Going on the Offensive to Stop COVID-19

Posted on Apr 30, 2020

COVID rapid tests in Lima, Peru
Clinicians working with Socios En Salud, as PIH is known in Peru, perform COVID-19 rapid tests in a neighborhood of Lima, Peru.
Photo courtesy of Socios En Salud

Global Situation in the Time of COVID-19

  • The current COVID-19 outbreak is a reminder that health emergencies know no borders and that strengthening health systems in the U.S. and globally is the best defense against future public health crises.
  • In the midst of this crisis, we can’t sit back and wait for social distancing to slow transmission- we must go on the offensive. As we’ve seen in Wuhan, China, and in South Korea over the course of this pandemic, successful public health responses include five key elements: social distancing, testing, contact tracing, isolation, and treatment.
  • It’s not too late. The time has come for us to get into the fight. We can still mobilize, take on the virus, and win. What’s needed is a decisive investment in a public health initiative big enough to meet the challenge. We can shut down the spread of the virus, prevent suffering and death, and allow the economy and society to reopen more quickly and safely
  • Far from being an equalizer, COVID-19 is amplifying preexisting social inequities tied to race, class, geography and access to the health care system in the U.S. and globally. In order to ensure history doesn’t repeat itself as we’ve seen with TB, HIV/AIDS, cholera, among other infectious diseases, we must ensure that during this moment we are critically examining our current systems and developing plans to change how health care is conceptualized and administered in the U.S.
  • Global solidarity and cooperation are necessary to control COVID-19 and future outbreaks. This moment calls for global ceasefires, halts to deportations and detentions—acting with care and compassion to protect human rights—and not detention, bullying and use of force. The only way we will end transmission of this virus and reopen our economy is if people participate fully in control measures and help one another to do so.

Recommendations for Next Stimulus Package -- Necessary Funds to Rebuild our Public Health Infrastructure

Closing non-essential businesses and services and implementing stay-at-home orders and lockdowns has not been easy. Yet these steps are working in flattening the curve and reducing the number of contacts that each person who tests positive has had. It is essential we take advantage of the time these measures have bought us, and fully implement four key elements of a robust public health response: testing, contact tracing, supporting those of us who have been exposed to successfully quarantine, and helping isolate and care for those of us who have the disease.

Moving too quickly to re-open non-essential services without all of these four key elements in place will spark a resurgence of the epidemic, cost more lives, and wreak even more economic damage than the first wave of this outbreak. Moreover, every state needs to implement these strong public health strategies in unison: failures to contain the virus in one state will impact all states. We thus urge the federal government to provide strong incentives for all states to invest in and rapidly scale these public health measures.

1. Testing

The slow ability to increase testing capacity nationally has been our Achilles heel in our ability to contain the spread of COVID-19 in the U.S. We are happy to see provisions of $25 billion for increased testing capacity in the stimulus package approved on Thursday, April 23rd, and hope that additional testing will come online rapidly in the upcoming weeks. All positive test results must be linked to public health surveillance database so that case investigators and contact tracers can do their jobs. Moreover, testing needs to be expanded in an equitable way, such that those communities with the highest numbers of cases and most vulnerable populations are prioritized.

2. Contact Tracing

We recently worked with U.S. Rep. Andy Levin and U.S. Sen. Elizabeth Warren to inform their Containment Corps strategy announced on April 22, focused on addressing the shortage of public health jobs for the long term and rapidly putting community members who lost jobs due to COVID-19 back to work for the public good.

Currently there are only 2,200 contact tracers on CDC payroll in the United States. Roughly 50,000 public health jobs have been lost since the Great Recession, and public health departments simply don’t have the resources to hire the people they need; in 2019, the federal government spent $265 million less on public health preparedness than in 2002.

