Apr 19, 2020 9:00 PM

Reopening could require thousands more public health workers

Posted Apr 19, 2020 9:00 PM

SEATTLE (AP) — Before stay-at-home orders are lifted, the nation's public health agencies want to be ready to douse any new sparks of coronavirus infection — a task they say could require tens of thousands more investigators to call people who test positive, track down their contacts and get them into quarantine.

Without the extra help, officials insist, states cannot possibly be ready to resume normal everyday activities, and some agencies are so desperate they are considering recruiting librarians and Peace Corps volunteers to join the effort.

“We are trying to build these teams and processes in the midst of a crisis,” said Sharon Bogan, a public health spokeswoman for Seattle and King County, which are seeking at least 20 more investigators.

As federal officials weigh how and when to reopen the country, experts worry that the United States does not have enough public health workers to suppress another outbreak, especially those qualified to do contact tracing, the critically important search for people who may have been exposed to the virus.

While the exact number of workers needed is a subject of debate, a top federal health official this week acknowledged the mandate to find many more.

“Everybody agrees that our public health capacity at the local and state level is not ready to take this on at a very large scale without reinforcements,” said Dr. Anne Schuchat of the Centers for Disease Control and Prevention, who oversees the agency’s coronavirus response work.

The work could require as many as 300,000 public health workers — a daunting number given that the combined federal, state, and local public health workforce has been shrinking and is now probably less than 280,000, according to some estimates.

To address the shortage of help, governments are weighing whether to enlist people with little to no experience in public health, including the Peace Corps volunteers, furloughed social workers and public health students. San Francisco is training librarians, medical students and people who work for the city attorney’s office.

The extra workers would help conduct testing, isolate sick cases and trace everyone those sick people had contact with.

It’s crucial that such a system be in place before government officials ease social-distancing guidelines, reopen schools or lift stay-at-home orders, said Dr. Tom Frieden, a former CDC director.

“If we have explosive spread when we reopen, we’ll have to close again. That will be very damaging, not just economically but from a health standpoint,” Frieden said.

The U.S. government has funneled about $800 million to states for coronavirus response work that can include contact tracing. On top of hundreds of staff sent to states to help with coronavirus work, the CDC has already assembled “community protection teams” of six to 12 people each to do contact tracing and investigate tools that could help with it. Some have already been deployed to states where spread of the virus has been relatively low.

Tiny Rhode Island has nearly 100 people "focused on nothing but contact tracing,” reaching out to hundreds of contacts of infected people each day, Gov. Gina Raimondo told reporters. She has urged all residents to take a minute each evening to write down who they physically encountered that day and where those encounters took place.

“If I’m going out to the store, I’ll put the date, what store I went to, and then the time I was there,” said Drew Grande, 40, of Cranston, Rhode Island. He started a contacts diary on a note-taking app on his phone after he heard the governor's request.

Contact tracing has changed over the last few months in the U.S. When the first handful of infections were being identified, teams of 20 or more might be assigned to each confirmed case. Investigations would often start with a staffer or two doing an in-person interview at a hospital bedside. Disease trackers might spend hours asking a sick person and that person's relatives who they had been in contact with since symptoms surfaced.

In-person interviews are often better, said Isaac Ghinai, a CDC disease tracker assigned to Chicago to work with that city's health department.

“There's a value to looking someone in the eye. You can build a relationship face to face that you can't always do by phone," he said. Some people are comfortable sharing personal details over the phone but others “require more cajoling.”

With hundreds of new cases emerging each day in Chicago, that kind of attention to individual infections has largely stopped. Instead, the priority is large groups of people who are particularly vulnerable, like those at nursing homes or homeless shelters. Many new confirmed cases are not being investigated, and when they are, the interviews may be done by only two or three people, and over the phone, Ghinai said.

Could there be a digital solution? Apple and Google are teaming up on a contact-tracing app, and other efforts use Bluetooth to gather data from phones that came close to an infected person. Seattle scientist Trevor Bedford has developed a digital interview that public health departments can use if they don’t have enough people trained in contact tracing.

Whatever the solution, it will take a while.

People have to be tested and diagnosed before contact tracing kicks into gear, and testing remains limited in many parts of the country. This week, the Association of American Medical Colleges sent a letter to the White House Coronavirus Task Force saying that testing materials and machines remain in short supply.

President Donald Trump has floated the idea of easing at least some restrictions as early as May 1.

