Now is the time for a national public health reserve
Even before the COVID-19 pandemic, health departments had limited staff, resources and time to support the diverse public health needs of our communities. This system will be further strained as the epidemic grows. We must immediately create a national public health reserve to shore up public health systems.
Reserve networks fill critical human resource gaps during emergencies. In the U.S., 67 percent of all firefighters are volunteers who backstop local firefighters in an emergency. In the health domain, the U.S. Centers for Disease Control and Prevention’s Epidemic Intelligence Service program has about 160 active “disease detectives” who are deployed to aid in outbreak investigations. Support for natural disasters and other public health emergencies is provided through the Medical Reserve Corps (MRC), a national network of approximately 180,000 volunteer health care professionals and first responders.
While some MRC units are responding to COVID-19 public health needs, they are not designed to support outbreak control activities on a national scale. Student public health organizations, such as the University of Washington School of Public Health’s Student Epidemic Action Leaders (SEAL) program, also support small-scale state and local outbreak investigations, including COVID-19. We must learn from these emergency response networks to mount a national response to save lives.
A national public health reserve would require a large, flexible, and sustainable pool of volunteers who can contribute to changing outbreak response. Public health schools and programs are uniquely positioned in this regard.
Collectively, they represent a large workforce. In 2016 alone, more than 12,000 public health graduate degrees were conferred from accredited U.S. schools. Many graduates have training in epidemic control strategies or related skills, skills that will desperately be needed as the number of cases escalates. Research faculty and professionals also represent a wealth of untapped potential. Many of these individuals have training in front-line epidemic control efforts (e.g., infectious disease epidemiologists) yet are not currently in positions engaged in COVID-19 response.
A reserve could provide public health support to frontline responders remotely without geographical boundaries. Shelter-in-place orders already have many skilled professionals working remotely. In addition, many researchers have time to commit to this cause. The National Institute of Health (NIH) has already granted flexibility for researchers impacted by COVID-19 as some research may no longer be possible during the pandemic. Indeed, scientists are hungry to plug-in as evidenced by the numerous websites and health care workers who have volunteered to slow the pandemic.
Over 7,000 US-based scientists registered in a national database to support laboratory testing and 40,000 medical professionals responded to a call for volunteers in New York. During this public health crisis, calls for action to support public health response activities (vs. medical response) are surprisingly absent. Current volunteer networks will not be equipped to meet the size and scale required to conduct enhanced surveillance and contact tracing as the epidemic surges, essential activities to identify and monitor people who may have come into contact with SARS-CoV-2. For example, in China, 18,000 people were mobilized to trace contacts in Wuhan alone.
Structural and operational aspects of coordination must not stand in our way of banding together as we battle the flames of COVID-19. We propose immediate state and federal funding to the Association of Schools and Programs of Public Health to develop and implement a governance structure, recruitment strategy, data sharing and privacy plan, and matchmaking process in conjunction with state and local health departments. Faculty and new public health graduates are an immediate source of volunteers.
Faculty sabbaticals, release from teaching duties, extensions to the tenure clock, and petitions to funders to divert existing research dollars to support COVID-19 response should be considered. As in Wuhan, a large group of reserve recruits and strong leadership will be necessary to trace contacts of every case as the response shifts to case-based activities.
The larger the workforce, the faster surveillance systems can conduct real-time epidemic monitoring, which will guide the development of relaxing social-distancing policies. Investments of time and resources to form a reserve will pay dividends as we consider how to safely resume a normal life.
With little time before more communities are overwhelmed, we need urgent and immediate action. Forming a coalition of public health experts who temporarily step away from “business as usual” is worth this investment during the most critical public health emergency of our time, and could be activated in the future.
Temporarily prioritizing this acute, critical need is essential to lift social-distancing orders and minimize economic impacts — allowing us to return to meeting the diverse public health needs of our communities. Let us not be constrained by public health as usual; this new epidemic calls for a pioneering, collective response to combat the fire.
Alison Drake, Ph.D. MPH is an assistant professor in the Department of Global Health at the University of Washington School of Public Health. She is an infectious disease epidemiologist whose research is focused on preventing mother-to-child HIV transmission and meeting women’s reproductive health needs.
Sandra McCoy, Ph.D. MPH is an associate professor in the Division of Epidemiology & Biostatistics at the University of California, Berkeley School of Public Health. Trained as an infectious disease epidemiologist, her research focuses on identifying innovative strategies to create demand for sexual and reproductive health services.