Issue Category: Infectious Disease

TFAH Statement on COVID-19 Preparations

March 3, 2020

Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize the following:


Emergency funding is critical now, with ongoing funding to prevent future emergencies

Congress should quickly approve a supplemental funding package, with significant investments in domestic and global public health, healthcare preparedness and research and development of medical countermeasures. Federal agencies should be preparing to quickly distribute funds to states and local governments, as any delay could cost lives.

Congress and the administration should not rely on transfers between health programs to solve this problem.  TFAH recommends that Congress use the supplemental funding package currently being considered to back-fill programs that have already been cut to transfer funding for the COVID-19 outbreak response. Reprogramming money from other public health initiatives, such as chronic disease prevention, won’t serve the public’s health in the long run.

The emergency supplemental funding should include the following priorities:

  • Domestic public health. States and local jurisdictions have stood up their emergency operations, identifying and investigating cases, isolating and quarantining individuals, screening travelers at airports, ensuring the laboratory capacity to test patients for the virus, coordinating with the health sector to guarantee needed services are available, assessing the needs of those who are most vulnerable because of social, economic or environmental conditions and communicating with the public and healthcare facilities. Attention needs to be paid to those people who seem to be most at risk for serious health complications due to COVID-19 including the elderly and people with underlying health conditions. The breadth of the response is quickly exhausting the funding provided in annual appropriations bills.
  • Healthcare response. Hospitals, health centers and other clinical facilities across the nation are preparing to identify, isolate and care for patients with COVID-19.    They must do so without interrupting the routine and necessary clinical services for those with other healthcare needs.  This will require training for healthcare workers on the identification of COVID-19 cases, and on appropriate infection control practices and treatment.  The health care sector needs resources for some of these activities and to ensure it has appropriate personal protective equipment, necessary clinical supplies and equipment, and surge capacity.
  • Medical countermeasures research and development. The U.S. government should prioritize development and procurement of COVID-19 diagnostics, vaccines, and treatments. This will require special measures to anticipate and plan to meet future need and to determine how to make appropriate services available to all with special attention to those in underserved communities.
  • Global health security. The U.S. must support global efforts through the World Health Organization, USAID and other agencies to boost the capacity of lower-income countries to detect and control infectious disease outbreaks.  This will protect Americans as well as other countries by decreasing the likelihood of transmission as a result of travel and commerce.
  • Invest in standing reserve funds. The supplemental should fully replace funds spent from the Infectious Disease Rapid Response Reserve Fund and add a significant amount of money in this fund, so new funding can be immediately accessed if needed to fight COVID-19 and as an investment in protecting Americans from future outbreaks.

The full cost of the outbreak will become clear in the next few months, but in the short term, a significant investment is needed now. Ongoing monitoring of the course of the outbreak will determine the total amount of additional funding that may be required.


Ensure that core public health is continually funded 

In addition to short-term supplemental funding, Congress must prioritize ongoing investment in public health as part of the annual appropriations process.  The nation’s ability to respond to COVID-19 is rooted in our level of public health investment of the last decade.  That is, being prepared starts well before the health emergency is upon us and is grounded in year-in and year-out investment in public health programs. In addition, our public health system needs a highly skilled workforce, state-of-the-art data and information systems and the policies, and plans and resources necessary to meet the routine and unexpected threats to the health and well-being of the American public.  The nation has been caught in a cycle of attention when an outbreak or emergency occurs, followed by complacency and disinvestment in public health preparedness, infrastructure and workforce between emergencies.  These are systems that cannot be established overnight, once an outbreak is underway.

Science is key to effective response

Science needs to govern the nation’s COVID-19 response, led by federal public health experts – including the CDC and NIH leadership – who have years of experience in responding to infectious disease outbreaks.  Keeping the public fully informed is critically important, if trust is to be retained. Policy decisions – from the federal to the local level – should also be based on the best available science.

Local governments and other sectors must prepare now for various contingencies.

  • Healthcare facilities must plan for a surge of patients. Such planning should include taking steps to ensure continuity of operations if a sizable number of their workforce is sick.  They must prioritize the safety of patients and workers, by using personal protective equipment and by providing adequate training. Healthcare coalitions – in coordination with governmental entities – should offer situational awareness and coordination between facilities.
  • Employers, including those in the healthcare sector, should adopt paid sick days protections for workers to protect the health and safety of other workers and the general public. In addition, they should assure their employees that missing work due to illness will not jeopardize their job.
  • Communities that are considering school or business closures or similar measures should consider unintended consequences and take appropriate action steps. If closings are necessary authorities should assist families for whom such action is especially problematic, such as low- income families and individuals without paid sick leave, and children who rely on school meals for adequate nutrition.  Homebound individuals who need access to health care personnel, equipment and medications may also need additional assistance.

