What is Needed for Community Recovery from the COVID-19 Pandemic

April 17, 2020|11:30 a.m.| Michael Fraser | Jim Blumenstock | Marcus Plescia

Glimmers of hope for recovery from the COVID-19 response started to shine this month when several thought leaders and policy experts shared recommendations on what is needed to move from the mitigation phase of COVID-19 to community recovery in four different papers and reports (here, here, here, and here). Each report outlines the major steps and the public health capacities needed to effectively control and prevent COVID-19 transmission both here in the United States and around the globe. The requisites to community recovery include universal COVID-19 testing capacity, public compliance with stay-at-home and physical distancing regulations and recommendations, and a public health and health care system with the capacity to respond to hotspots and outbreaks of COVID-19 as restrictions on movement and gathering are gradually lifted.

Testing. Despite ample criticism of federal efforts to develop a COVID-19 test, there are several available now. Testing supplies are continuing to catch-up with demand, but personal protective equipment (PPE) and supplies to protect those doing the testing and laboratory work are not. Why is a test requisite? A rapid, simple test that can safely and quickly be administered at the community level will help us accurately determine who has the virus and who may be at risk of transmitting it, and more effectively manage isolation and quarantine activities for those infected or exposed. Until we have the capacity for rapid testing needed to reach every American there will be no widespread economic recovery. Scaling up COVID-19 testing has to be job number one for everyone. Every plan for recovery is wholly dependent upon it.

Voluntary Compliance. Today, the entire response to COVID-19 prevention is based on the willingness of Americans to comply with stay-at-home orders and guidelines around physical distancing. Every American and visitor to America, in every state and territory, should be expected to do the right thing and adhere to recommended non-pharmacologic interventions. Yes, as Americans, we value our freedom, liberty, and the unique ways we all pursue life, liberty, and happiness. And yes, these core American values conflict with tried and true—though potentially temporary if we all get on-board—public health community mitigation strategies that require us to limit our freedom to move, gather, work, worship, and share. To increase adoption of physical distancing and stay-at-home orders, we must continue to make sick leave and unemployment benefits widely available so staying home is possible for everyone that has to. We must appeal to American patriotic duty, altruism or rational self-interest to avoid infection and embrace the motto “stay informed, stay home, and stay healthy.” Otherwise, there will be no widespread economic recovery.

Public Health and Health Systems Capacity. COVID-19 laid bare what our contemporary governmental public health agencies and our public and private health care systems can and cannot do when faced with a global pandemic that scales and spreads to every single U.S. state and territory in less than six weeks. Public health leaders have long advocated for more support for pandemic preparedness at the local and state level and now we see why. But this is not a “we told you so” moment. It is governmental public health’s opportunity to demonstrate what it really takes to contain outbreaks and prevent infection.

In addition to the role public health officials are now playing in dealing with real-time health care system and laboratory shortfalls, we also need every governmental public health agency to simultaneously develop jurisdiction-specific public health suppression and recovery plans that specify exactly what public health and health care capacity is needed to allow our cities, counties, states, and territories, to gradually and safely get back to a reasonable state of “normal.” For most public health agencies, implementing suppression and recovery plans will mean reiterating the need to stay home in areas where it is recommended or mandatory, and quick deployment of public health teams to conduct rapid community-based testing for COVID-19. These actions must be followed by active contact investigation and wrap-around supports for quarantined or isolated community members with COVID-19. Communities should decide to reopen based upon expert review and consideration of local, state, and regional epidemiological data and after careful assessment of the capacity of the public health and healthcare systems in each jurisdiction to rapidly identify and suppress outbreaks and provide health care for those who become ill.

We cannot do this today, tomorrow, or even next week. We do not (yet) have enough rapid, point of care test that can be used by contact investigators in communities to identify COVID-19 prevalence and isolate positive cases and their contacts. We certainly do not (yet) have enough public health workers to do the work of contact investigation. Our organization estimates that there are roughly 2,200 disease intervention specialists (DIS) trained and working in state and territorial health agencies primarily in the areas of sexually transmitted disease and tuberculosis control, or one DIS for every 150,000 Americans. We must quickly and urgently ramp up our contact investigation and epidemiology capacity in the next four to six weeks. This is achievable but we must move swiftly. Now is not the time to be laying off state and local public health employees as government revenues decline. Rather, we have to work to determine how each and every person in a public health agency can do their part to control this epidemic and get our society back to some semblance of life before COVID-19.

To be perfectly clear: the entire U.S. economic recovery, and by extension global economic recovery, is based on three things:

  1. a robust public health workforce
  2. the ability to implement rapid testing and contact investigation in every community
  3. a public willing to comply with public health orders and regulations that may impact different parts of the country in various ways at different times.

Yes, health care and other response partners need to have what they need to effectively transport and treat COVID-19 patients and save lives, but that is not the core mission of public health agencies—preventing disease in the first place is. The need to pivot to prevention is now greater than ever. Public health security is national and economic security. While we cannot predict the future, what we do in the next few weeks to prepare for a fast ramp-up of our public health and health care capacities to manage a slow return to normal will directly influence it.

Michael Fraser, PhD, MS, CAE, FCPP, is CEO at ASTHO
Jim Blumenstock, MS, is chief program officer for health security at ASTHO
Marcus Plescia, MD, MPH, is the chief medical officer at ASTHO