Some observers believe restrictions could be eased first in places where the spread is low, if rigorous testing and contact tracing could prevent a sudden explosion in infections.

But Schuchat warned that "there is no way the entire country could relax mitigation on May 1 and the country not experience a major resurgence.”

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Apr 19, 2020 9:00 PM
American schools may look radically different as they reopen

SAN FRANCISCO (AP) — School administrators across America are trying to re-imagine classrooms — and the prospect of reopening schools — in the era of social distancing.

Will there be staggered start times? Will students be asked to wear face coverings? Will class sizes be cut in half? What about school assemblies and sports and school buses and lunchtime?

With the majority of schools nationwide shut down, educators are scrambling to plan for the future after a chaotic few weeks that, for many districts, included closing all schools, deciding whether to waive assessment tests and whether and how to do distance learning. Next comes the important question of when schools can safely re-open.

California Gov. Gavin Newsom laid out a few possible scenarios this week for reopening the state’s public schools to 6 million students, saying the timeline was still unclear but when students do eventually return things will look radically different.

“We need to get our kids back to school,” Newsom said. “And we need to do it in a safe way.”

The biggest challenge for schools is how to continue physical distancing among children and adults to ensure that “kids aren’t going to school, getting infected and then infecting grandma and grandpa,” Newsom said.

That could mean requiring schools to stagger schedules, with some students arriving in the morning and the rest in the afternoon. Officials will be rethinking gym class, recess, school assemblies and all scenarios where students gather in large groups, he said. State officials, educators and unions will discuss those ideas and other possibilities for safe schooling in the coming weeks and months.

Robert Hull, president and chief executive of the National Association of State Boards of Education, said administrators across the country are asking not how, but if, schools will reopen in the fall, and planning for any number of scenarios.

Everything is being considered, he said, from masks and gloves to cutting class sizes and adding portable classrooms. Officials also are weighing the virus’s impact on how school buildings and buses are cleaned, how to protect custodial staff, how food is prepared and how health care is delivered.

“Everybody says we hope we return to normal,” Hull said. “It’s not going to return to normal anytime soon because the new normal is going to be different.”

For the moment, many districts are focused on trying to get through the school year while keeping an eye on what might happen in the fall.

“You’re making battle plans,” Hull said. Schools need to plan for a variety of possibilities: What if the virus is contained? What if the curve is flattened but there are still infections in the community? What if a new wave is starting? Schools need “not just Plan A and Plan B, but it maybe Plan C and Plan D.”

Newsom said he won’t loosen California’s mandatory, stay-at-home order until hospitalizations, particularly those in intensive care units, “flatten and start to decline.” And he said the state needs more testing, treatment and the ability for businesses, schools and childcare facilities to continue the physical distancing that has come to dominate public life. He said he would revisit the question of easing restrictions in two weeks.

Similar conversations are taking place at state school boards across the country. The issue is on Idaho’s agenda Thursday, and several other states, including Arkansas and Mississippi, are starting to have the discussion, Hull said.

Issues of equity loom, including how to measure what students are learning and how to help those who have fallen behind. Many of the association’s members are discussing what to do this summer and contemplating whether to extend the school year to offer summer learning, Hull said.

When students do return to school in California’s rural Mariposa County, they will likely have to follow the same check-in procedure that local government employees do now, county Health Officer Eric Sergienko said. Before coming in each day, government employees answer a series of screening questions in a smart phone app with a checklist of symptoms. If they answer “yes” to any questions they have to stay home, and then get a follow-up call from a health officer.

“We would do the same thing for school,” Sergienko said. “If any (students) had symptoms, then we would exclude them from school.”

Education funding cutbacks have already led to teacher shortages in California and made campus nurses rare, raising questions about how officials might cope with extended days and ensure kids are healthy, said Tony Wold, associate superintendent of the West Contra Costa Unified School District, which includes 55 schools.

“We can’t just build new schools overnight. Even if the state gives us more money, where will the teachers come from?” said Wold, listing the ways schools are not built for social distancing. In his district near San Francisco, schools already stagger lunchtimes and put 8 to 10 kids at each table. Gym classes can have upwards of 50 students, and there are no empty, unused classrooms.

He said some schools will likely extend virtual learning into the fall or possibly figure out a rotation mixing online learning and classroom education.

“We’re trying to reinvent how to do our business in a way we never did it before,” Wold said. “This is probably the most Herculean challenge I have ever seen in public education.”

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