Impact of Covid-19 on Public Health

An Australian public health reflection from Monash Health on lessons learned from the Covid-19 pandemic. We discuss the public health strategies to help stop the “infodemic”, crucial elements for a health programme to be successful, Australian national Covid-19 response framework and what the very important lessons are learned from our own experiences fighting the pandemic. With an uncertain future short and long term priorities are addressed.

Samir Redzepagic, Public Health Officer, Monash Health

1. Please describe your extensive background in the medical field and at Monash Health.

First of all, I would like to thank the editorial office of the AmericaHHM Magazine for inviting me to this editorial interview which covers this very current and still challenging topic of Covid pandemic. I studied medicine both in US and Europe after which I entered general surgery and cardiothoracic surgical residency in Berlin, Germany. Additional training in heart and lung transplant with German Heart Institute in Berlin where I spent my initial 2 years working as a consulting surgeon before moving to the Alfred Hospital Cardiothoracic and Transplant Services in Melbourne, Australia. Spent considerable time in research as well, mainly associated with transplant surgery and basic science. Further interests in minimally invasive cardiac procedures, aortic surgery and surgery for heart arrhythmias. Always had interest in public health and epidemiology which I treated as my hobby in medical domains. As the Covid pandemic hit in early 2020, I decided to step aside and join Victorian Department of Health in a public health officer and mentor role. It was a very challenging period for myself and all my much more experienced colleagues at the Department. I used that period to additionally advance and educate myself in Public Health and Medical Administration and commenced MBA with La Trobe University as well. After spending 18 months with Department of Health Victoria in Melbourne, I was offered a public health role at the newly formed Monash Health Public Health Unit in Oct 2021, which covers the whole south east of Melbourne approx. 3.5 million residents. I am currently involved in developing strategies and management of residential age care facilities in this area.

2. How could a public health strategy help stop the infodemic?

It’s a very difficult question which we all in public health and wider are trying to tackle, but in my opinion it starts from every individual and everyone counts. I would have few suggestions for your readership.

1. As individuals be critical when you look at social media and talk to reliable sources in the area.

2. Don't spread false information through your online networks. If you encounter false information, please politely ask the person who shared it to remove it.

3. Report false information to the platform administrators without any hesitations and delays.

4. Verify and check the shared information whenever you're in doubt.

5. Make more noise than people who share fake news or false information.

6. If you are part of the health provider services please discuss regular media briefings with scientific and confirmed facts

7. Promoting health strategies in education from kindergartens to tertiary academic institutions.

8. Going proactively in the communities, especially diverse and disadvantaged. Attracting community leaders to join the discussions and advocate for their base.

9. Inversing in new platforms-especially social media before they are taken over by deniers.

The new Delphi Covid consensus, which was just published, the volume and velocity of information during the COVID-19 pandemic has made it difficult for individuals to evaluate the accuracy of any given piece of information. When public health officials' communications fail to accurately reflect the reality that SARSCoV-2 transmission is largely airborne, they regrettably contribute to the spread of incorrect information. Additionally, governments have handled erroneous information in the COVID-19 pandemic context in an inconsistent manner. There are undoubtedly a lot of places where misleading information may be found, which weakens the social cohesiveness required for effective public health responses. The public health officials had engaged populations with low levels of immunity ineffectively as the pandemic was starting to spread.

3. What are the crucial elements required for a public health programme to be successful?

This is just a slide that represents these crucial elements for an effective and successful public health program and was developed by Australian Federal Department of Health with our collaboration from Melbourne and Victoria. I am always using it as a starting point.

It only took few months early in the Covid-19 pandemic 2020 to develop this very simple and flexible plan that proved to be very successful over last few years.

As you can see the very essence of this framework is the fundamental base level strategies in community settings, individuals at higher risk, business sector, and high risk settings being accordingly adjustable in Tier 1 and 2 scaled up options when required.

So having a national community based framework not only to deal with the current Covid-19 pandemic but for all the potential future pandemics and crisis situations is one of the crucial elements for a public health response and programme to be successful.