The full extent of the outbreak in terms of public health, healthcare and personal costs remains to be seen.  We do know that taking immediate steps to mitigate the effects of the outbreak will save lives and prevent harm.

Nuevo Informe Coloca A 25 Estados Y Distrito De Columbia En Un Nivel De Alto Rendimiento (10) en Medidas De Salud Pública Para Preparación De Emergencias

A medida que aumentan las amenazas, la evaluación anual determina que el nivel de preparación de los estados para emergencias sanitarias está mejorando en algunas áreas, pero está estancado en otras

(Washington, DC) – Veinticinco Estados y el Distrito de Columbia tuvieron un alto desempeño en una medida de tres niveles de preparación de los Estados para proteger la salud public durante una emergencia, según un nuevo informe publicado hoy por Trust for America’s Health (TFAH, por su sigla en inglés).  El informe anual, Ready or Not 2020: Proteging the Public’s Health from Diseases, Disasters and Bioterrorism, encontró una mejora año tras año entre las 10 medidas de preparación para emergencias, pero también señala áreas que necesitan mejoras. El año pasado, 17 Estados se clasificaron en el nivel superior del informe.

Para 2020, 12 Estados se ubicaron en el nivel de rendimiento medio, por debajo de 20 Estados y el Distrito de Columbia en el nivel medio el año pasado, y 13 se ubicaron en el nivel de rendimiento bajo, el mismo número que el año pasado.

El informe encontró que el nivel de preparación de los estados ha mejorado en áreas claves, que incluyen fondos de salud pública, participación en coaliciones y pactos de atención médica, seguridad hospitalaria y vacunación contra la gripe. Sin embargo, otras medidas clave de seguridad de la salud, que incluyen garantizar un suministro de agua seguro y acceso a tiempo libre remunerado, está estancado o perdido.

Nivel de Rendimiento Estados Numero de Estados
Alto AL, CO, CT, DC, DE, IA, ID, IL, KS, MA, MD, ME, MO, MS, NC, NE, NJ,
NM, OK, PA, TN, UT, VA, VT, WA, W		 25 Estados y DC
Medio AZ, CA, FL, GA, KY, LA, MI, MN, ND, OR, RI, TX 12 Estados

Bajo		 AK, AR, HI, IN, MT, NH, NV, NY, OH, SC, SD, WV, WY 13 Estados

 

El informe mide el desempeño anualmente de los Estados utilizando 10 indicadores que, en conjunto, proporcionan una lista de verificación del nivel de preparación de una jurisdicción para prevenir y responder a las amenazas a la salud de sus residentes durante una emergencia. Los indicadores son:

Indicadores de Preparación
1 Gestión de incidentes: adopción del Pacto de licencia de enfermería 6 Seguridad del agua: Porcentaje de la población que utilizó un sistema de agua comunitario que no cumplió con todos los estándares de salud aplicables.
2 Colaboración comunitaria intersectorial: porcentaje de hospitales que participan en coaliciones de atención médica. 7 Resistencia laboral y control de infecciones: porcentaje de población ocupada con tiempo libre remunerado.
3 Calidad institucional: acreditación de la Junta de Acreditación de Salud Pública 8 Utilización de contramedidas: porcentaje de personas de 6 meses o más que recibieron una vacuna contra la gripe estacional.
4 Calidad institucional: acreditación del Programa de acreditación de gestión de emergencias. 9 Seguridad del paciente: porcentaje de hospitales con una clasificación de alta calidad (grado “A”) en el grado de seguridad del hospital Leapfrog.
5 Calidad institucional: tamaño del presupuesto estatal de salud pública, en comparación con el año pasado. 10 Vigilancia de la seguridad de la salud: el laboratorio de salud pública tiene un plan para un aumento de la capacidad de prueba de seis a ocho semanas.

Cuatro Estados (Delaware, Pensilvania, Tennessee y Utah) pasaron del nivel de bajo rendimiento en el informe del año pasado al nivel alto en el informe de este año. Seis Estados (Illinois, Iowa, Maine, Nuevo México, Oklahoma, Vermont) y el Distrito de Columbia pasaron del nivel medio al nivel alto. Ningún Estado cayó del nivel alto al bajo, pero seis pasaron del nivel medio al bajo: Hawaii, Montana, Nevada, New Hampshire, Carolina del Sur y Virginia Occidental.

