Publications

In this case study, we describe a well-resourced private school in New York City that implemented COVID-19mitigation measures based on public health expert guidance and the lessons learned from this process

Improving indoor air quality (IAQ) will diminish routine exposure to airborne diseases,^1,2 limit outbreaks or epidemics,³ and lower risks of noninfectious respiratory conditions like asthma that affect the health of millions each year.⁴ Improving IAQ is also cost-effective. Proper ventilation and filtration in crowded public indoor settings can significantly reduce the costs of illness at a benefit-cost ratio ranging from 3:1 to 100:1,⁵ exceeding similar ratios for most other public health interventions.⁶

The COVID-19 pandemic has caused approximately 20 million deaths worldwide (0.25% of the world's population) and brought health systems in many places to the brink of collapse. As tragic and consequential as this has been, future pandemics could be worse.

An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention.

The Johns Hopkins Center for Health Security hosted a meeting, “National Strategy for Improving Indoor Air Quality,” in Washington, DC, on September 8, 2022. The meeting featured a keynote speaker and four expert panels focused on the importance of indoor air quality (IAQ), challenges to providing healthy indoor air across the United States, international perspectives and strategies for healthy air improvements, and catalyzing needed science and technology innovation in the IAQ field. Dr. Ashish Jha, White House COVID-19 Response Coordinator, opened the meeting by reiterating the importance of IAQ to the Biden-Harris Administration. 

The US nursing workforce crisis represents a danger to the quality and safety of patient care and an imminent threat to the nation's health security. The COVID-19 pandemic has exposed a range of perversities related to the nursing profession, including the inequitable financing and compensation of the nursing workforce, lack of workplace protections, and the perception that nursing is a subservient profession. It has also exacerbated workforce issues that predated the pandemic, leading to physical and mental exhaustion, lack of trust and perceptions of betrayal by hospital leaders, and moral injury and burnout. Nurses are critical to the sustainability of the US healthcare system, to the health of communities, and to the ability of the nation to respond to health security threats, including pandemics, natural disasters, and other large-scale emergencies. In the absence of an adequate labor supply of nurses, healthcare services are substantially degraded, hindering the country's ability to respond to emergencies and ultimately putting patients at risk.

In October 2020, David Cutler and Lawrence H. Summers published a brief article in JAMA Viewpoint estimating that COVID-19 would cost the United States $16 trillion dollars, when combining economic damages and monetized health and life loss. This figure has been extensively cited and used in policy discussions. In this article, we update their estimate, using facts about the disease and its costs to society that have become known since their paper was published. 

We find that the total harms of COVID-19 to the U.S. are still about $16 trillion (with a range of $10 trillion and $22 trillion) but the components of harm are significantly different than those estimated by Cutler & Summers. The pandemic caused less economic damage than they projected, but more mental health damage.

The COVID-19 pandemic has shown that false or misleading health-related information can dangerously undermine the response to a public health crisis. These messages include the  inadvertent spread of erroneous information (misinformation) or deliberately created and propagated false or misleading information (disinformation). Misinformation and disinformation have contributed to reduced trust in medical professionals and public health responders, increased belief in false medical cures, politicized public health countermeasures aimed at curbing transmission of the disease, and increased loss of life.

Many kindergarten through 12th grade (K-12) schools in the United States do not have good ventilation. This is a longstanding problem with demonstrably negative effects on student learning. We can and should act to fix this to ensure good indoor air quality for all students, educators, and school staff. During the COVID-19 pandemic, it is even more important that ventilation problems in K-12 schools be addressed now. Along with other mitigation measures, improvements in ventilation in K-12 schools can decrease the risk of SARS-CoV-2 spread.