The impact of our public health work extends well beyond our jurisdiction. While the population of DC is just over 700,000, it is a part of the National Capital Region (NCR), which comprises DC as well as southern-MD and northern-VA. With a population of approximately seven million, the NCR is the sixth largest metropolitan area in the US. Much of this population travels into DC daily to work, seek healthcare, shop, eat, and enjoy the city’s history. DC also attracts thousands of domestic and international tourists annually, ranking in the top 100 most visited cities in the world. These visiting populations more than triple the number of people in DC on a given day.
The large number of people moving in and out of DC daily, coupled with our high density of medical facilities, means that ~30% of all emergency patients seen and 55-80% of admissions at our medical facilities are MD or VA residents. Protecting the health of all individuals in DC (both residents and visitors) is supported by both DC Health and DC PHL resources and requires constant collaboration with neighboring jurisdictions to share data and assist in investigations and response efforts. With several National Special Security Events held in DC annually, including international summits and Presidential Inaugurations, the demands of planning enhanced surveillance further stresses our agencies. All of these factors emphasize how important it is that we have sufficient resources and staff to protect the health of DC residents.
DC Health has made significant strides to improve epidemiologic capacity during the last five years. We have transitioned all case reporting from faxed forms to an online REDCap system, made significant updates to our infectious disease webpages and education materials, and successfully expanded our work in healthcare-associated illnesses (HAI), birth defects surveillance, and influenza surveillance. The majority of this work is supported by ELC funding. In addition, this team takes the lead during public health emergencies, such as Zika and Ebola, which can be time intensive and require surge support, causing routine surveillance to suffer. Challenges including staff time and resources remain as we strive to address the public health threats that affect our population.
The DC PHL has also undergone a transformation. The laboratory was moved out of DC Health and into the newly created Department of Forensic Science at the end of 2012, and shortly thereafter, much of the PHL leadership left. Since then we have taken advantage of the resources provided to us through the ELC cooperative by increasing lab capacity, implementing a routine courier to the 7 DC hospitals, and enhancing outreach efforts to increase sample submission. These actions, in addition to the work of the Laboratory Epidemiology Coordinator, has led to large increase in surveillance sample submission across program areas. The largest success story was outreach requesting remnant influenza samples for viral subtyping. This effort, solely sponsored by ELC funds, equated to a 128% increase of sample submissions this year.
With the frequency with which many DC residents and visitors travel internationally, our jurisdiction is uniquely at risk for the introduction of a multitude of diseases, necessitating our ability to maintain routine surveillance and respond to a variety of public health threats. DC Health and DC PHL are both at a critical phase where we can either continue to grow or stagnate and lose the advances we have achieved. Without continued and increased funding, the multiple competing responsibilities of staff members will limit progress, and restrict our ability to have timely identification and response to both routine and novel public health concerns and to achieve our ultimate goal – protecting the health of visitors to and residents of DC.