SUNRISE, SUNSET

A REFLECTION ON THE END OF THE COVID-19 PUBLIC HEALTH EMERGENCY

May 17, 2023

In today’s installment, I’m interrupting my regularly scheduled programming about the public health employment market to explore my personal reactions to the ending of the COVID-19 Public Health Emergency last week.

“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about.”

~ Haruki Murakami

So many questions

Last week, the WHO declared the end of the global COVID-19 PHEIC (public health emergency of international concern) status, and the COVID-19 public health emergency declaration in the US came to an end. While there are many important conversations to explore about lessons learned for science and policy — eg, the timing of these decisions, whether the world will be ready for the next pandemic, how people will continue to access medical care, and more — I want to focus on the immediate emotional response. One of the surprising outcomes of writing this column about the trials and tribulations of the public health employment market has been its power to create community and reach people who thought that they were alone in experiencing unique challenges. My hope is that, by publicly excavating my complicated emotions at this time, I might enable others in a similar situation to begin to feel that we are walking this path together, and to start to reach out to one other for support and community.

I’ve spent the last 3+ years immersed in the COVID-19 pandemic response as an epidemiologist on the front line at governmental health departments, and I have questions about these End of Pandemic fanfares. So many questions. What comes next? Why is it assumed that we progress straight from “emergency” to “normal” status? Why is there no in-between phase or recovery plan? Normally, we epidemiologists are famed for our ability to respond to any question with our standard nuanced answer of “It depends.” Why are we choosing this moment now to lean towards a binary response, as we lack any language for the gray areas that fall between pandemic and endemic?

What does it mean to say the pandemic is over, when my immunocompromised cousin was hospitalized with severe COVID-19 just last week? When my son woke up with a possible sore throat this week and my first reaction was still to reach for a COVID test before he goes to school? When my family is still masking in public places in order to protect my children’s grandmother, who is currently enduring chemotherapy? When this infectious disease epidemiologist is still burned out and unemployed?

How do we protect those among us who remain vulnerable? How does this country begin to repair from the loss of more than a million of its people? What do we teach our children from this experience? What do I do to heal my grief?

Early days

I’ve been keeping a journal throughout this period — I tried to read it to gather material for this column, but it’s still too raw and painful. Instead, I cast my mind back to memories indelibly seared during the early days of the public health emergency, to see how far we’ve come. Were you here with me?

I remember the last large public event I attended at one of my children’s schools, where we first self-consciously engaged in elbow bumps and other parents asked me whether they were supposed to take these warnings seriously, like really? I remember where I was standing when I realized that my family was about to be confined to our home for an extended period, and I was going to have to rely on one of these jokers in my house to cut my hair. During those scary early days when we weren’t quite sure how this novel virus was transmitted, I remember the days I came home from work at the health department, avoiding the anxious hugs of my young children, to go straight into a scalding shower; and the nights I spent sleeping in the basement to spare my spouse any possible contamination. I remember that as my son blew out his nine birthday candles, he wished for health for his family and friends, and for kindness between all people. Now that he’s just turned twelve, I am trying to gather the strength to ask him how he feels about how his birthday wishes turned out.

Don’t feed the trolls

I shared the Murakami quote above on social media last week, along with some personal reflections on the end of the COVID-19 Public Health Emergency. For the most part, my musings met a supportive reaction and hug emojis. I know I’m not supposed to even read the trolls but I just can’t help myself. Move on, they said. Get over yourself. It’s over, it’s all been over for a while. The rest of us are already back to normal. Get with the program. You’re on your own.

This lack of compassion and kindness quite took my breath away, even if it is true that everyone else has moved on already. And this reaction that I had not anticipated truly educated me about the rise of individualism and the lack of community in the United States, how we got here, and why I feel so alone. Are you here too?

Illustrative ambiguity

I illustrated my social media post with a photo from a recent family vacation.

Was it a sunrise or a sunset?

Some commenters interpreted my symbolic illustration as the sun setting on the COVID-19 emergency; others as the dawn of a new post-emergency era. I could easily tell you which one it was because I am the photographer.

But maybe the ambiguity is the point.

One phase is ending and a new one is beginning. The sun is setting, and at the same time, somewhere else it is rising. I’m not sure how the world “after” COVID-19 is going to look. Without many of the assurances I previously took for granted, including stability and well-being among my family members. Without a job, still. Without my dad, my father-in-law, my brother-in-law, my daughter’s dear friend. (Their deaths were not all due to COVID-19, but for each of these losses, COVID-19 profoundly shaped our experiences of illness, treatment, caregiving, and mourning.)

As the public health emergency ends, we enter a new phase of rebuilding and hope for the future. And my hopes at the dawn of this new age are for compassionate leadership and learning, both within our public health circles and more widely. For elevated and consistent resources devoted to public health and prioritizing health equity. For secure career paths that help public health professionals at all stages to feel cherished and to develop their skills. For public health workplaces with sufficient funding to enable them to break free of the toxicity and dysfunction that plague them and create cultures of well-being. For a healthcare system that values and operationalizes equitable access to care. For environments in which public health employers are incentivized to build the internal capacity of our workforce and institutional memory rather than outsourcing on fixed term contracts. For a world that prioritizes the values of kindness and compassion and caring for the vulnerable among us.

Moving forward

In the last week, I’ve seen many articles emerging in the media that seek to derive lessons learned from the COVID-19 pandemic, in particular for public health. It’s fascinating to me that they largely recognize the long-standing neglect of the US public health system and even the need to modernize its ancient creaky data systems, but frequently emphasize technologies at the expense of staffing. As I read about the undeniable needs for tests and vaccines and therapeutics and surveillance systems, I ask myself who will be funding the humans responsible for organizing and administering them. We need to advocate loudly for funding to create secure, well-resourced jobs in public health that will offer career development paths and enable public health professionals at all career stages to feel cherished.

As we open this new chapter, I ask for recognition of the scars we bear and the memories we carry, and I seek to learn from them. Please remember that for those of us whose lives have been upended by the pandemic, who have lost our loved ones, who have experienced immeasurable trauma, who have supported our families through mental health challenges, who have lost friends and community, whose efforts have left us burned out, whose personal and professional identities have been reshaped beyond recognition… there is no “back to normal.”

The Public Health Workforce is Not OK

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