Further to that I would like to emphasize that health systems are continuing to face enormous staffing shortages mainly to do with the mental and physical health impacts on their workers from the pandemic. Healthcare workers continue to experience unaddressed mental health issues due to protracted working hours and increased risks in healthcare settings. Governments have not always addressed the high out-ofpocket expenditure to consumers for some pandemic control measures (for example, testing) and personal protective equipment (for example, facemasks). The COVID-19 pandemic continues to reveal vulnerabilities in the global supplychain framework for essential public health supplies. The COVID19 pandemic has catalysed opportunities for rapid innovation in digital health solutions throughout the care continuum.

During public health emergencies like the global Covid-19 outbreak, managing regional economies of scale and scope using internationally pooled procurement can unquestionably assist health services in enhancing access to necessary medications and supplies.. Community-based interventions and services to address pandemic-related issues continue to be underused by healthcare providers in many countries.

As recent research has indicated that when the risk of harm to others is increasingly prevalent, the authorities may determine that the right of all citizens to good health overrides the autonomy of any one individual who chooses not to be involved in the vaccination program. As we are aware that medical autonomy acknowledges that every person who has decision-making capacity has the right to make decisions regarding their treatments and immunization, even when their decisions may contradict their health providers’ recommendation and support. Despite the availability of immunization services, vaccine reluctance—which can range from postponing to outright rejection—remains a significant obstacle to managing the COVID-19 pandemic as a hazard to public health in every nation.

4. What have we learned about public health from the pandemic?

The main emphasis of future responses should concentrate on how to improve and strengthen our public health systems and collaborate accordingly not only on a local level but much wider to easier exchange and disseminate the critical scientific data flow. These are some of the facts learned through the pandemic which I will further elaborate on.

Healthcare providers and systems have experienced wide-ranging challenges throughout the Covid pandemic, from periods of relative calm and control to periods of struggle and near collapse. Although many healthcare systems will continue to be at risk of being overtaken by the new waves, the unanimous agreement among the Covid Delphi consensus panellists strongly implies that those risks may be addressed and mitigated. The absence of an evidence-based data, a globally accepted platform of minimal COVID-19 pandemic response recommendations and standards is one of several factors that endanger health systems in a structural manner. While the community transmission of SARS-CoV-2 still continues to havoc around the world and create risks to health systems, especially through variants of concern, robust virological surveillance should be implemented in all areas.

Given the persisting uncertainties regarding the prevalence, virulence, severity, and duration of post-COVID-19 morbidity due to extended Covid, pertinent public health strategies should better account for the possible longterm implications of undetected transmissions of COVID-19. In order to deliver improved public health and clinical targets relating to the COVID-19 pandemic, all member nations should give the World Health Organization (WHO) the go-ahead. This endeavour should focus especially on cases, immunisation rates, morbidity, and mortality. Massive economic impact, particularly expenditures borne by consumers and businesses, raises the stakes for the health care system.

Removing financial obstacles to COVID-19 tests, personal protective equipment, medical treatment, and patient care are just a few of the risks that should be addressed with strong structural and economic recommendations. There should also be a clear plan to support the establishment of local and regional production hubs for COVID-19 supplies, medications, and vaccines, as well as the necessary legislative and regulatory changes and reforms to address market weaknesses and risks. Authorities and healthcare professionals should think about using a flexible approach in nations where access to PCR or fast antigen tests is inadequate or constrained. The duties of primary healthcare should be enhanced and properly supported in order to lessen the impact and load on hospitals, and the physical, mental, and social wellbeing of the healthcare workforce should also be improved.

The recommendations should stimulate expanding IT infrastructure expenditures, further modifying and enhancing user interfaces, and efforts to widen access, especially for vulnerable demographic groups and individuals. Digital health will play an additional significant role. Investing in the development of applications and platforms to identify the best digital health solutions Relevant public health policies should better take into account the potential long-term effects of undiscovered COVID-19 transmissions given the ongoing uncertainties surrounding the prevalence, virulence, severity, and duration of post-COVID-19 morbidity caused by extended Covid. All members should grant the World Health Organization (WHO) the go-ahead in order to meet better public health and clinical