“El creciente número de amenazas para la salud de los estadounidenses en 2019, desde inundaciones hasta incendios forestales y vapeo, demuestra la importancia crítica de un sistema de salud pública sólido. Estar preparado es a menudo la diferencia entre daños o no daños durante emergencias de salud y requiere cuatro cosas: planificación, financiamiento dedicado, cooperación interinstitucional y jurisdiccional, y una fuerza laboral calificada de salud pública “, dijo John Auerbach, presidente y CEO de Trust for America’s Health.

“Si bien el informe de este año muestra que, como nación, estamos más preparados para enfrentar emergencias de salud pública, todavía no estamos tan preparados como deberíamos estar”. Se necesita más planificación e inversión para salvar vidas”, dijo Auerbach.

El análisis de TFAH encontró que:

  • La mayoría de los Estados tienen planes para expandir la capacidad de atención médica en una emergencia a través de programas como el Pacto de Licencias de Enfermería u otras coaliciones de atención médica. Treinta y dos Estados participaron en el Pacto de Licencias de Enfermeras, que permite a las enfermeras licenciadas practicar en múltiples jurisdicciones durante una emergencia. Además, el 89 por ciento de los hospitales a nivel nacional participaron en una coalición de atención médica, y 17 estados y el Distrito de Columbia tienen participación universal, lo que significa que todos los hospitales del estado (+ DC) participaron en una coalición. Además, 48 ​​Estados y DC tenían un plan para aumentar la capacidad del laboratorio de salud pública durante una emergencia.
  • La mayoría de los Estados están acreditados en las áreas de salud pública, manejo de emergencias o ambos. Dicha acreditación ayuda a garantizar que los sistemas necesarios de prevención y respuesta ante emergencias estén implementados y que cuenten con personal calificado.
  • La mayoría de las personas que tienen agua de su hogar a través de un sistema de agua comunitario tenían acceso a agua segura. Según los datos de 2018, en promedio, solo el 7 por ciento de los residentes estatales obtuvieron el agua de su hogar de un sistema de agua comunitario que no cumplía con los estándares de salud aplicables, un poco más del 6 por ciento en 2017.
  • Las tasas de vacunación contra la gripe estacional mejoraron, pero aún son demasiado bajas. La tasa de vacunación contra la gripe estacional entre los estadounidenses de 6 meses en adelante aumentó del 42 por ciento durante la temporada de gripe 2017-2018 al 49 por ciento durante la temporada 2018-2019, pero las tasas de vacunación todavía están muy por debajo del objetivo del 70 por ciento establecido por Healthy People 2020.
  • En 2019, solo el 55 por ciento de las personas empleadas tenían acceso a tiempo libre remunerado, el mismo porcentaje que en 2018. Se ha demostrado que la ausencia de tiempo libre remunerado exacerba algunos brotes de enfermedades infecciosas. También puede evitar que las personas reciban atención preventiva.
  • Solo el 30 por ciento de los hospitales, en promedio, obtuvieron las mejores calificaciones de seguridad del paciente, un poco más que el 28 por ciento en 2018. Los puntajes de seguridad hospitalaria miden el desempeño en temas tales como las tasas de infección asociadas a la atención médica, la capacidad de cuidados intensivos y una cultura general de prevención de errores. Dichas medidas son críticas para la seguridad del paciente durante los brotes de enfermedades infecciosas y también son una medida de la capacidad del hospital para funcionar bien durante una emergencia.

Otras secciones del informe describen cómo el sistema de salud pública fue fundamental para la respuesta a la crisis de vapeo, cómo las inequidades en salud ponen a algunas comunidades en mayor riesgo durante una emergencia y las necesidades de las personas con discapacidad durante una emergencia.

Se puede acceder al informe completo en Ready or Not 2020 report.

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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional. www.tfah.org. Twitter: @ healthyamerica1

New Report Places 25 States and DC in High Performance Tier on 10 Public Health Emergency Preparedness Measures

As Threats Increase, Annual Assessment Finds States’ Level of Readiness for Health Emergencies is Improving in Some Areas but Stalled in Others

February 5, 2020

(Washington, DC) – Twenty-five states and the District of Columbia were high-performers on a three-tier measure of states’ preparedness to protect the public’s health during an  emergency, according to a new report released today by Trust for America’s Health (TFAH). The annual report, Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, found year-over-year improvement among 10 emergency readiness measures, but also notes areas in need of improvement. Last year, 17 states ranked in the report’s top tier.

