Two public health leaders on COVID-19 and what’s next

As the United States settles into a new phase of the COVID-19 pandemic, mask mandates are few and far between, hospitalizations have plummeted and more than three-quarters of Americans have received at least one COVID-19 vaccination. But the past two years have also brought nearly a million deaths in the U.S. from the virus, and the pandemic continues to upend daily lives. 

Georges Benjamin, a physician, former secretary of the Maryland Department of Health and Mental Hygiene, and current executive director of the American Public Health Association, gave a commencement address to more than 200 University of Pittsburgh School of Public Health graduates on Sunday, May 1. During the ceremony, Pitt’s Senior Vice Chancellor of the Health Sciences and John and Gertrude Petersen Dean of the School of Medicine Anantha Shekhar awarded Benjamin an honorary doctorate in public health.

Pittwire took the opportunity to sit down with him and Pitt Public Health Dean Maureen Lichtveld, a scientist and expert in climate change and environmental health who spent nearly two decades at the Centers for Disease Control and Prevention, to ask them about lessons learned from the U.S. response to the pandemic and the future of the nation’s health.

If you could go back to any point during the past two years and change one aspect of how the U.S. responded to COVID-19, what would you change?

Benjamin: We started way too late in planning and engaging communities, which resulted in not having concrete plans for that last mile of getting shots into arms. There were things we didn’t know at the time. But we could have, for example, explained the research process to people so that they knew we had been working on these types of vaccines for over 20 years. This wasn’t something that was made up. We should have worked with state and local health departments and helped them put their processes in place and had them involved in the planning.

As a nation, were we adequately prepared for something like this to happen?

Lichtveld: I would say that a big problem was not having a workforce in place to deal with [the pandemic], as well as not having a front line in place. We didn’t learn lessons from bioterrorism, influenza preparedness and from disasters such as Hurricane Katrina. Or if we learned them, we weren’t able to translate them into action.

Mask mandates have largely disappeared throughout the country. In your view, is that a positive sign or problematic?

Benjamin: Masks are a protective tool, and we should explain to people that there is a time to use them. I like to use this analogy: When it rains, you use an umbrella. You may even use a raincoat or rain boots, but at least you use an umbrella. It’s the same thing with a mask: If you’re going someplace where you think you may be exposed, then you put on the mask. If not, you take the mask off.

[In a mask-optional world, kindness is required.]

Lichtveld: We simply did not give the public enough information to engage them in choices. When we made it a mandate, we actually gave people the opportunity to balk against it and didn’t make the case for how masking would protect them and their loved ones. In environmental health, I always say, “If you don’t want to protect yourself, think about your kids, think about your mom.”

Both of you are passionate about climate change. Has it impacted the pandemic?

Lichtveld: They are sadly related in a negative way. The biggest issue is the sense of urgency is not there. We now know the vast amount of change in the climate is due to human activity. It is absolutely preventable and we can take action, but we are not. It’s also a global problem. For example, Saharan dust from Africa impacts childhood asthma in Puerto Rico. We cannot say we are in the United States and we are fine, or that we are in Pittsburgh and we are fine. The health of the environment is inextricably linked to the health of people.

[Pitt Public Health launches a new undergraduate degree program.]

Benjamin: I would add that maintaining human health is a complex process with many interrelated issues. Diseases don’t occur in isolation from other things. What happens is that climate changes the ecology of our environment and therefore is much more likely to drive humans and organisms that would not normally be easily linked, closer together. I think the biggest issue immediately is that climate change results in a range of air quality issues that harm our lungs. People who have injuries to their lungs are much more likely to get really sick and die sooner, should they get infected with COVID-19. There is a direct connection between climate change and our environment which makes us more prone to get really sick from COVID-19, in addition to all of the other long-term indirect environmental things that change our ecology.

What did we learn as a nation through the pandemic?

Benjamin: I think looking forward we are going to recognize that our failure to fundamentally invest in a strong and well-resourced public health system caused our whole economy to come to a screeching halt — because of a little bug we can’t see. I am an emergency physician and having practiced for over 30 years, it’s clear to me that it’s a whole lot cheaper, more efficient and healthier for a society if we were to prevent these things from happening in the first place.

Lichtveld: Another thing we discovered is that we can be quite productive even when we are not physically in the office. This hybrid situation where we can work at home and in the office will always be with us. It enabled us to be together as families and for parents to teach their children. Even so, I couldn’t agree more with Georges. Until we sustainably invest in our public health infrastructure — the people who work there, the data system and the organizational setting — we won’t have a good front line.

What other thoughts would you like to share?

Benjamin: I think the future of scientific research, particularly in a research-intensive environment, involves multidisciplinary teams working on problems like at Pitt’s School of Public Health. The other important piece is engaging the communities as part of everything you do. We need to figure out how to share landmark research and cutting-edge science with the average person. This will require more investment in behavioral science, communication science and maybe even political science. We need to put it together with biological science to get an optimal mix of what we know.

Lichtveld: I couldn’t have made a better case for why I have these two priorities: precision public health and climate and health. Those are the priorities I came in with as dean, and that is exactly why.

— Amber Curtaccio, photo by John Altdorfer