COVID-19 and Public Health Preparedness: The Need for a Paradigm Shift

Cities have long relied on public health infrastructure, albeit invisible, to maintain the health of their residents. This infrastructure is most effective work when it remains in the shadows. It stops contagion and the inevitable spread of illness before it happens, before it has the opportunity to transform a community in the many ways that are now so familiar to us all.

The latest threat to our collective health is the ongoing outbreak of the respiratory disease known as Coronavirus Disease 2019 (COVID-19). COVID-19 presents particular challenges to densely populated urban communities because of the clever way the virus transmits from person to person. COVID-19’s basic reproduction number (R0) is estimated to be between 2.2 and 2.7, meaning that, on average, each infected person spreads the infection to an additional two persons. Until this number falls below 1.0 the outbreak will not abate.

The COVID-19 pandemic is a stark reminder of the ongoing challenge of emerging pathogens and the critical need for a robust public health infrastructure to respond to such threats. This includes ongoing surveillance, rapid testing, and appropriate treatment. We are witnessing the ways in which our short-term thinking has led to underfunded public health entities, resulting in an inability to respond effectively in times of emergency.

It is essential that we shift our paradigm from reactive to proactive. Once the threat of this virus subsides—and it will—we must renew our commitment to a public health infrastructure that will help us to respond more rapidly to the next threat.

Jennifer Pinto-Martin is Executive Director, Penn Center for Public Health Initiative; Viola MacInnes/ Independence Professor, Penn School of Nursing; and Professor of Epidemiology, Perelman School of Medicine.

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