According to urban legend, U.S. Surgeon General William Stewart made a bold proclamation in the later 1960s: “It is time to close the book on infectious diseases, and declare the war against pestilence won.” While subsequent research has unearthed no evidence that Stewart actually uttered these words, the statement reflects a pervasive naivety in the public health world of that era, resulting from enormous leaps forward in containment of infectious disease in the postwar years. During the two decades between the end of WWII and Stewart’s tenure as Surgeon General, the U.S. achieved many key milestones in infectious disease management, per the CDC Museum’s online timeline:
- In 1949, the last U.S. case of naturally-occurring smallpox was reported
- By 1951, malaria was considered eradicated in the U.S.
- In 1953, the CDC created a National Surveillance Program to respond to and watch for communicable disease outbreaks
- In 1957, the CDC released national guidelines for an influenza vaccine
- In 1963, the establishment of the Immunization Assistance Grant Program elevated and maintained immunization against poliomyelitis, diphtheria, pertussis (whooping cough), and tetanus
Despite these great strides, one need look no further than today’s headlines to see that the war against pestilence is still raging. Since March of 2020, the COVID-19 pandemic has triggered an ongoing public health crisis that has continuously upended social, economic, and political systems around the world. Indeed, the pandemic has brought about a much-needed awakening to the threat of large-scale viral outbreaks, as well as everyday viral and pathogenic spread that society has long deemed acceptable. The impact of viral spread — from influenza to COVID-19 — ripples through nearly every aspect of our domestic and global societies. This blog post will examine the many consequences of viral diseases and how the upheaval brought on by the COVID pandemic can be a springboard into forging a better path forward.
The Public Health Consequences of COVID and Viral Spread
The American Public Health Association (APHA) defines public health as the promotion and protection of people’s health in the communities where they live, work, and play. Prior to the COVID pandemic, leaders in the U.S. public health space had voiced concerns that U.S. public health entities were understaffed, unequipped, and woefully underfunded. In a discussion paper for the National Academy of Medicine (NAM), a group of researchers painted a bleak picture of the state of public health in the U.S. just prior to the COVID pandemic. They noted that in the past decade, local health departments have eliminated more than 56,000 jobs, while state health agencies have eliminated over 10,000. They also noted that the U.S. has exhibited a bias for reaction rather than prevention, with per capita spending on public health services only about 1-3% of per capita expenditures on medical care.
Against this backdrop of resource-constrained circumstances, COVID burst onto the public health scene in March 2020. The pandemic laid bare the outdated infrastructure, insufficient workforce, and inequities in access and outcomes that were already inherent in the U.S. public health system. One widely-reported key indicator of COVID’s negative impact on public health has been the revelation that COVID reduced U.S. life expectancy by 1.5 years – the largest decline seen in a single year since World War II. While this decrease in life expectancy affects all Americans, those who contract the virus and survive face other potential challenges that will require public health support. Experts are still learning what the negative, long-term health conditions post-COVID may be, but issues identified thus far include respiratory issues, joint pain, and cardiovascular inflammation. Educating the public on these long-term effects and finding ways to manage them will be an important part of post-pandemic public health.
The Social Consequences of COVID and Viral Spread
When it comes to the impact of viral diseases like COVID, the public health consequences are the most visible, but deeper dives into the data reveal additional social nuances. According to the latest data from the Johns Hopkins Coronavirus Resource Center, COVID-19 has killed over 619,000 people in the U.S. to date. The CDC has noted that COVID “has unequally affected many racial and ethnic minority groups, putting them more at risk of getting sick and dying from COVID-19.” In tracking risk for different racial and ethnic groups, the CDC has documented how the following groups are at increased risk when compared to white, non-Hispanic persons:
American Indian or Alaska Native, non-Hispanic persons
- 1.7x more likely to have a recorded case of COVID
- 3.4x more likely to be hospitalized due to COVID
- 2.4x more likely to die due to COVID
Black or African American, non-Hispanic persons
- 1.1x more likely to have a recorded case of COVID
- 2.8x more likely to be hospitalized due to COVID
- 2.0x more likely to die due to COVID
Hispanic or Latino persons
- 1.9x more likely to have a recorded case of COVID
- 2.8x more likely to be hospitalized due to COVID
- 2.3x more likely to die due to COVID
Asian, non-Hispanic persons are the only ethnic/racial group recorded by the CDC to have lower or parity rates of cases, hospitalization, and death when compared to white, non-Hispanic persons. To explain these increased risks for infection, hospitalization, and death, the CDC has commented, “Race and ethnicity are risk markers for other underlying conditions that affect health, including socioeconomic status, access to health care, and exposure to the virus related to occupation, e.g., frontline, essential, and critical infrastructure workers.”
In April 2020, the Center for Economic and Policy Research (CERP) published a report titled, “A Basic Demographic Profile of Workers in Frontline Industries.” The researchers defined frontline industries as grocery, convenience, and drug stores; public transit; trucking, warehouse, and postal services; building cleaning services; health care; and child care and social services. The CEPR team discovered that 64.4% of frontline workers are women; 41.2 % of frontline workers are people of color (defined as Black, Hispanic, Asian-American, Pacific Islander, or some category other than white); and 23% of frontline workers live in low-income families.
Based on their findings, the CERP researchers urged Congress to ensure that all frontline workers would have health insurance, paid sick and family leave, free child care, student loan relief, and consumer and labor protections. Unfortunately, this recommended legislation never came to fruition. As reported by consulting firm McKinsey in a recent expert roundtable, one measurable consequence of this lack of legislative support and financial relief was that 2.5 million women exited the workforce during the pandemic. McKinsey has projected that employment for women may not recover to pre-pandemic levels until 2024 (two years after the projected recovery for men).
