Reflections from the early pandemic

I found this reflection, written by me on March 28, 2020. I had no idea at that time what was to come.

My heart breaks as I watch my Twitter feed filled with stories of healthy healthcare providers who have fallen ill to COVID-19 and others pleading for Personal Protective Equipment (PPE). Our community is grieving and expressing stress in so many different ways.

Based on my experiences, I can see this situation from many different sides. I previously worked with the Public Health Emergency Preparedness (PHEP) Program, where I was a part of making disaster and public health emergency plans and coordinating exercises, training, and response efforts for my community. From this standpoint, I understand that funding had to be cut in certain areas. I remember when funding was cut, and subsequently, meetings where hard decisions were made on where to allocate the funding and supplies. I thought, "If only we had a crystal ball."  Ultimately, the problem is that we do not know what the future holds. It is easy to determine in retrospect, even 24-48 hours into a disaster, what we "should have done." The likelihood of having a worldwide pandemic was not on our radar. Decisions had to be made based on prior experiences.

Part of those experiences for me included the stress of a critical shortage of PPE from my experience as a staff nurse in the Pediatric ICU during H1N1. For a short time, the bedside nurse maintained one mask per day per provider and one gown per patient until soiled, which was hung on the door. I remember frank discussions in these meetings and conference calls with others who had similar experiences when requesting the funding and maintenance of stockpiles of PPE. During H1N1, resources were deployed and readily available from the Strategic National Stockpile (SNS), a function of the Pandemic and All-Hazards Preparedness Act (PAHPA) upon deployment of the asset (Centers for Disease Control, 2010). Unfortunately, this is not the case today.

The Strategic National Stockpile expanded from a CBRN (Chemical Biologic, Radiologic, Nuclear) threat response resource to a broader "all-hazards preparedness resource. Although the funding overall remained stable, this resulted in a net loss that is specific to public health emergencies like Pandemics. (Board on Health Sciences policy, 2016). The unfortunate thing about a disaster is that we do not know precisely what resources we will need or how much until the actual request is made. It is all based on an estimate of the initial response and assessment based on historical data and research on what will occur. Part of the plans includes the allocation of scarce resources, which we are currently experiencing.

I agree that the delay of weeks was far too long, and we will suffer long-term consequences of it. Often the hardest decision to make in an emergency, especially with an unprecedented event, is the first decision which is, that it is an emergency. As nurses, we often see similar issues when caring for patients.

At this point, we must decide what we are going to do now. We must learn from these mistakes and move forward. I think we will see a rapid shunting of funding to Public Health Preparedness and an uptick of Health Policy during this time. This is an optimal window of opportunity for policymaking. At this time, those who have potential solutions are merging into the stream of politics to make rapid change. shelter-in-place. We are already experiencing unprecedented shelter in place orders, curfews, and new laws or government directives that even weeks ago many likely thought would never happen in America.

I remain hopeful that we are resilient. We will have tragic losses, however together I do believe that we can be stronger on the other side of the war on this virus.

References

Board on Health Sciences Policy, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. (2016, October) The Nation's Medical Countermeasure Stockpile: Opportunities to Improve the Efficiency, Effectiveness, and Sustainability of the CDC Strategic National Stockpile: Workshop Summary. Washington (DC): National Academies Press (US); The Strategic National Stockpile: Origin, Policy Foundations, and Federal Context. https://www.ncbi.nlm.nih.gov/books/NBK396378/

Centers for Disease Control (2010). The 2009 H1N1 Pandemic: Summary Highlights, April 2009-April 2010. https://www.cdc.gov/h1n1flu/cdcresponse.htm

Longest, B. B. (2015). Health policymaking in the United States (Sixth edition). Health Administration Press; Association of