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

This story comes from KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operating programs at the KFF (Kaiser Family Foundation). KFF is a non-profit organization providing information on health issues to the nation.

LIVINGSTON, Montana – Shannon Piccolo walked into the hotel with a tote 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 want you to have some Narcan on hand,” Park City-County Health Department Director Piccolo 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 boxes 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, where health officials are concerned about a recent surge in the use of the synthetic opioid fentanyl in much of the country.

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This is the first time local health departments have provided door-to-door training and supplies to prevent overdose deaths. The underlying strategy was developed during pandemics when public health officials distributed rapid tests and vaccines in high-risk settings.

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

The pandemic exposed the gaps and inequities in the US public health system, and often led to a backlash against local officials trying to slow the spread of the coronavirus. But one positive result, in part due to the increase in federal dollars, is that healthcare workers are beginning to adapt lessons learned from their COVID-19 response to other aspects of their work.

In Atlanta, for example, the county health department plans to send kits to homes to test for the disease, a program modeled on the distribution of Covid rapid tests. In Houston, health officials announced this month that they would begin monitoring the city’s wastewater for monkeypox, a strategy widely used to gauge how far and fast COVID has spread. And in Chicago, government agencies have tweaked Covid assistance to tag-team the rise in gun violence.

Some of these adaptations should cost little and be relatively simple to incorporate into the departments’ post-pandemic work, such as using vans purchased with COVID relief funds for vaccine distribution and testing. Other tools cost more money and time, including updating the COVID-generated data and surveillance systems to be used in other ways.

Some public health workers worry that the lessons woven into their operations will be lost once the pandemic is over.

“Whenever we have a public health crisis in this country, we have a boom-and-bust cycle of funding,” said Adrian Casalotti with the National Association of County and City Health Officials.

Some federal pandemic relief funding is scheduled for years, but other allocations have already dried up. Local health workers will be left to prioritize what to fund with what’s left.

Meanwhile, historically short-staffed and underfunded health departments are responding to challenges that intensify during the pandemic, including delayed mental health treatment and routine care.

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“You’re not just starting from where you were two and a half years ago, there’s a really high mountain to climb,” Casalotti said. “But places that were able to build some of their systems can adapt to allow them to understand real-time public health challenges.”

In Atlanta, the Fulton County Board of Health offers residents free, in-home tests for sexually transmitted diseases. The state has historically had the highest rates of reported STDs in the nation.

“This program has the power to demonstrate the scalable effects of equal access in historically underserved communities,” Joshua O’Neill, 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 attempting a statewide program to crowdsource data on fatal and non-fatal opioid overdoses. Those working on the project are frustrated that national efforts to track Covid outbreaks cannot be extended to the overdose epidemic.

Commissioner of the Chicago Department of Public Health. Alison Arvadi said her team is expanding a Covid data-driven approach to track and report neighborhood-level data on opioid drug overdoses. The nonprofits and city agencies that worked together through the pandemic now meet each month to look at the numbers to shape their response.

Arvadi said the city is trying to use the pandemic-driven growth in money and attention for programs that can last beyond the Covid emergency.

“Every day, we’re having these debates about, ‘How long do we continue? How big do we go?'” Arvadi said. “I think this is the moment. We’ve shown what we can do during COVID, we’ve shown what we can do when we have some more funding.”

The city also opened a new safety center modeled after its COVID-19 response to combat gun violence. For the first time, staff from city departments are working together on safety issues by tracking data, connecting people in high-risk areas to 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 focusing on addressing food security, violence prevention, and diabetes education. Arvadi said she hopes to continue public health efforts in areas with long-standing health disparities by using a patchwork of grants to retain 150 of the 600 people initially hired through pandemic relief dollars.

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“The message I really told my team was, ‘This is our opportunity to do something we’ve wanted to do for a long time,'” Arvadi said. “We built some of that and I just, I’m going to kick and scream before I let it all come crashing down.”

Back in Montana, Desnick said not every change depends on funding.

As 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 begin with COVID case counts and expand to include flood levels, federal cleanup aid, and ice cream socials for people to meet first responders.

Piccolo, the county’s health director, spent about an hour that day in July offering opioid overdose response training and supplies at key hotels in Livingston. Three hotel managers took up the offer, two asked him to come back 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 adaptation for her work that doesn’t require a constant stream of COVID aid. The state supplied Narcan boxes. Otherwise, she said, “it’s just about taking the time to do it.”

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