Writing in the New York Times, Ezekiel Emanuel, David Michaels, Rick Bright, and Michael Osterholm, all former members of President Joe Biden's advisory board on Covid-19, explain how the country's public health system needs to change before "the next crisis is upon us, leaving people to wonder why we did not do a better job of preparing."

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How to prepare for the next crisis

"We are nearly three years into the Covid-19 pandemic, a health crisis so long, disruptive and deadly, it should have transformed the country's preparation for the next public health emergency," the authors write. "Sadly, it has not."

Although the government's response to the pandemic has improved over time, the authors note that there still much more that should have and could have been done. To better prepare for future health crises, the authors recommend six ways to improve the country's public health system and response, including:

1. Making testing surveillance more comprehensive

Currently, "[t]here is still no comprehensive reporting system for individuals to easily submit their at-home test results to public health agencies, rendering a broad swath of infections across the country invisible to officials trying to slow their spread," the authors write.

Similarly, the national wastewater surveillance system for Covid-19 is still "limited, uncoordinated and insufficiently standardized," making it more difficult to collect and test samples. To mobilize an effective response to a crisis, public health officials need to be able to track the data they collect, the authors write.

2. Improving indoor air quality

According to the authors, several respiratory infections, including flu and common colds, as wells as other medical conditions, are caused by airborne pathogens and particulate matter. However, improving indoor air quality could help reduce the risk of viral infections and lead to better health outcomes overall.

For example, early research from Italy suggests that replacing the air in classrooms six times per hour could reduce the risk of Covid-19 infection by 80%. Other studies suggest that better indoor air quality is associated with better cognitive functioning in both children and adults.

The United States should set national indoor air quality standards, and buildings should be required to post whether they meet the standards, the authors write. Initially, the focus should be on high-risk congregate settings, including schools, nursing homes, assisted-living facilities, and jails and prisons.

3. Enhancing national data collection and analysis

Currently, CDC does not have a comprehensive data infrastructure to collect and consolidate information from local and state health agencies. Because of this limited data, the United States had to largely rely on data from Britain, Israel, and South Africa to track new variants and measure the effectiveness of Covid-19 vaccines throughout the pandemic.

"Public health officials will find themselves flying blind in the next emergency if this system is not fixed," the authors write. To address this issue, CDC earlier this year launched the Center for Forecasting and Outbreak Analytics, which aims to provide insights into the future of the Covid-19 pandemic and future infectious disease outbreaks.

4. Improving worker safety

According to the authors, "a change in the culture around sickness" is needed to protect workers and improve their safety. In particular, the authors say that paid sick leave, especially for those working in low-income jobs and the gig economy, is needed.

"Everyone in a workplace benefits if colleagues feeling flulike symptoms remain home," the authors write. This is particularly important in industries where infections can easily spread, including health care, hospitality, public transportation, and retail.

5. Expanding outreach to underserved groups

Many of the people at the highest risk of infection, including people with disabilities, older adults living alone, rural residents, non-English speakers, and those with low health literacy, are also the hardest to reach.

To ensure that these groups are not left out and disparities in care and outcomes do not widen, proactive outreach, rather than passive engagement, is necessary, the authors write.

6. Fixing domestic production capacity and speeding up clinical research

Throughout the pandemic, supply chain issues led to shortages of necessary equipment, including high-quality masks, gloves, and disposable gowns. In the future, a stable domestic production capacity and supply chains for raw materials will be needed.

Speeding up clinical research will also help the country evaluate new treatments more quickly. According to the authors, NIH will need to change "how it organizes, funds and rewards scientists for participating in large, pragmatic clinical trials, especially but not only in public health emergencies."

Overall, "[t]he Covid pandemic laid bare the nation's vulnerabilities to new and deadly pathogens that can spread quickly across the globe and kill people in vast numbers in awful ways," the authors write. "… We must act before the moment passes and the next crisis is upon us, leaving people to wonder why we did not do a better job of preparing." (Emanuel et al., New York Times, 10/19)