For 2020, 12 states placed in the middle performance tier, down from 20 states and the District of Columbia in the middle tier last year, and 13 placed in the low performance tier, the same number as last year.

The report found that states’ level of preparedness has improved in key areas, including public health funding, participation in healthcare coalitions and compacts, hospital safety, and seasonal flu vaccination. However, other key health security measures, including ensuring a safe water supply and access to paid time off, stalled or lost ground.

Performance Tier States Number of States
High Tier AL, CO, CT, DC, DE, IA, ID, IL, KS, MA, MD, ME, MO,
MS, NC, NE, NJ, NM, OK, PA, TN, UT, VA, VT, WA, WI		 25 states and DC
Middle Tier AZ, CA, FL, GA, KY, LA, MI, MN, ND, OR, RI, TX 12 states
Low Tier AK, AR, HI, IN, MT, NH, NV, NY, OH, SC, SD, WV, WY 13 states

 

The report measures states’ performance on an annual basis using 10 indicators that, taken together, provide a checklist of a jurisdiction’s level of preparedness to prevent and respond to threats to its residents’ health during an emergency. The indicators are:

Preparedness Indicators 
1 Incident Management: Adoption of the Nurse Licensure Compact. 6 Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards.
2 Cross-Sector Community collaboration: Percentage of hospitals participating in healthcare coalitions. 7 Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
3 Institutional Quality: Accreditation by the Public Health Accreditation Board. 8 Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
4 Institutional Quality: Accreditation by the Emergency Management Accreditation Program. 9 Patient Safety: Percentage of hospitals with a top-quality ranking (“A” grade) on the Leapfrog Hospital Safety Grade.
5 Institutional Quality: Size of the state public health budget, compared with the past year. 10 Health Security Surveillance: The public health laboratory has a plan for a six-to eight-week surge in testing capacity.

Four states (Delaware, Pennsylvania, Tennessee, and Utah) moved from the low performance tier in last year’s report to the high tier in this year’s report. Six states (Illinois, Iowa, Maine, New Mexico, Oklahoma, Vermont) and the District of Columbia moved up from the middle tier to the high tier. No state fell from the high to the low tier but six moved from the middle to the low tier. Hawaii, Montana, Nevada, New Hampshire, South Carolina, and West Virginia.

“The increasing number of threats to Americans’ health in 2019, from floods to wildfires to vaping, demonstrate the critical importance of a robust public health system. Being prepared is often the difference between harm or no harm during health emergencies and requires four things: planning, dedicated funding, interagency and jurisdictional cooperation, and a skilled public health workforce,” said John Auerbach, President and CEO of Trust for America’s Health.

“While this year’s report shows that, as a nation, we are more prepared to deal with public health emergencies, we’re still not as prepared as we should be. More planning and investment are necessary to saves lives,” Auerbach said.

TFAH’s analysis found that:

  • A majority of states have plans in place to expand healthcare capacity in an emergency through programs such as the Nurse Licensure Compact or other healthcare coalitions. Thirty-two states participated in the Nurse Licensure Compact, which allows licensed nurses to practice in multiple jurisdictions during an emergency. Furthermore, 89 percent of hospitals nationally participated in a healthcare coalition, and 17 states and the District of Columbia have universal participation meaning every hospital in the state (+DC)  participated in a coalition. In addition, 48 states and DC had a plan to surge public health laboratory capacity during an emergency.
  • Most states are accredited in the areas of public health, emergency management, or both. Such accreditation helps ensure that necessary emergency prevention and response systems are in place and staffed by qualified personnel.
  • Most people who got their household water through a community water system had access to safe water. Based on 2018 data, on average, just 7 percent of state residents got their household water from a community water system that did not meet applicable health standards, up slightly from 6 percent in 2017.
  • Seasonal flu vaccination rates improved but are still too low. The seasonal flu vaccination rate among Americans ages 6 months and older rose from 42 percent during the 2017-2018 flu season to 49 percent during the 2018-2019 season, but vaccination rates are still well below the 70 percent target established by Healthy People 2020.
  • In 2019, only 55 percent of employed people had access to paid time off, the same percentage as in 2018. The absence of paid time off has been shown to exacerbate some infectious disease outbreaks . It can also prevent people from getting preventive care.
  • Only 30 percent of hospitals, on average, earned top patient safety grades, up slightly from 28 percent in 2018. Hospital safety scores measure performance on such issues as healthcare associated infection rates, intensive-care capacity and an overall culture of error prevention. Such measures are critical to patient safety during infectious disease outbreaks and are also a measure of a hospital’s ability to perform well during an emergency.

