We are living through an extraordinary and unprecedented event. With the exception of the 1918 influenza pandemic, which infected nearly 500 million people worldwide, modern times has not experienced a global health crisis of this magnitude. As a health geographer, I have spent most of my career studying the geographic spread of infectious disease, and the impacts of place and space on population and community health. In the classroom, I teach students about disease emergence – we discuss the consequences of complex and interrelated processes such as deforestation, urbanization, globalization of food chains, population growth, and inequality and poverty on the evolution, emergence, and spread of infectious diseases. The HIV pandemic is a case in point – it evolved from a simian virus, emerged from the forests due to rapid changes in West Africa’s agricultural sector which led to large-scale deforestation, and was transported around sub-Saharan Africa by the trucking industry. From major ports of call, it spread across the world. We dodged a bullet with SARS and MERS, largely because these viruses had low human-to-human transmission potential. The Ebola epidemic was scary, but the disease is not airborne and people aren’t contagious until they shows symptoms, so it’s much easier to contain. Scientists have been predicting a global epidemic for decades. Among my colleagues, there was never a question of if a pandemic would occur, but when.
Given all this, I have been stunned by the global response to this novel coronavirus and COVID-19. A global pandemic requires a coordinated global response. Nothing could make that more clear than a simple map of the epidemic. But as a global community, we seem to have been caught flat footed. Similarly, the U.S. response has not been ideal. An effective health response of this magnitude needs to operate effectively across multiple geographic scales – from global and national, to state and local. As I reflect over the past several weeks, it’s this local response that frustrates me the most.
As a researcher who works closely with communities across Ohio, I am particularly distressed by the strain COVID-19 has placed on the local public health system. Much of the burden of an epidemic falls to our local health departments – entities like Columbus Public Health or Greene County Public Health that oversee day to day operations that keep our population healthy and safe. Most of the time, their activities focus on health education, immunization clinics, well-baby visits, health screenings, and food safety. They serve a vital role in our communities. But local public health has been drastically underfunded for decades and it’s in times of crisis when the flaws in this become painfully clear. They are attempting to field a coherent and effective response to a global health crisis without the resources they need. Like firefighters and police, our local public health workers serve the public good and deserve our support, and not just in times of need. A hope of mine is that the COVID-19 pandemic is a turning point in public support for local public health systems and that we will, as a community, come together to serve their needs in the future so they can serve ours.
In the meantime, stay safe, hug your children and for goodness’ sake, wash your hands!
A good resource for reliable COVID-19 information can be found on Harvard’s health blog.