The virus ‘new normal’ points to larger public health mission ⋆

With COVID-19 still a public health reality but no longer considered a public health emergency, it’s time for policymakers, health care systems and the public to think more broadly about public health, a former White House COVID-19 czar said Thursday.

There is a new normal, said Dr. Ashish Jha, dean of the school of public health at Brown University. The risks from COVID-19 haven’t gone away, but they’re different now, and the threat from COVID needs to be looked at alongside other respiratory diseases and other major public health concerns, from gun violence to opioid addiction, he said.

“I don’t think the goal should be to go back to the way we did things,” said Jha, who served as the White House COVID response coordinator from March 2022 until he stepped down in June 2023. He spoke Thursday in a webinar sponsored by the University of Southern California Center for Health Journalism.

“We actually need a very different strategy that is the new normal,” he said. “It’s got to be way better.”

On the one hand, he said, COVID-19 itself is much less of a risk for people who have been fully vaccinated. For immunocompromised people and for older patients, the risks are greater, Jha said, but they, too, have a lower risk if they have kept up with their shots.

Long COVID appears to be much less of a risk for younger people and for people who have kept up with the vaccine, he said — but that doesn’t make it unimportant. An estimated 3-6% of Americans are believed to have the condition, many of them infected early in the pandemic, he said. “We have to find strategies for treating them, helping them get better, and supporting them.”

Together, COVID, flu, respiratory syncytial virus (RSV) and other respiratory viruses may kill up to 100,000 vulnerable people annually in the U.S., Jha said. Getting vaccination rates up can save lives, he added, but those illnesses also cause “massive disruptions” to work and school.

Jha said the COVID pandemic and strategies to combat it point to how health care should change, not just to address the SARS-CoV-2 virus but respiratory viruses that are virtually taken for granted, starting with influenza.

“We need to reformulate COVID into this broader set of challenges,” he said. “I have always felt that we under-treat and under-manage flu, that we do not take flu seriously enough, that flu kills way too many vulnerable Americans every year unnecessarily.”

Flu deaths, about 30,000 a year, “can be cut by two-thirds or three-quarters if we do a better job of getting people vaccinated, getting people treated,” Jha said.

Former White House COVID response coordinator Dr. Ashish Jha, right, assesses the state of COVID-19 and public health in a webinar Thursday. He was interviewed by Washington Post reporter Fenit Nirappil, at left. (Webinar screenshot)

And combating COVID offers lessons on other ways to reduce serious illness and death from those other illnesses. Those include masking in crowds indoors and doing “much more” to improve indoor air quality.

The deep cleaning routines that were recommended early in the pandemic did little to suppress the spread of the virus, “but it does help for flu and RSV, particularly flu, so handwashing — that comes back into play for some of the other respiratory viruses,” he added.

“I actually think we can lower the burden of respiratory infections much more broadly,” Jha said. “And that is not the normal of 2019. That will be a more equitable normal, but that will be a much, much better normal.”

The pandemic brought to the fore how weakened the nation’s public health infrastructure has been, he observed.

“Public health has been underfunded for decades” — and then was put “in front of managing one of the biggest crises our country has ever faced,” Jha said.

“We literally spend $4 trillion on health care. We spend a fraction of that on our public health,” he said. “We’ve got to change that ratio.”

In the aftermath of the deep politicization that public health leaders faced, many have left the field, leading to less experience at the top of some agencies, he said, while the enactment of laws and policies undermining public health authority, particularly in more conservative states, “leaves us all substantially weaker.”

The U.S. needs to rebuild trust in public health agencies while trying to make it less of a partisan divide, Jha said.

“These public health crises — whether they be viruses, opioids, climate change, gun violence — they are bipartisan things. They affect people across the political spectrum equally,” he said. “We have got to do a better job of building that back. It’s going to be a long road. I see no quick fixes.”

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authored by Erik Gunn
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