The report includes recommended policy actions that the federal government, states and the healthcare sector  should take to improve the nation’s ability to protect the public’s health during emergencies.

Other sections of the report describe how the public health system was critical to the vaping crisis response, how health inequities put some communities at greater risk during an emergency, and the needs of people with disabilities during an emergency.

Read the full text report

New Maps Track Laws Related to Tobacco Pricing Strategies and Syringe Service Programs in US

(Philadelphia, Pa – Novermber 19, 2019)  Two new maps published to LawAtlas.org today — syringe service programs (SSPs) and tobacco pricing strategies — offer a comprehensive look at US laws that address tobacco pricing strategies and access to clean syringes through syringe service programs.

“States have a vital role to play in promoting the health and well-being of their residents. These datasets, along with other resources produced under the Promoting Health and Cost Control (PHACCS) in States initiative, will provide decisionmakers, advocates, and other key stakeholders with the evidence and business case for the adoption of policies that have been shown to improve community health,” said Adam Lustig, MS, Manager and Co-Principal Investigator of the PHACCS initiative.

The maps are the first two legal data resources in a new series created and maintained by the Center for Public Health Law Research at Temple University’s Beasley School of Law (CPHLR)  with the Trust for America’s Health (TFAH).

Researchers from the Center used the scientific policy surveillance process in collaboration with experts from TFAH to provide states with detailed information about the current state of US laws that could be used to improve community health through cost-saving policy changes.

“You must first measure a policy to understand its impact on health and cost. These maps give policymakers, advocates, practitioners and other stakeholders a comprehensive look into what these laws say and how the nuanced characteristics differ across the US,” said Lindsay Cloud, JD, Director of the Policy Surveillance Program at CPHLR. “The policy surveillance process we use is the gold standard for legal research because it creates objective, detailed legal data that can be used for evaluation and provides a clear visual to identifying gaps and areas for policy improvement.”

The project will include 13 datasets on a variety of public health topics through the end of 2020, ranging from universal pre-kindergarten and school nutrition standards, to housing and economic policies like the Earned Income Tax Credit and paid sick and family leave laws. The laws displayed were in effect as of August 1, 2019.

The two datasets released today, on syringe service programs and tobacco pricing strategies, represent two of the harm reduction-focused datasets in the series.


Syringe Service Programs

Syringe service program (SSP) policies authorize the legal sale and exchange of sterile syringes, and are one of the most effective and scientifically-based methods for reducing the spread of HIV and Hepatitis. This legal map identifies where SSPs have been explicitly authorized by the law, legal exemptions for individuals who access SSPs if they’re in possession of paraphernalia if stopped by law enforcement, and additional services an SSP must provide directly or through referrals.

Some key findings from this dataset include:

  • 31 states have passed laws that explicitly authorize SSPs. This number has nearly doubled since 2014 (18 states as of August 1, 2014).
  • In four of the 31 states – Delaware, Florida, Hawaii, and Maine – the law requires a one-for-one exchange of syringes.
  • In three states – Colorado, Georgia and Ohio – SSPs are also required to provide HIV and Hepatitis screenings.


Tobacco Pricing Strategies

Tobacco use and exposure to second-hand smoke are leading causes of preventable death in the US. One strategy to decrease tobacco use and promote quitting is to increase the price of tobacco products. This legal map details US laws that apply taxes or set pricing limits for tobacco products, like traditional cigarettes, e-cigarettes, and others.

Some key findings from this dataset include:

  • All 50 states and the District of Columbia tax cigarettes.
  • All 50 states and the District of Columbia have taxes on non-cigarette tobacco products.
  • 14 states and the District of Columbia also tax e-cigarettes, either by taxing the device, the liquid, or both.
  • 31 states and the District of Columbia prohibit selling cigarettes, non-cigarette tobacco products, or both below cost.
  • 32 states preempt local taxation of tobacco, either through explicit prohibitions on local tobacco taxation or through general limitations on the power of local governments to impose their own excise taxes.

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Learn more at www.tfah.org

The Center for Public Health Law Research at the Temple University Beasley School of Law supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. Learn more at http://phlr.org