Picking up the pieces: Lessons learned about optimal public health and acute-care hospital collaboration during pandemics

Just before the coronavirus disease 2019 (COVID-19) pandemic, we marked the centenary of the 1918 Spanish Flu pandemic.1 We were preparing for outbreaks of highly infectious diseases, such as Ebola virus disease, with drills and protocol revisions.Before that, most healthcare epidemiologists and infection preventionists had close relationships with local departments of health (DOH) and public health agencies (PHAs).We reported specific infections to the DOH and orchestrated safe discharge plans for patients with communicable diseases such as tuberculosis (TB).In 1893, New York City (NYC) became the first city in the United States to attempt to control the spread of TB through a combination of screening, reporting, treatment, and follow-up, including detention and court-ordered treatment of nonadherent individuals.By these means, NYC successfully decreased cases of TB.This effort was accomplished by adequate funding in addition to robust collaboration between physicians, hospitals, and the DOH.Similar efforts occurred nationally, and after a resurgence of TB in the 1990s, strategies for its control were laid out in a national plan. 2 We became accustomed to PHAs providing timely, evidencebased, practical guidance, and developed positive working relationships with local DOH.Although the arrival of a respiratory viral pandemic was anticipated by experts, not until the COVID-19 pandemic did we realize that our preparedness and communication were suboptimal.This pandemic demonstrated the importance of succinct, truthful, and unified communication, not only for the consumption of the healthcare community but also for the public.Given rapidly evolving information, at times we found ourselves hampered by PHAs guidance that in prior situations provided a significant amount of support and resources.However, working together through remote and recent pandemics created a path forward for more effective collaboration.Herein, we present lessons learned from recent intensive PHA collaboration by our large academic health system in NYC, during the COVID-19 and mpox emergencies. Gather feedback and align prioritiesAs with any successful undertaking, it is important to begin with an outline of goals and priorities, and a plan to achieve them.This makes expectations clear, serves to identify areas that require improvement or support, and holds all parties accountable to established outcomes.The process of setting those goals should ideally be a bidirectional conversation between the PHAs, local healthcare epidemiologists, and healthcare institutions.This communication would help to ensure that goals can be achieved and reflect everyone's interests.