“Since my personal area of expertise is public health emergency preparedness, I had the opportunity to work as part of the public health response to SARS in 2003, avian influenza (2005), novel influenza A (H1N1), Zika and other outbreaks globally and locally. I was actually teaching methods in field epidemiology (outbreak investigation) in the spring of 2020 and in the first few weeks of class we were viewing the epidemic curve for COVID-19 during each class session. I remember thinking that we would probably continue to do this for the entire semester and try to stay up to date with the news about COVID-19,” says University of Delaware MPH Program Professor and Founding Director Jennifer Horney. “At the time, I thought this could be the outbreak that would hit the sweet spot that we avoided with avian flu in 2005 and swine flu in 2009 — both easily transmitted person to person AND a severe disease with relatively high mortality rates — and that there may be pretty severe impacts on the public that could last 6-18 months. I obviously never anticipated the scope and scale of the COVID-19 pandemic.”
But since the University does not have a medical school and the epidemiology program was relatively new, Professor Horney offered her expertise to the University-level committees that were forming to deal with the pandemic. “I ended up serving on both the policy-focused and the operations-focused committees. I think it was important to have epidemiology at the table, particularly as testing became more widely available, as we needed to work more closely in coordination with the state’s Division of Public Health on contact tracing, and as we needed to develop policies to safely reopen our clinical programs and other essential elements of the University.”
For their small program, they needed to keep pushing forward. Says Professor Horney, “Our first cohort of MPH students had just started their second semester of their first year when we went home for an early spring break and did not return to face-to-face instruction. A majority of our students were already working in governmental public health roles, and they were suddenly facing tremendous demands at work while being enrolled in a graduate program that suddenly shifted to an online format. We continued to focus, not only on growing the program, but on providing very intensive supports to our current students.”
There were other challenges. Horney says that because the program was so new, “I think we had to convince decision-makers at the University of the value of having public health students working in roles both on campus — such as contact tracing and as health ambassadors — and in the Division of Public Health as part of their full-time jobs or even in practicums and internships. We also had to appreciate the constraints from our public health practice partners to move new initiatives forward and to engage our students.”
She cites lessons learned in the process: “I think we forgot — or no longer had the capacity to effectively apply — a lot of the basic lessons learned from 9/11 and other public health emergency responses once we stopped investing in academic programs to assist with both workforce development and public health emergency preparedness research. With turnover, retirements and public health workforce shortages more generally, that work wasn’t nearly finished when those programs ended. Going forward, we should all think about the evidence base that has been created as part of this response — what worked, what didn’t — and how the response to COVID-19, although unique, is relevant to many other types of public health emergencies and disasters.”
She continues, “I think universities in general are focusing too much on the ‘return to normal,’ without putting much strategic thinking into what the new normal should be. As any of us who study disasters know, that won’t increase our resilience to future emergencies, which are more likely than ever. There isn’t nearly enough ‘outside-the-box’ thinking to re-envision what public health training and education should look like, what skills and abilities our future public health leaders need, and how we finally overcome the data and other technology deficits that marred nearly every aspect of the public health response to COVID.”
