Livingston, Mont. — Shanan Piccolo walked into a hotel with a tote bag full of Narcan and gave 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’d rather have some Narcan on hand,” Park City-County Health Department Director Piccolo told the hotel manager.
The manager listens to Piccolo’s instructions on how to use Narcan, the brand name for the drug naloxone, and adds four boxes of nasal spray to the hotel’s first-aid kit.
The transaction takes less than 10 minutes. About 8,000 people visited the Piccolo III hotel on that hot July day in the mountain town of Livingston, where, in much of the country, health officials are concerned about a recent surge in the use of the synthetic opioid fentanyl.
This is the first time local health departments have offered door-to-door training and supplies to prevent overdose deaths. The underlying strategy was forged during the pandemic when public health officials quickly distributed tests and vaccines in high-risk settings.
“We learned that from Covid,” said Dr. Laurel Desnick, the county’s public health officer. “We go to people who don’t have time to come to us.”
The pandemic has exposed gaps and inequities in the US public health system and often pitted local officials against trying to contain the spread of the coronavirus. But one positive outcome, spurred in part by increased federal dollars, is that health 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 planned to send home kits to test for the disease, a program modeled on the distribution of rapid Covid tests. In Houston, health officials announced this month that they will begin monitoring the city’s wastewater for monkeypox, a technique widely used to measure how far and fast Covid has spread. And in Chicago, government agencies tweaked covid cooperation to tag-team the rise in gun violence.
Some of these adaptations should cost little and be relatively easy to incorporate into the departments’ post-pandemic work, such as using vans bought with Covid relief money for vaccine delivery and disease testing. Other tools, including updating surveillance systems to use Covid-related data and other means, cost more money and time.
Some public health workers worry that the lessons woven into their actions will be lost once the pandemic passes.
“When we have a public health crisis in this country, we have a boom-and-bust cycle of funding,” said Adrienne Casalotti, with the National Association of County and City Health Officials.
Some federal pandemic relief funds will last for years, but other allocations have already dried up. Local health workers will be left to prioritize what to finance with what’s left.
Meanwhile, historically understaffed and underfunded health departments are responding to challenges that have intensified during the pandemic, including delayed mental health treatment and routine care.
“It’s not where you started two and a half years ago, there’s actually a higher mountain to climb,” Casalotti said. “But places that were able to build some of their systems could adapt them to allow for a more real-time understanding of public health challenges.”
In Atlanta, the Fulton County Board of Health offers free, at-home tests for venereal diseases to be mailed to residents. The state has historically had some of the highest rates of reported STDs in the country.
“This program has the potential to demonstrate the scalable effects of equitable access in historically underserved communities,” Joshua O’Neill, the county’s director of sexual health programs, said in a press release announcing the kits.
Changes go beyond government. University of Texas researchers are piloting a statewide program to crowdsource data on fatal and unexpected opioid overdoses. Those working on the project were disappointed that national efforts to track the Covid outbreak did not extend to the overdose epidemic.
Dr. Alison Arwadi, commissioner of the Chicago Department of Public Health, said her team is expanding the Covid data-driven approach to track and report neighborhood-level data on opioid overdoses. Nonprofits and city agencies that have worked together through the pandemic now meet each month to look at the numbers to shape their response.
Arwadi said the city is trying to use the pandemic-driven boost in money and attention for programs that may have existed outside of the Covid emergency.
“Every day, we have this debate, ‘How long do we continue? How big are we going to go?’” Arwadi said. “I feel like this is such a moment. We have shown what we can do during Covid, we have shown what we can do if we have some extra funds.”
The city also opened a new safety center modeled after its Covid-19 response base to address gun violence. Employees from different city departments are working together on safety for the first time by tracking data, connecting people in the highest-risk areas to services, and supporting local efforts like funding neighborhood block clubs and restoring safe spaces.
Separately, neighborhood-based organizations dedicated to conducting Covid contact tracing and education are focusing on food security, violence prevention and diabetes education. Arwadi said he hopes to continue grassroots public health efforts in areas with chronic health disparities, using a patchwork of grants to retain 150 of the 600 people initially hired through pandemic relief dollars.
“The message I’m really telling my team is, ‘This is our opportunity to do something we’ve wanted to do for a long time,'” Arwadi said. “We made some of it and I’m just, I’m going to kick and scream before I break it all down.”
Back in Montana, Desnick said not every change depends on funding.
When flooding destroyed buildings and infrastructure in and around Yellowstone National Park in June, the Park County Health Department used a list of contacts collected during the outbreak to send updates to schools, churches and businesses.
Desnick regularly posts public health video updates that begin with Covid case counts and expand to include information about flood levels, federal cleanup assistance, and ice cream socials where people can meet first responders.
Piccolo, the county’s health director, spent about an hour that day in July providing opioid overdose response training and supplies to hotels in Livingston’s core. Three hotel managers took up the offer, two told him to come back later, and one scheduled an all-staff training later that week. Piccolo plans to expand the program to restaurants and music venues.
It’s the kind of adaptation to his job that doesn’t require a constant stream of Covid aid. The state provided Narcan boxes. Otherwise, he said, “it’s just about taking the time to do it.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.
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