For members of the Upstate Medical University Public Health Program, located in Syracuse, NY, the threat posed by COVID-19 emerged gradually. It was easy to dismiss at first, since potential pandemics like SARS 1, MERS and H1N1 were serious, but regionally and/or temporally contained. However, the arrival of SARS-COV2 in Italy, with devastating impact, demonstrated how it could travel and what it could do; by February 2020, physicians in Seattle were treating the first patients in the US, and their descriptions rang an alarm bell. It would take a month before it would arrive in New York State, home to Upstate Medical University. But by then, the institution was already institutionally in an incident command posture, awaiting the inevitable identification of the first cases in the region, which would arrive in March 2020.
Parallel to the institution-wide response, the Department of Public Health & Preventive Medicine (which houses the Upstate Public Health Program) pulled together its own response team, both to prepare its own programs and operations for the oncoming wave, as well as to respond as needed to broader institutional or regional requirements. Before long, members of the department were pulled into the incident command structure. Incident command was focused largely on protecting the hospital from being overrun by patients; the department had its own graduate program, teaching, research operations and service projects, which all had to pivot to remote work and online instruction.
While figuring out how the collective talents of the department could contribute to the incident command, departmental and programmatic leadership also foresaw that the “two-week pause” on in-person work and instruction would likely not be even close to enough, and they immediately made the decision to move the program to remote instruction for the remainder of the semester and for department members to be set up to work from home for a long period of time. That quick action served the school well, as the quick pivot was successful, and they stayed remote for more than a year and still do much of their work and a fair portion of instruction remotely. According to Department Chair Chris Morley, PhD, “My first thoughts, almost simultaneously, were: We are public health, we need to be fully engaged in this response; and we need to keep our students, our faculty and staff, our institution, our families and our community as safe as possible.”
The departmental team ended up contributing in a variety of ways. They helped lead local modeling and prediction efforts for several incident commands, organized information sharing, surveillance systems and dashboards in collaboration with other teams and brought health behavior theories to the table as well. The roles expanded as members of the department eventually started consulting with educational institutions, public agencies (including fire and police), critical access hospitals and manufacturers on mitigation, testing strategies, health communication and more generally explaining the pandemic.
Says Dr. Morley, “Our two most important actions were to immediately recognize the long-term nature of what we were facing, and shift into it; and then commit our expertise, training, bodies and souls to the fight, and be ready to serve. That may sound overly dramatic and insubstantial, but I believe that adopting these stances is what allowed us to operate effectively and to do the substantive things we were able to achieve and provide.”
Of course, there were challenges. At first, a lot of groups, constituencies, departments and professions were newly thrown together. Morley says, “We certainly felt misunderstood as public health in a medical institution, but it was more widespread than that. To deal with the chaotic, volatile and sometimes contentious environment, we all had to go back to that mindset of service and to remind ourselves and one another what we KNEW and what we brought to the fight.”
“Once our institution settled into a routine, I ended up tremendously proud not just of our public health department, but of the entire Upstate Medical University. We banded together, achieved things and provided both care and sound advice to the entire region and state. The next fight, of course, would be against the politicization of the pandemic. I wish we could say we all overcame that (it still exists); what I will say is that we, as individuals and as a department, learned a whole new set of skills and applications in dealing with the public, with different constituencies and with toxic criticism hoisted by politically charged COVID deniers, along with the more generally (and understandably) pandemic-fatigued among us.”
There are still lessons to be learned, he says. “Public health needs to find ways to communicate what it does. That is first and foremost. We lost a lot of time needing to prove that our skillsets were not only useful, but necessary. In doing so, I also think that we need to communicate the distinction between what is medical and what is public health. We are already seeing the mindset shift away from communally stopping viral spread because we have reasonable vaccines, reasonable therapeutic approaches and a lot of fatigue. The concept that now, hospitals won’t get overwhelmed and most people won’t die is seen as reason enough to ‘live with the virus’ (and return to pre-pandemic life). This posture RELIES upon faith specifically in medical intervention, as opposed to primary prevention and population-level action. It also leaves behind those at greater risk for serious outcomes. I think our perspective needs to be better communicated.”
“Finally, we MUST find ways to communicate messages in succinct, clear and direct ways. We still can’t tell people how to test, when to mask, etc. without stumbling into arguments. Our public agencies appear to be hamstrung by an aversion to controversy and extreme political pressure. This has led to nearly useless proclamations and policies that are often internally contradictory or watered down and easily questioned.”
