Editorial: COVID, contractors and the future of public health | Editorial

IN A SURPRISE MOVE this week, the Rappahannock Area Health District announced that dozens of contractors brought in to deal with COVID are being shut down.

This sudden change of course should focus our community’s attention on two important issues. Can we manage the pandemic with fewer people to lead us? And why are our local health departments so dependent on contract workers?

COVID is not a defeated virus. Entering the school year, we are again faced with new variants. Kathy Katella, writing for Yale Medicine, reports: “As of early July 2022, a strain called BA.5—the most contagious so far along with BA.4, another subvariant—is causing more than 50% of cases , making it the predominant type in the United States.”

Predictably, nationally, the number of COVID cases is rising again.

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Locally, we are seeing the same thing. According to the New York Times COVID tracker, Fredericksburg, Spotsylvania and Stafford are all seeing increases in infections and hospitalizations. Further, the test positivity rate in all three areas is above 20%, which is “very high, suggesting that cases are being significantly undercounted.”

The same tracker reports that two of our three local hospitals—Mary Washington Hospital and Stafford Hospital—are at 100% ICU occupancy. Mary Washington has 15 COVID patients in ICU; Stafford has four. Spotsylvania Regional Medical Center is at 50% capacity, with six beds available.

It is not difficult to see that a sudden increase in cases would create a significant problem.

Many of the contractors issued by RAHD are critical in containing and handling surges. They work with schools, businesses and long-term care facilities to mitigate and treat points of infection.

However, last week Gov. Glenn Youngkin continued to politicize the pandemic, declaring that unvaccinated children exposed to COVID-19 should not be routinely quarantined. “Today marks a change in my administration’s recommendations for optional quarantine for exposure to COVID-19 in child care settings and schools as the severity of the disease decreases.”

On the one hand, Youngkin has a point. Early data show that the subvariants are not leading to a significant increase in deaths. Furthermore, we are much better equipped to handle COVID now than when the outbreak first hit our shores. Vaccines and oral antivirals like Paxlovid and rapid testing are now in our tools

What Youngkin fails to realize, however, is that the COVID battle has changed. Dr. Leana S. Wen teaches at George Washington University and writes regularly on public health issues for the Washington Post. The battle early in the pandemic, she notes, was between those who support restrictions (like mask mandates) and those who oppose restrictions. Youngkin is still stuck in that fight.

We are in a place, Wen says, where “mandates can go.” Instead, she writes, “resources should go specifically to help those most vulnerable to severe outcomes from COVID-19.”

While Youngkin wants to act like the worst is behind us, we’re just changing “the way we’re living with COVID,” says Dr. Adam Lauring of the University of Michigan.

In short, the war has moved from the national and state level to the community one. And local public health departments are the best-

positioned to wage this battle.

This makes the firings of RAHD contractors deeply troubling. When another strike happens, and it will, RAHD will not be ready.

Losing contractors hampers the response to COVID, and it puts more strain on an overburdened system that can’t handle everything it needs to do.

A May 2022 report from the Virginia Public Health Association reveals that Virginia has failed to adequately fund public health for 20 years. In fact, from 2000 to 2020, funding for the Virginia Department of Health has been flat, leading to massive staff shortages.

To her credit, Rep. Abigail Spanberger has joined a bipartisan push to fund the Centers for Disease Control with $11 billion in the fiscal year 2023 appropriations bill. This will help our local public health departments respond to our current challenges.

It will not make up for years of underfunding. It’s time for Virginia to step up and hire a steady level of professionals to protect the commonwealth through the current pandemic and whatever health threats lie ahead.

COVID exposed gaps in public health. Contractors saved us, but they are not a permanent solution. And when they withdraw, a system struggling from two decades of underfunding to carry out its core tasks is unable to respond to emergencies.

Local health departments are critical to our well-being. We have learned our lesson about underfunding them.

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