What we’re left with is a hollowed out public health system that knows how to beat this virus, but doesn’t have the resources to do it. Short-term surge capacity for contact tracing must work to reinforce existing departments of public health in each state and incorporate federally qualified community health centers (CHCs), and link to their existing public health data collection systems, rather than creating a completely parallel, privatized system.

This is what Gov. Charlie Baker and the Commonwealth of Massachusetts’ Contact Tracing Collaborative (CTC) commenced on April 3rd.

Tech-enabled solutions for contact tracing, such as those announced by Apple, Google, and Novid, can be strong complements to the human-to-human components of the MA CTC approach. As stand alone solutions, the technology may have limitations, especially when it comes to helping to provide psychological first aid for people learning of their positive status or that they were in contact with someone who tested positive, and in linking contacts to necessary resources to ensure they can safely quarantine or isolate.

3 & 4. Supported Quarantine and Isolation

Identifying positive cases and their contacts is essential, but it is a first step. People who have been exposed to the virus, but who are not yet sick, need to be in quarantine for a minimum of 14 days. Those who become infected need to receive medical care and remain out of physical contact with others for three days after the resolution of fever, for a minimum of 7 days.

Many people need support—financial, material, medical and social—to successfully complete stints of quarantine and isolation. It is worth emphasizing that if people are unable to adhere to quarantine and isolation, and go on to infect others, the testing and contact tracing program will be  ineffective, and the outbreak will not be brought under control. It is imperative that people be given the supports they need to be successful in this regard.

Studies from past quarantines demonstrate consistently that quarantine and isolation failures are driven primarily by food and job insecurity. We anticipate people will require a range of supports including food and cash assistance, home delivery services, medical support, and social services like dependent care, mental health and substance abuse counseling. Careful attention to the needs of marginalized communities will be necessary. Social support specialists from communities with highest need and highest case burden should be hired to add to existing social worker numbers and work to identify community resources and connect each case and contacts to these resources.

Already the MA CTC is finding that people are afraid to receive calls from contact tracers due to their immigration status. Given the inequities that exist in our society, many immigrant communities remain key hot spots for coronavirus spread. All people currently in the U.S., regardless of their immigration status, must be treated equally and provided the same access to testing, isolation and treatment if we are to succeed in stopping the spread.

A further consideration is that many people’s homes are not conducive to quarantine or isolation. They are too crowded to avoid spreading the infection to others in the household, or they are not safe. Establishing safe non-residential quarantine and isolation facilities in local hotels and universities can further reduce transmission and should be considered.

We are in the process of modeling the costs of home and non-homed based quarantine and isolation, as well as the costs of not providing these supports. We expect federal investment in these measures will be well worth the price, given the alternative of the high cost in lives and livelihoods that will result from an unchecked epidemic, especially among our most vulnerable communities where we’re already seeing the correlation between poverty and COVID-19 transmission.

Financing the Public Health Response

The federal government can provide financing for the public health response in a number of ways. For example, channeling public health financing to states through expansion of TANF, SNAP, SSI, or Medicaid or other federally subsidized programs, or creating a new one, should be considered.

War Bonds are one potential mechanism we also think has potential. War Bonds are a funding concept that have enjoyed wide popularity since they were first issued in 1917, particularly in times when citizens are motivated to show their patriotism and willingness to pull together as one nation. Using the War Bond model, “COVID Victory Bonds” would be long dated (30 years) debt instruments issued in small denominations for the retail public and backed by the credit of the U.S. Government. The bonds would be issued at below face value, with little or no annual interest, but would be guaranteed to double in value on or before maturity.

Our proposal would be for the federal government to disburse this funding to states to distribute solely for the purposes of stopping the COVID epidemic. This would entail funding state-operated testing and contact tracing programs and providing funds for individuals asked to quarantine or isolate themselves, including sufficient subsidies for food and housing, means-tested income replacement, and a range of support services.

If you believe this is a solid plan for battling COVID-19 and funding a national response, please reach out to members of Congress and share this proposal.

Look Up Your Elected Official

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