Include community prevention efforts to combat the triple epidemic

a The viral hurricane has made landfall on healthcare systems battered by three years of the pandemic. With the official start of winter weeks away, children’s hospitals are facing overwhelming numbers of children infected with RSV and other viral diseases. Schools that promised a “return to normal” are now reporting widespread absenteeism and even closures from RSV and influenza in many parts of the country, contributing to parents missing work in record numbers. With this year’s flu season beginning about six weeks ago, the Centers for Disease Control and Prevention (CDC) has already declared a pandemic influenza as the number of hospitalizations for the flu has risen to the highest point in more than a decade.

A storm of this proportion should require not only clinical crisis measures, but societal prevention efforts as well. But instead of deploying public health strategies to weather the storm, the United States is abandoning them.

Even before the so-called triple pandemic arrived, health systems in the United States were on edge. But as the tide of decline threatens to upend staggering hospitals, so has the appetite for public health measures. Pediatricians declare “This is March 2020” and issue pleas for help while public health efforts to flatten the curve and reduce transmission rates of Covid-19 — or any infectious disease — have effectively evaporated. Unmanageable patient volumes are seen as deterministic, or described as a predictable consequence of an ‘immunity debt’, despite significant uncertainty surrounding the scientific basis and practical usefulness of this concept.

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The Covid-19 pandemic should have made us more prepared for this moment. It has helped the public understand that respiratory viruses are primarily spread through shared indoor air. Public health practices to stop the spread of Covid-19 — such as masking, moving outdoor activities, and limiting large gatherings during surges — have been built into the daily routines of many Americans. RSV and influenza are also less transmissible than Covid-19, making them easier to control through sound public health practices.

Instead of calling on these first-line practices as pediatric intensive care units flood and classrooms close, though, the United States is counting on its precious and fragile last lines of defense to fight the triple pandemic: healthcare professionals and medical facilities.

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Warnings and advisories issued recently by the United States Public health leadersAnd the Clinical leadersAnd the PolicyAnd the media has consistently neglected to mention masking as a powerful short-term public health strategy that can mitigate the spread of viral diseases. Instead, recent guidelines have exclusively encouraged hand washing and cough etiquette. These recommendations run counter to recent calls to build on a better understanding of respiratory virus transmission.

US Efforts To ‘Move On’ From Thinking About Covid, Created ‘New Normal’ Abnormal – A style in which we normalize resort to crisis measures, such as treating patients in tents, rather than using commonsense public health strategies. Treating Covid like the flu – or influenza like Covid – effectively means we don’t treat the disease as if it were a serious threat to health systems and public health. It seems more plausible to mobilize Department of Defense troops and FEMA personnel to cover shortcomings in the health system than to require people to wear masks.

The triple pandemic has already caused the first child deaths in the United States, adding to the ongoing death toll from Covid. Allowing health systems to reach the brink of collapse will lead to many preventable deaths among children and other vulnerable patients who cannot access the care they need.

By any accounting, these losses are shocking and tragic. But they should strike us as particularly abhorrent and shameful because the triple pandemic is a crisis co-opted, in a sense, by leaders, health agencies, and institutions. Over the past year, the Biden administration and its allies have repeatedly encouraged the public to step down from public health measures, with the president even stating in September that “the pandemic is over.” By shifting the real risks out of sight and failing to push for more robust measures to mitigate Covid, these messages have set the country on a trajectory for its current conditions, in which pediatric RSV patients are being rushed to hospitals hundreds of miles away because there is no capacity to treat them in person. their communities.

Living with viruses should mean adopting simple public health measures rather than learning to live with staggering levels of disease and death. Leaders in public health and medicine must issue appropriate and timely guidance that reflects the latest science rather than speculating on the prevailing winds of public opinion. Instead of self-censoring their recommendations for fear of political repercussions, they should continue to promote a whole host of public health strategies, including masking in crowded indoor public spaces during surges.

The triple pandemic should bring renewed urgency to policies that will reduce the toll of seasonal disease on health, education, and the economy. Improvements in indoor air quality in public spaces, including schools, child care centers, and workplaces, can reduce the spread of disease and have many proven health and economic benefits, yet the United States still lacks standards to guide infrastructure or safety standards in place the work. Paid leave that enables workers to stay home when they are sick can reduce disease transmission as well as loss of income, yet the United States is one of the only high-income countries without paid sick leave or family medical leave.

Greater efforts must also be made to increase influenza and Covid vaccination coverage and to bring the RSV vaccine online as quickly as possible. Only about half of high-risk adults under 65 got a flu shot last year, a gap that could be filled with more aggressive vaccination campaigns. The goal should be to reduce annual influenza deaths using the broader set of strategies made possible by the pandemic – rather than tying Covid deaths to them.

Amidst the many sobering stories of the triple epidemic outbreak, there is some good news. As the Covid-19 experience has shown, it is possible to reduce the number of respiratory viruses such as influenza and RSV. However, this work requires appropriate resources, policies and political will. Americans need not accept the rushes of winter illnesses and bypassing health systems as the inevitable new normal. Instead, the country should view the triple pandemic as a call to revitalize public health strategies in response to these threats to the health of our communities.

Anne N. Sosin is a public health practitioner, researcher, and policy fellow at the Nelson A. Rockefeller at Dartmouth College. Lakshmi Ganapathi specializes in pediatric infectious diseases and instructor of pediatrics at Harvard Medical School. Martha Lincoln is an assistant professor of cultural and medical anthropology at San Francisco State University.


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