At the 2023 Southern California State of Reform Health Policy Conference last week, leaders of local public health departments discussed crucial lessons learned from the COVID-19 pandemic, as well as how to bolster public health in the region going forward.
Muntu Davis, MD, is the county health officer of the Public Health Department of Los Angeles County. He said public health generally falls into four categories, including understanding surveillance, disease control, and public education. Davis acknowledged how the COVID-19 pandemic is not over, and that the virus continues to spread, creating worse death and hospitalization rates than the flu.
“In order to have an effective public health system, it’s not just the public health department. It’s also our community and partners [who need to be involved] in order to work and do the things that are needed.”
— Davis
A primary issue Davis seeks to address is long-haul COVID, also known as long COVID-19. According to the Centers for Disease Control and Prevention, some individuals who have been infected with the COVID-19 virus experience long-term symptoms and effects.
Long COVID-19 symptoms may last for weeks, months, or years, and most often occur in individuals who had more severe COVID-19 illness. Long COVID-19 symptoms include tiredness or fatigue, fever, shortness of breath, cough, brain fog, changes in smell or taste, and lightheadedness.
Davis said the entire community, including public health officials, policymakers, the press, providers, and patients must all work together to protect each other from communicable diseases. A major hurdle that Davis said the department ran into was public mistrust. As a direct result, the Public Health Department of LA County made investments and partnerships with community-based organizations, which community members trusted.
“We had to make investments in those organizations in order to get messages out,” Davis said.
Kim Saruwatari, the public health director of the Riverside Department of Public Health, said it’s important to have conversations and mutual understandings concerning public health policy decisions between those directly impacted and elected officials.
“A big lesson for us that we learned is, we have to think about the context of our actions in terms of the greater community.”
— Saruwatari
In Riverside County, migrant farmworkers and hospitality workers make up a good portion of the population, and multi-generational households are common. Riverside County also collaborated with community-based organizations and faith-based organizations as publicly trusted entities to spread accurate messaging about the COVID-19 pandemic. The county also formed business teams to meet with business owners and discuss how to safely operate the facility with the ongoing viral spread.
Saruwatari highlighted how generally, during public health emergencies, a public health crisis takes place and mass amounts of funding are issued, the public health crisis becomes managed, and then poof goes funding.
“We all received hundreds of millions of dollars for COVID-19 preparedness and response. That all goes away in 2024 … how do we keep the infrastructure that’s been built that’s allowed us to make these huge advances in equity and public health response capabilities.”
— Saruwatari
Michael Sequeira, San Bernardino County’s county health officer, emphasized Davis’s concern on long haul COVID-19, and mentioned that his goal is to set up long COVID centers.
“We’re failing these people,” Sequeira said. “There are a lot of people that are very sick, and we don’t have an answer.”
Sequeira echoed the comments Saruwatari made about public mistrust, and said much of it came from presidential leadership undermining national COVID-19 expert Dr. Anthony Fauci.
“How come we have Ron Paul and some of these people who aren’t MDs just completely undermining what [public health leaders like Fauci] are saying … we didn’t teach people some basic infectious disease and physiology,” Sequeira said.
He added that there were times where federal healthcare leadership, including Fauci, contradicted itself, but said it is because US health officials were learning more about COVID-19 in real time, and “had to learn on the fly.”
For Sequeira, the future of public health funding is unpredictable.
“Our public health department went from about 815 employees pre-pandemic, to about 1,500. So we almost doubled,” Sequeira said. “We had this huge infusion of money.”
While much of those funds were directed to increase public health department staffing levels, and to provide temporary funding, Sequeira said that much—about 85 to 90 percent—of public health funding is dependent on grants and renewals. He said maintaining relationships with the public and community-based organizations is crucial in the future, but the funding aspect of public health needs to experience a shift.
“It really shouldn’t be grant-driven. The government needs to just step up and support public health in that way,” Sequeira said.