Community-Based Outbreak Investigation And Response: Enhancing Preparedness, Public Health Capacity, And Equity.

Throughout the COVID-19 pandemic, the US has struggled with many aspects of the public health response, from determining where transmission is occurring to building trust with communities and implementing interventions. Three factors have contributed to these challenges: insufficient local public health capacity, siloed interventions, and underuse of a cluster-based approach to outbreak response. In this article we introduce Community-based Outbreak Investigation and Response (COIR), a local public health strategy developed during the COVID-19 pandemic that addresses these shortcomings. COIR can help local public health entities conduct disease surveillance more effectively, take a more proactive and efficient approach to mitigating transmission, coordinate response efforts, build community trust, and advance equity. We offer a practitioner's lens, informed through on-the-ground experience and engagement with policy makers, to highlight the financing, workforce, data system, and information-sharing policy changes needed to scale up COIR throughout the country. COIR can enable the US public health system to develop effective solutions to many of today's public health challenges and improve the nation's preparedness for public health crises in the years to come.

Integrating The US Public Health And Medical Care Systems To Improve Health Crisis Response.

The operational cleavage between the US public health and medical care systems contributed to the country's difficulty in containing community spread of COVID-19 in the pandemic's first months. We provide an overview of the independent evolution of these two systems, drawing on case examples and publicly available outcome data, to demonstrate how three fundamental elements of epidemic response-case finding, mitigating transmission, and treatment-were undermined by the lack of coordination between public health and medical care and how these gaps contributed to health disparities. We propose policy initiatives to address these gaps and facilitate coordination across the two systems: build a case-finding diagnostic system to quickly identify and mitigate the emergence of health threats in communities, develop data systems that facilitate the transfer of critical health intelligence from medical institutions to public health departments, and establish referral pathways for public health practitioners to connect people with medical services. These policies are practicable because they build on existing efforts and those currently in development.