Public health agencies adapt COVID lessons to curb overdoses, gun violence

This news comes from KHN (Kaiser Health News), a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Survey, KHN is one of the three main operational programs at KFF (Kaiser Family Foundation). KFF is a non-profit organization equipped to provide information on health issues to the nation.

LIVINGSTON, Montana – Shannan Piccolo walked into a hotel with a bag full of Narcan and a speech about how easy it is to use the drug that can reverse opioid overdoses.

“Hopefully your business will never have to respond to an overdose, but we’d rather have some Narcan on hand just in case,” Piccolo, director of the Park City-County Health Department, told the manager of the hotel.

The manager listened to Piccolo’s instructions on how to use Narcan, the brand name of the drug naloxone, and added four canisters of nasal spray to the hotel’s first aid kit.

The transaction took less than 10 minutes. It was the third hotel Piccolo had visited on that hot July day in Livingston, a mountain town of about 8,000 people where, as in much of the country, health officials are concerned about a recent surge in the use of synthetic fentanyl opioid.

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It was the first time the local health department offered door-to-door training and supplies to prevent overdose deaths. The underlying strategy was created during the pandemic when public health officials distributed rapid tests and vaccines in high-risk settings.

“We learned that from COVID,” said Dr. Laurel Desnick, the county’s public health officer. “We go to people who might not have time to come to us.”

The pandemic exposed gaps and inequities in the US public health system and often resulted in crackdowns on local officials trying to slow the spread of the coronavirus. But one positive result, fueled in part by an increase in federal dollars, is that health workers are beginning to adapt the lessons they’ve learned from their response to COVID-19 to other aspects of their work.

For example, in Atlanta, the county health department planned to mail kits to homes to test for the disease, a program modeled on the distribution of rapid COVID tests. In Houston, health officials announced this month that they will begin monitoring the city’s wastewater for monkeypox, a tactic widely used to gauge how far and quickly COVID spreads. And in Chicago, government agencies have modified the COVID co-ops to label an increase in gun violence.

Some of these adaptations should cost little and be relatively simple to incorporate into post-pandemic departmental work, such as using vans purchased with COVID aid money to distribute vaccines and test for the disease. Other tools cost more money and time, including updating transmitted data from COVID and surveillance systems to be used in other ways.

Some public health workers worry that the lessons embedded in their operations will disappear once the pandemic has passed.

“When we have public health crises in this country, we tend to have a boom-and-boom funding cycle,” said Adriane Casalotti, with the National Association of County and City Health Officials.

Some federal pandemic relief funds are slated to last for years, but other allocations have already ended. Local health workers will be left to prioritize what to fund with what’s left.

Meanwhile, historically understaffed and underfunded health departments are responding to challenges that intensified during the pandemic, including delayed mental health treatment and routine care.

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“You’re not just starting from where you were 2 1/2 years ago, but there’s actually a higher mountain to climb,” Casalotti said. “But countries that were able to build some of their systems can adapt them to allow more real-time understanding of public health challenges.”

In Atlanta, the Fulton County Board of Health has offered residents free, at-home STD tests by mail. The state has historically had some of the highest rates of reported STDs in the country.

“This program has the power to demonstrate the scalable effects of equitable access in historically underserved communities,” Joshua O’Neal, the county’s director of sexual health programs, said in a press release announcing the kits.

The changes go beyond government. University of Texas researchers are piloting a statewide program to collect data on fatal and nonfatal opioid overdoses. Those working on the project are frustrated that the national effort to track COVID outbreaks has not been extended to the overdose epidemic.

Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said her team is expanding the data-driven approach of COVID to track and report neighborhood-level data on opioid drug overdoses. Nonprofits and city agencies that worked together during the pandemic now meet monthly to look at the numbers to shape their response.

Arwady said the city is trying to use the money and attention spurred by the pandemic for programs that can last beyond the COVID emergency.

“Every day, we’re having these debates about how long are we going to continue?” How big are we going to go?’” Arwady said. “I feel like it’s such a moment. We’ve shown what we can do during COVID, we’ve shown what we can do when we have some extra funding.”

The city also opened a new safety center modeled on its COVID response base to combat gun violence. Employees from all city departments are working together on safety issues for the first time by tracking data, connecting people in higher-risk areas with services and supporting local efforts like funding neighborhood block clubs and restoring safe spaces.

Separately, neighborhood-based organizations created to handle COVID contact tracing and education are shifting focus to address food security, violence prevention and diabetes education. Arwady said she hopes to continue grassroots public health efforts in areas with long-standing health disparities by using a series of grants to retain 150 of the 600 people initially hired through pandemic aid dollars.

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“The message I’ve really been telling my team is, ‘This is our opportunity to do things we’ve wanted to do for a long time,'” Arwady said. “We built part of this and I’m just going to kick and scream before I let it all come apart.”

In Montana, Desnick said not every change relies on funding.

When flooding destroyed buildings and infrastructure in and around Yellowstone National Park in June, the Park County health department used a list of contacts gathered during the pandemic to send updates to schools, churches and businesses.

Desnick posts regular public health video updates that began with a count of COVID cases and expanded to include information on flood levels, federal cleanup assistance and ice cream socials for people to meet first responders.

Piccolo, the county’s health director, spent roughly an hour that day in July going to hotels in downtown Livingston to provide opioid overdose response training and supplies. Three hotel managers accepted the offer, two asked her to return later, and one scheduled an all-staff training for later that week. Piccolo plans to expand the program to restaurants and music venues.

It’s the kind of adjustment to her job that doesn’t require a constant stream of COVID aid. The state supplied the Narcan boxes. Otherwise, she said, “it’s just about taking time to do it.”

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