The Economic and Political Consequences of COVID and Viral Spread
In addition to the public health and social tolls of COVID, the current pandemic has created significant economic and political disruptions. In 2020, the global economy contracted by an estimated 4.4%, marking the worst decline since the Great Depression and plunging the world into recession. The US economy, for its part, saw its largest decline in 74 years, shrinking by 3.5% in 2020 and leaving tens of millions of Americans jobless. With global viral outbreaks set to increase, experts estimate that pandemics could cost up to $23.5 trillion globally over the next 3 decades.
Like COVID, more routine viral diseases also come with a hefty economic price tag. By some estimates, seasonal influenza costs the United States upwards of $87 billion in lost productivity and health care expenses, while norovirus costs around $10 billion. The other diseases that viruses contribute to and exacerbate — cancer, diabetes, cardiovascular disease, and others — cost the US billions more.
These economic impacts have clear socio-political consequences. Viral outbreaks tend to hit low-income and minority populations harder, exacerbating existing health and economic disparities. An analysis from the IMF found that because pandemics tend to worsen societal inequalities, they often lead to social unrest. This sets off a vicious cycle: unrest increases inequality, which then increases unrest.
Economic inequality and accompanying unrest have political consequences during pandemic periods. For example, scholars have linked conspiracy theories around the 1832 cholera outbreak in Paris to the most deadly examples of class repression in the nineteenth century: the 1848 French revolution and the bloody destruction of the Paris Commune. Nearly two centuries later, the subversive grip of conspiracy theories, misinformation, and other expressions of social panic have similarly deepened socio-political fault lines and hampered the U.S. COVID pandemic response.
As the Pew Research Center pointed out in an article marking the one-year point of the pandemic, “The biggest takeaway about U.S. public opinion in the first year of the coronavirus outbreak may be the extent to which the decidedly nonpartisan virus met with an increasingly partisan response.” To underscore how uniquely and politically divisive the pandemic has been in America, the Pew Research Center authors went on to observe, “America’s partisan divide stood out even by international standards: No country was as politically divided over its government’s handling of the outbreak as the U.S. was in a 14-nation survey last summer.” In fact, 77% of Americans said the nation was more divided during the pandemic than prior – 30% more than the average in 13 other nations surveyed.
Finding New Solutions for a New Era
While the COVID-19 pandemic is unprecedented in recent history, it is actually just one of many serious viral outbreaks in the past century. The 1918 Spanish flu pandemic killed 675,000 people in the United States, taking ten years off the average national life expectancy (vs. the 1.5 year decline in U.S. life expectancy recently attributed to COVID). Since the start of the 21st century, the world has dealt with a spate of deadly viral outbreaks, including SARS (2002 – 2003), the swine flu (2009), MERS (2012), Ebola (2014 – 2016), and Zika (2015).
But quieter viruses — many of which society more or less accepts as part of the status quo — have been taking their toll on our health, as well. Coupled with pneumonia, influenza is one of the top ten causes of death in the United States, accounting for 55,000+ deaths each year. There is even mounting evidence that influenza is a trigger for cardiovascular disease, the number one cause of death in the U.S. For those already suffering from cardiovascular disease, influenza can increase risk of complications and death.
Viral infections have also been implicated in other leading causes of death. Studies show that viral infections may play a role in the development of Type I Diabetes, while autoimmune disease studies reveal that infection with the Epstein Barr Virus (EBV) is associated with multiple autoimmune diseases, including Systemic Lupus, Sjögren’s syndrome, rheumatoid arthritis, and multiple sclerosis. Viruses can also cause cancer, the second leading cause of death in the U.S., with seven viruses classified as Group 1 human carcinogens by the International Agency for Research on Cancer.
In addition to viral threats, another serious risk persists in the form of antimicrobial resistance. The World Health Organization (WHO) has described antimicrobial resistance as “one of the top 10 global public health threats facing humanity.” The severity of this threat is due to the decreasing ability to treat common infections from “multi- and pan-resistant bacteria” (or “superbugs”) with common antimicrobials like antibiotics. Some experts have described antimicrobial resistance as “the next pandemic,” with WHO Director-General Tedros Adhanom Ghebreyesus cautioning, “Antimicrobial resistance may not seem as urgent as a pandemic, but it is just as dangerous.”
As global viral outbreaks become more common and routine viruses like influenza continue to claim American lives each year, it is clear that opportunities to reassess the American and international approaches to infection prevention are rife. Even though “closing the book” on infectious diseases may continue to elude epidemiologists and leaders in the social, political, and economic realms, there are still ways to improve the tools for containing and managing these pathogenic threats. One key area of opportunity is investing more into viral and epidemiological research as well as research into bolstering the pipeline of antimicrobials and antibiotics to offset human vulnerability to viral and bacterial threats. A related opportunity space is the overall improvement of indoor environments, where Americans spend 90% of their lives, with an emphasis on equipping these spaces to mitigate and eliminate infection and pathogen transmission.
Along with the public health, social, political, and economic obstacles COVID-19 introduced, the virus also opened the door to rethinking existing systems and rebuilding them better than ever before. R-Zero was founded to seize that opportunity. Our mission is to fundamentally change how society approaches infection prevention in the built environment, starting with our flagship UV-C disinfection device, Arc. UV-C disinfection is significantly safer, more efficient, and more effective than chemical disinfection. With Arc, we have modernized UV-C disinfection devices and made them accessible to the mass market for the first time.
At R-Zero, we believe we shouldn’t accept the current burden of viral spread and pathogenic risk. We have the technological capability to do better: we just need to harness it. We will continue to do our part in battling the injustice of pathogenic risk and viral spread by building out our biosafety platform, facilitating a new standard for infection prevention equal to the challenges and innovations of our present and our future.
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