential workers, parents of school age children, racial and ethnic minority populations, and rural populations, among others. While studied for many decades, public awareness and social momentum for understanding the ramifications of interpersonal and structural discrimination on health outcomes have further underscored the importance of this work in the context of COVID-19. The COVID-19 pandemic has provided a stark example of the consequences of failing to adequately address long-standing social determinants and structural disparities related to the public's health.

Federal, state, local, and other public health agency roles in preparedness

Even prior to the September 11, 2001, terrorist attacks and the subsequent mailing of letters and packages contaminated with anthrax spores, public health agencies were focused on the topic of public health emergency preparedness. However, in the last 20 years, based on lessons learned from the public health responses to a number of emergencies, the public health emergency preparedness field has adapted and evolved to changing circumstances. The greatest of these has been changes to funding and funding mechanisms. These include grants and cooperative agreements from the Centers for Disease Control and Prevention that support state, tribal, local, and territorial health departments' ability to detect and respond to public health threats. During public health emergencies, including COVID-19, a mix of supplemental funds, relief packages, and emergency funds are used to support temporary surge capacity, often supporting additional Epidemiology and Laboratory Capacity and an expanded contract-based workforce. In addition to public health emergency preparedness, public health agencies also provide many essential services that are invisible to most when working well, and the need for these essential services continues during an emergency response. In an increasingly connected world, collaborative cross-jurisdictional and global relationships with groups such as the World Health Organization tribal public health agencies, and others are also essential for protecting the public's health. The response to the COVID-19 pandemic has drawn attention to the many gaps in our decentralized public health system in the U.S., including inadequate investment in the public health workforce.

A Qualitative Study of the COVID-19 Response Experiences of Public Health Workers in the United States.

The mental health impacts of the COVID-19 pandemic on frontline, patient-facing healthcare staff have been described in several studies, but the effects of the COVID-19 response on the US public health workforce have not been well characterized. In early 2021, we conducted interviews with a subset of public health practitioners in the United States who participated in a cross-sectional survey and indicated their willingness to participate in a follow-up interview. An interview guide was developed to collect information about professional roles since the start of the pandemic, aspects of the individual COVID-19 response that impacted mental health, and aspects of the organizational/institutional COVID-19 response that impacted mental health, as well as the strengths and weaknesses of, opportunities for, and threats to public health professionals and organizations going forward. Interviews were transcribed and inductively coded to identify themes. Of the 48 people invited to participate, 24 completed an interview between January 28 and February 23, 2021. Five key themes were identified through inductive coding of interview transcripts: (1) teamwork and workplace camaraderie, (2) potential for growth in the field of public health, (3) considerations for adaptive work environments (eg, remote work, work out of jurisdiction, transition to telework), (4) politicization of response, and (5) constrained hiring capacity and burnout. After more than a year of public health emergency response to the COVID-19 pandemic, it is critically important to understand the detrimental and supportive factors of good mental health among the public health workforce.