A call to action on the third anniversary of the COVID-19 pandemic

March 11, 2023, marked three years since COVID-19 was declared a pandemic by the World Health Organization (WHO). Nearly 7 million people opens in new tab/window around the world have died from a virus that was once unknown to mankind, and countless others have been infected, many of whom are living with long COVID. In New York City, the first epicenter of the pandemic in the United States, over 45,000 lives have been lost and nearly a quarter million hospitalized, according to the NYC Department of Health opens in new tab/window.

As we transition into a post-pandemic world, it is an optimal moment to take stock of how the pandemic disproportionately devastated our most vulnerable communities, reflect on lessons learned from the acute phase of the pandemic, and adopt practices that create more resiliency and equity in healthcare systems. While the lessons learned from the Covid-19 pandemic are numerous, we share three specific calls to action.

1. Ensure healthcare for all.

All people, regardless of race, sexual orientation, gender, insurance status and citizenry, should have access to high quality healthcare services. Those who have suffered the most in this pandemic have often been the most marginalized and vulnerable members of our communities. Those who may not have insurance coverage or the ability to pay for healthcare services, or live below the poverty line historically, have experienced higher rates of illness and death. These inequalities have emerged through the exacerbation of chronic disease and the interaction of the pandemic with social determinants of health. COVID-19 has magnified our established social, economic and political inequalities. It is imperative at this time that the right public health policies are undertaken opens in new tab/window so future pandemics do not increase health inequalities in generations to come.

2. Focus on the frontlines.

COVID-19 followed four influenza pandemics opens in new tab/window in the past century. And it won’t be the last pandemic. Knowing there will be more threats in the future, we must continue to protect those working on the frontlines and provide them with the tools and resources they need to respond to emerging threats. This includes proactively investing in the emotional and psychology wellbeing of healthcare workers and innovating the development and manufacturing infrastructure for personal protective equipment (PPE) — for example, creating re-usable personal protective equipment that is comfortable, easy to use and accessible. We must expand beyond the walls of a single institution or healthcare system and work together to develop a coordinated intersystem during times of crisis to create greater economies of expertise and clinical care. By doing so, we would mitigate disparities in staff, space and supplies. We must develop an accurate and consistent way of data sharing to maintain data across silos and mitigate misinformation, disinformation and lack of user-friendly information. By addressing issues COVID-19 exposed, we would have better abilities to scale innovation, share data and coordinate with communities to tailor interventions that could be lifesaving.

3. Support global mental health transformation.

As stated in the WHO’s 2022 World Mental Health Report: Transforming Mental Health for All opens in new tab/window, global mental health care delivery must be transformed. The pandemic disrupted mental health care. During COVID-19’s first year alone, the prevalence of anxiety and depression rose by about 25%. The countries most severely affected by Covid-19 had the highest surge in depressive disorder and anxiety disorders. Nearly 1 billion people worldwide — approximately 1 in 8 people — live with mental health disorders. One in every 100 deaths is caused by suicide, according to the WHO opens in new tab/window. Distressingly, suicide is the leading cause of death in adolescents. And 71% of individuals with psychosis go untreated.

The pandemic has brought to the forefront the importance of population mental health. Seamless integration of mental health care must be incorporated into primary care and general inpatient or outpatient hospital care that is focused on recovery. It is imperative that community-based mental health centers be available at schools, prisons and social services. We must train up primary care clinicians in mental health care through innovative approaches to boost the numbers of mental health specialists. Technology needs to be scaled up for tele-mental health services to broaden the reach the whole population. Seamless human rights- and community-based prevention and mental health care systems must be created. The pandemic has been a wake-up call for improved mental health care opens in new tab/window for everyone.

Through learning what has and has not worked, we can truly make significant and lasting changes in healthcare and create more resilient and equitable health systems. We are excited to share that in a forthcoming book, to be released end of 2023, NYC Health + Hospitals opens in new tab/window, the nation’s largest municipal healthcare system, will detail the heroic and lifesaving work that has been done to combat the pandemic — from standing up incident command, expanding testing capacity, adding on beds to accommodate a wave of sick patients to building one of the world’s largest fleet of contact tracers in an urban city. Each of the 22 chapters will cover critical “lessons learned” to prepare for future pandemics.

We hope this book will be one of the foundations for emergency managers, healthcare administrators, policymakers and others to use, reference and make meaningful changes in healthcare.