The unsung heroes of public health

Asked if monkeypox represents another pandemic like COVID-19, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the CDC has been responding aggressively, educating professionals healthcare and patients alike.

Monkeypox is now spreading across the world and putting the US public health system once again on the front lines in a battle to keep the country safe.

Asked if monkeypox represents another pandemic like COVID-19, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the CDC has been responding aggressively, educating professionals healthcare and patients alike. “We have been working extraordinarily hard and we are still in a position where we can contain this,” she said.

CBS News Chief Medical Correspondent Dr. Jonathan LaPook asked, “There’s no crystal ball, of course, but do you think monkeypox will spread more widely to the general population?”

“I think we are going to see more cases before we see fewer, and that is because we will have more tests,” he replied. “We’re more educated, people know what they’re looking for and how to test it.”

The total number of monkeypox cases in the US has been growing steadily and is now over 2,800. While anyone can get monkeypox, the virus is spreading predominantly among gay, bisexual, and other men who have sex with men.

Walensky said: “As far as we know at this point, it appears that most of the transmission is occurring with close personal contact.”

With the US public health system front and center, “Sunday Morning” thought this would be a good time to explore what the system actually does.

LaPook asked Michelle Williams, dean of the faculty at the Harvard TH Chan School of Public Health, “Why is public health different from the practice of medicine?”

“In medicine, the individual is the patient; in public health, you can think of the individual, the community, the planet as the patient,” he replied.

Williams said the roughly 270,000 public health workers in this country are unsung heroes, underappreciated because the public takes their contributions for granted. “When public health works, nothing bad happens. So you don’t notice that kid that spilled on the bike got up and it’s okay because he’s wearing a helmet,” she said.

Public health workers have a lot on their plate, including eliminating disease; reduce workplace injuries; ensure clean water and better sanitation; reduce injuries from fires and car accidents; and keep our food safe to eat.

Tre Williams, a health inspector in Oklahoma City, showed LaPook how he does his job during a visit to a restaurant: “I’m here checking to make sure I’m not stacking plates. You know, if you stack wet dishes on top of each other, bacteria build up. We don’t want that.”

“This is the kind of thing that the general public has no idea about, right? Aren’t you seeing this? LaPook asked.

“Fine fine. Absolutely.”

The US public health system has a long history. In 1799, Boston established one of the first health departments in the country, headed by none other than Paul Revere.

Since 1900, advances in health and safety have increased life expectancy in the US by about 25 years.

Still, during the COVID pandemic, local health departments have had to scramble and improvise. In Oklahoma City, Patrick McGough, who heads the City/County Health Department, explained their schedule for shots, boosters and flu shots. “We are providing this service for free to the public. People just move on. They don’t have to go on a date, nothing! It’s warmer, it’s friendly, you’re in your own car.”

The structure of the public health system is extremely complex: state and local departments, educational institutions, private industry, and major government agencies such as the Department of Health and Human Services, the National Institutes of Health, the CDC, and the FDA. No one person runs the entire system, and not all branches have the resources they need.

For example, the technology to securely share health information electronically has been around for decades, but at the height of the pandemic, doctors were faxing orders for COVID tests to the Oklahoma City/County Health Department.

LaPook asked, “Why the hell would anyone still need to use a fax machine?”

“It’s basically doctors’ offices,” replied McGough. “Not everyone has secure ways to transfer information about you as a patient.

“We need a health care information exchange that is at our fingertips, where health departments and hospitals and primary care physicians can share information quickly and easily,” he said.

But that’s not what we have. Instead, there is a patchwork of reporting systems across the country that don’t communicate with each other effectively, which is critical during the early stages of outbreaks like COVID and monkeypox.

And, Dr. Walensky said, there are more challenges. When asked if the CDC has the authority to require public health agencies across the country to send him information, he replied, “We don’t.”

In fact, reporting cases from across the country is volunteer.

LaPook asked, “Are the data systems in place right now to properly collect all the necessary information?”

“They don’t,” Walensky said. “We have made a lot of progress during COVID, but we still have a lot of work to do. It would be really helpful if we had the capacity, the data systems, the workforce, the lab systems in place, the public health infrastructure really in place, so that we can bring health to all of America.”

“Why don’t we have those systems in place right now?”

“There has been a chronic underfunding for decades of a public health infrastructure in the United States,” he replied.

And Michelle Williams said the public health system is facing a brain drain. “We know that burnout is real and widespread,” she said.

When asked when his last vacation was, Patrick McGough replied, “Um, I haven’t had a vacation.”

It is estimated that since 2008 at least 38,000 state and local public health jobs have disappeared.

The collision of public health and politics has not helped. In Oklahoma City, McGough is feeling the heat. “Yeah, a lot of hate emails, a lot of hate emails, horrible text messages, all kinds of things,” he said.

LaPook asked, “So when people question your motives, how does it feel?”

“I see that I have staff on the front lines giving everything they have: their family time, their own health, their own finances. And then being attacked and called all sorts of things, it didn’t happen just because the pandemic hit. Something else happened. Something made people lose faith. And it is for the disappearance of the public. It can end public health.”

Despite these challenges, Michelle Williams is seeing what makes her optimistic at Harvard: a 50% year-over-year increase in applications to her school of public health.

How do you explain that? “They are running toward the opportunity to make an impact in this world,” she said. “And I’m inspired by that. Because we will prevail. It will take more time, but we will prevail.”

Leave a Comment