Public health agencies adapt Covid lessons to curb overdoses, STDs and gun violence

LIVINGSTON, Mont. — Shannon 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 opiate overdoses.

“We hope that your business will never have to respond to an overdose, but we would prefer that you have some Narcan on hand just in case,” Piccolo, director of the Park City County Health Department, told the hotel manager.

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

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

It was the first time the local health department offered door-to-door education and supplies to prevent overdose deaths. The basic strategy was forged during the pandemic, when public health officials rolled out rapid tests and vaccines in high-risk settings.

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

The pandemic has exposed the gaps and inconsistencies in the U.S. public health system and often led to backlash against local officials trying to slow the spread of the coronavirus. But one positive outcome, fueled in part by increased federal dollars, is that health care workers have begun to adapt the lessons they learned from their response to covid-19 to other aspects of their work.

In Atlanta, for example, the county health department plans to mail home disease testing kits, a program modeled after the rollout of rapid covid tests. In Houston, health officials announced this month that they will begin monitoring city wastewater for monkeypox, a tactic widely used to gauge how far and how fast covid is spreading. And in Chicago, government agencies have changed covid cooperation to mark the rise in gun violence.

Some of these adaptations should cost little and be relatively easy to incorporate into departmental work after the pandemic, such as using vans purchased with COVID relief money to deliver vaccines and disease testing. Other tools cost more money and time, including updating data carried by Covid and surveillance systems to be used in other ways.

Some public health officials worry that the lessons woven into their operations will be lost once the pandemic passes.

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

Some federal pandemic relief funds are slated to last for years, but other funds have already run out. 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 have intensified during the pandemic, including delayed mental health treatment and routine care.

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

In Atlanta, the Fulton County Board of Health offered to mail residents free home tests for STDs. The state has historically had some of the highest rates of reported STDs in the nation.

“This program has the power to demonstrate the scalable effects of equitable access to historically underserved communities,” said Joshua O’Neill, the county’s director of sexual health programs, in a news 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 opiate overdoses. Those working on the project are frustrated that national efforts to track Covid outbreaks have not covered the overdose epidemic.

Dr. Allison Arwadi, commissioner of the Chicago Department of Public Health, said her team is expanding the data-driven approach to covid to track and report neighborhood-level data on opioid overdoses. The nonprofits and city agencies that worked together during the pandemic now meet monthly to crunch the numbers to shape their response.

Arwadi said the city is trying to use the boost in money and attention brought on by the pandemic for programs that can continue beyond the COVID emergency.

“Every day we have debates about ‘How long will we go on?’ How big are we going to get?” Arwadi said. “I feel like this is the moment. We’ve shown what we can do during covid, we’ve shown what we can do when we have a little extra funding.”

The city also opened a new safety center modeled after its COVID-19 response base to combat gun violence. Officials from different city departments are working together on safety issues for the first time, tracking data, connecting people in the most at-risk areas with services, and supporting local efforts like funding neighborhood clubs and restoring safe spaces.

Separately, neighborhood-based organizations created to handle COVID contact tracing and education are shifting their focus to addressing food security, violence prevention and diabetes education. Arwadi said he hopes to continue grassroots public health efforts in areas with longstanding health care disparities by using a mix of grants to retain 150 of the 600 people initially hired through pandemic relief dollars.

“The message I’ve been really telling my team is, ‘This is our opportunity to do things that we’ve wanted to do for a long time,'” Arwadi said. “We built some 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.

With the flood of 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, which began with the number of Covid cases and expanded to include information on flood levels, federal cleanup assistance and ice cream socials for people to meet the individuals, first responders.

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

It’s the kind of adaptation 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 the time to do this.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operational programs at KFF (Kaiser Family). KFF is a charitable, non-profit organization providing information on health issues to the nation.

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