Giving Public Health Experts a Voice

As a public health practitioner, passionate advocate for public safety and doctor of public health, I would like to think I have a voice during a global public health crisis.

That voice is not being heard.

I begged officials to reconsider when they first put out the recommendations not to wear a mask. I implored my family to wear a mask in January, and asked our local hospital to reconsider their no mask policy. I wrote countless unanswered letters to public officials and heads of hospitals who were initially telling doctors not to wear masks because it “scared the patients.”

I made countless un-returned calls to county politicians explaining we were opening up too quickly without taking into account the parameters that needed to be in place and data we need to collect in order to open safely. I explained how we must understand and observe how each phase of reopening was affecting transmission of the virus before moving forward.

I wrote articles as early as March explaining why the CDC’s initial no mask recommendations were ill-founded and not evidenced based, presenting compelling and persuasive evidence to back up these assertions.

I was ignored.

My voice has effectively been silenced, just like many other public health experts across the nation. It seems the decisions we make in regards to COVID-19 are largely in the hands of those outside of public health and medicine, and without the required expertise. I am frustrated because we (the public health, scientific and medical community) know better, but no one is listening. Still, I will keep trying in hopes my voice is finally heard.

Below are my current recommendations for moving forward in this new reality:

• We need to shut down again to gain control of the virus. This will require a state wide shelter in place order for those states (like California) where we do not have the virus under control. I do not think we can contain the current level of viral transmission by any other means. If we want to approximate any sense of normal again, safely, shelter in place will be the only way. Let’s take the necessary hard steps to gain control. (No, herd immunity is not an answer, as it will result in significant number of preventable deaths to achieve.)
• Opening up schools at this point is reckless and will contribute to the spread of the virus, hampering other efforts. If we had done this right the first time, opening up schools may have been a real possibility. But now, it is not. We should not roll the dice when it comes to children’s lives. Not to mention the educators and children’s families who will undoubtedly be seriously affected. We have enough evidence that opening up schools could end tragically, particularly in high-case states. Needless to say, education is very important, hence my strong recommendation to shelter in place so we can control the virus enough to open up schools. Public health is not the enemy, it is the answer.
• When it is time to reopen, it needs to be done slowly and fastidiously — over the course of many months or perhaps a full year, not a few reckless weeks. When we re-open, we need each phase to represent a clinical study where we test the hypothesis of the spread we expect to see, compared with what is observed, to ensure safety and control before proceeding to the next phase. The fewer cases we have when we start reopening, the less probability of each phase igniting a surge. There are no shortcuts, unless you want to be sent back to GO (for monopoly fans). Let me repeat, there are no shortcuts.
• We must improve testing — both quantity of tests, as well as shortening the time it takes to get results back. The complete lack of a federal response in this area puts this burden on states and the private sector.
• We need to reliably trace all cases. This means we need enough people trained to do contact tracing, and a public that willingly cooperates with this process.
• Refusal to wear masks in public spaces, particularly indoors or where social distancing is not possible, must be enforced with real-time consequences.
• We need more transparency, accountability, and honesty from our leaders and we need to demand it now. We need to stand behind the experts and make sure their voices are heard.

If we can do all of this successfully, I do believe we can beat this virus. But we have to come together to get it done and we need to act fast. Stand up, Public Health!

This piece was written by Jennifer, Dunphy, DrPH, MBA, Chief Population Health Officer and Senior VP, Regal Medical Group, one of the nation’s largest independent physician associations. To follow Dr. Dunphy on Twitter, click here.