Cracks in the System: The Effects of the Coronavirus Pandemic on Public Health Systems

The novel coronavirus disease 2019 (COVID-19) pandemic has rapidly wrought havoc on the world, exposing the gaps in public health systems of countries that were previously considered most prepared for infectious disease outbreaks. Notably, despite being ranked highest on the Global Health Security Index, the United States has been severely hit with nearly two million confirmed cases and one hundred thousand deaths by the end of May 2020. In addition to the public health fragmentation from the federal to the state level and lagging regulations, early reports highlight substantial socioeconomic disparities and health system barriers contributing to the spread and impact of the pandemic in the United States. In this review, we explore the impact of COVID-19 on public health systems by assessing systems through the lens of the Centers for Disease Control and Prevention’s Ten Essential Public Health Services. Building on prepandemic and COVID-19 observations and lessons, we propose recommendations moving forward to prepare for future waves and other disease outbreaks.