Q&A: Preparing for Pandemic, An Interview with Umair Shah, MD, Harris County Public Health
By Sean Price Texas Medicine June 2020


Even many of the best-prepared state and local public health systems in the U.S. have struggled to keep up with the demands of COVID-19.

Texas Medicine spoke with Umair Shah, MD, executive director of Harris County Public Health (HCPH), the largest local public health entity in the state, to find out what problems his agency has faced and the lessons learned so far from dealing with COVID-19.

What was the biggest obstacle public health faced going into the COVID-19 crisis?

Testifying before Congress, I have made the case many times that public health is underfunded. For every dollar that is spent in America on health, on average 96 cents of that dollar is spent on health care delivery, and only four cents is spent on public health prevention. In our Harris Cares report we released last November (a special study of county health needs, tma.tips/Harris
Cares2020), we laid out all the issues public health had, such as data sharing [among health care institutions], public health infrastructure, uninsured and vulnerable populations, etc. A few months later during a pandemic, all these items we brought up earlier are surfacing. We have to give public health serious attention all the time, not just during a pandemic or emergency.

Can you give an example of how this lack of funding hurts HCPH’s ability to protect the public?

What happens is that when we’d hire a physician – and this has been true on multiple occasions – we’d hire a physician to address what was killing most Americans on a daily basis [before the pandemic]: high blood pressure, chronic diseases, obesity, heart disease, and diabetes. So, we’d hire a physician to help with chronic disease prevention. And then that physician – because we do not have enough resources to be able to handle infectious disease responses – gets pulled over to be part of the Ebola response or the Zika response or now COVID-19. It is not like the virus magically moves all those other conditions off the table. People are still going to die or be impacted by those other ailments, but then we have to make decisions because we have resource constraints.

How else has this affected the COVID-19 response?

Another example is in epidemiology. Epidemiologists have a very specific skill set. They are not on a street corner waiting to be hired. It is hard to recruit, train, and retain them. And if you do not have those individuals as part of your capacity in advance of an emergency, then you are in the middle of the emergency and you do not have the ability to [focus resources on the problem] as you should. That has been a significant problem as well. I am hopeful we get through this [pandemic] quickly, but we need to have a serious discussion in our country about where we invest our precious dollars because, unfortunately, public health is not where we invest it.

Disease outbreaks tend to spark rumors and misinformation. What kind have you seen with COVID-19, and how have you countered it?

There has been misinformation about who’s been impacted [by the disease]. First Asian Americans and specifically Chinese-Americans [have been blamed for the pandemic]. Also, there is a significant number of people who think if they get tested it is [the same as getting] a vaccine or a treatment. And people forget there are so many websites out there that are not credible. There are lot of business models trying to make a lot of money, and they are selling things and telling people things [that are false]. We are trying to fight misinformation with information [mostly through the HCPH website at tma.tips/HCPH]. We also have the dashboard that comes up [on COVID-19]. And we have an electronic screening tool that we have created to help individuals self-assess to understand if they are truly at risk for COVID-19 or if their symptoms could be related to another health condition (tma.tips/AssessCorona). That is state of the art.

You’ve mentioned before that practicing physicians and public health officials don’t always speak the same language when it comes to health priorities. Has that been a problem in this crisis?

As far as physicians go, there has been real interest in working with public health and understanding the role of public health. Physicians are really trying hard to understand the language of public health now. I would have hoped that there was more of that interest previously. We have started to think [about] epidemiology, transmission rates, case fatality rates. That is very much the language of public health. A lot of people are very quickly trying to come up to speed on that, but when you try to do it just in time, it is not as well thought out as when you’re doing something on an ongoing basis.

When we get past this, what are some of the first conversations you’ll have with physicians about what could be done better?

That we have a significant component [in medical education] for population health and why it is important for all of us to be public health practitioners. That idea has to be built into graduate medical education, graduate nursing education, and beyond. We have to do a markedly better job of understanding population health and how that works with an individual’s health perspective.

What are the biggest challenges you see for the post-pandemic world?

When this gets into our rearview mirror, there is a very big tendency to forget about things – to go on with the next headline. And I hope that does not happen. That is one thing. The other is that our country – our globe – is transforming in a way that I do not think any of us could have anticipated in very quick order. We have talked about telework, telecommuting, and telehealth policies for years, but this is the first time you have seen people enact them because they are worried about the health and safety of their workforce. That is a fundamental change to the way we do business. And it is the same thing with schools and education and health care delivery. Doctors are using web portals to communicate with their patients – things that we never thought that we could see so quickly. Those are the kinds of advances we are seeing now [and need to examine further]. COVID-19 truly will have left a long-lasting impact on life as we all know it.

Tex Med. 2020;116(6):27-28
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Last Updated On

July 10, 2020

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Sean Price


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Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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