Fredericksburg Free Lance-Star: Editorial: COVID, contractors, and the future of public health


IN A SURPRISE MOVE this week, the Rappahannock Area Health District announced that dozens of contractors brought on to deal with COVID are being terminated.

This sudden change of course should focus our community’s attention on two important matters. Can we manage the pandemic with fewer people to guide us? And why are our local health departments so heavily dependent on contract workers?

COVID is not a defeated virus. Heading into the school year, we are again confronting new variants. Kathy Katella, writing for Yale Medicine, reports: “In early July 2022, a strain called BA.5—the most contagious one so far along with BA.4, another subvariant—is causing more than 50% of cases, making it the predominant strain in the United States.”

Predictably, nationwide, the number of COVID cases is again on the rise.

Locally, we are seeing the same. According to the New York Times COVID tracker, Fredericksburg, Spotsylvania, and Stafford are all seeing increases in infections and in hospitalizations. Further, the test positivity rate in all three areas is over 20%, which is “very high, suggesting that cases are being significantly undercounted.”

The same tracker reports that two of our three local hospitals—Mary Washington Hospital and Stafford Hospital—are at 100% ICU occupancy. Mary Washington has 15 COVID patients in its ICU; Stafford has four. Spotsylvania Regional Medical Center is at 50% capacity, with six available beds.

It’s not difficult to see that a sudden uptick in cases would create a significant problem.

Many of the contractors released by RAHD are critical in isolating and dealing with surges. They work with schools, businesses, and long-term care facilities to mitigate and deal with infection spikes.

Nonetheless, last week Gov. Glenn Youngkin continued to politicize the pandemic, declaring that unvaccinated kids exposed to COVID-19 don’t have to routinely quarantine. “Today marks a shift in my administration’s recommendations to optional quarantine for exposure to COVID-19 in child care and school settings as the severity of the disease decreases.”

On one hand, Youngkin has a point. Early data shows that the subvariants aren’t leading to notable upticks in deaths. Further, we are far better equipped to handle COVID now than when the outbreak first hit our shores. Vaccines and oral antivirals like Paxlovid and rapid testing are now in our toolkits

What Youngkin fails to understand, however, is the COVID battle has changed. Dr. Leana S. Wen teaches at George Washington University and writes regularly about public health issues for the Washington Post. The struggle early in the pandemic, she notes, was between those who support restrictions (like mask mandates) and those who oppose restrictions. Youngkin is still stuck in that struggle.

We’re at a place, Wen says, where “mandates can go.” Instead, she writes, “resources should especially go to help those most vulnerable to severe outcomes from COVID-19.”

Whereas Youngkin wants to act like the worst is behind, we are only shifting “in the way we’re living with COVID,” says Dr. Adam Lauring of the University of Michigan.

The struggle, in short, has moved from the national and state levels to the community level. And local public health departments are best-

positioned to carry out this battle.

That makes RAHD’s contractor dismissals deeply worrisome. When another spike occurs, and it will, RAHD won’t be ready.

The loss of contractors hampers COVID response, and it places more strain on an overburdened system that can’t handle all it has to do.

A May 2022 report by the Virginia Public Health Association reveals that Virginia has been failing to adequately fund public health for 20 years. In fact, from 2000 to 2020, Virginia Department of Health funding has been flat, leading to massive staffing shortages.

To her credit, Rep. Abigail Spanberger has joined a bipartisan push for funding the Centers for Disease Control at $11 billion in the fiscal year 2023 appropriations bill. That will help our local public health departments respond to our current challenges.

It won’t make up for years of underfunding. It’s time Virginia step up and hire a viable level of professionals to protect the commonwealth through the current pandemic, and whatever health threats lie ahead.

COVID exposed the chasms in public health. Contractors bailed us out, but they aren’t a permanent solution. And when they’re pulled away, a system struggling from two decades of underfunding to do its core jobs is in no position to respond to emergencies.

Local health departments are critical to our well-being. We’ve learned our lesson about underfunding them.

It’s time to act.

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