381: Pandemic Polling, Ending the PH Emergency

Alyssa Boyea, ASTHO Director for Infectious Disease Preparedness, highlights resources to help public health agencies improve their COVID-19 communication and messaging approaches; Dr. Anne Zink, ASTHO President and Chief Medical Officer for the State...

Alyssa Boyea, ASTHO Director for Infectious Disease Preparedness, highlights resources to help public health agencies improve their COVID-19 communication and messaging approaches; Dr. Anne Zink, ASTHO President and Chief Medical Officer for the State of Alaska, discusses issues related to the end of the public health emergency on May 11th; an ASTHO blog addresses breastfeeding resources for women who are incarcerated; Dr. Umair Shah, Secretary of Health for Washington State, is part of a national panel discussion about new solutions to improve bio-surveillance and data modernization in response to biothreats; and ASTHO’s Health Equity Summit is scheduled for April 25th and 26th.

Health Affairs News Article: Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications

ASTHO Webpage: COVID-19 Public Health Communications Resource Hub

ASTHO Brief: Increasing Access to Breastfeeding Resources for Mothers Who Are Incarcerated

ASTHO Webpage: Health Equity Summit – A Movement for Justice

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This is Public Health Review Morning Edition for Tuesday, March 21st, 2023. I'm Robert Johnson. Now today's news from the Association of State and Territorial Health Officials.



We started this collaborative project which is funded and supported by CDC in 2020. Really, with the goal to provide state and local public health agencies with actionable data that communicators and health officials could use to really enhance and support COVID-19 communication efforts.



ASTHO's Alyssa Boyea a talking about a project that has worked to improve public health, communication and messaging during the pandemic. The project according to Boyea, has three core pieces.



The first is health opinion polls of the public. The second is a learning community for state public health leadership and communicators. And then lastly, we also do a lot of resources such as survey briefs, ask the expert webinars and podcasts to not only disseminate the latest survey findings but also to address key public health communication questions or issues that we've been hearing.



Boyea he says the opinion polling has been one of the projects most popular deliverables.



We've also done several evaluations of our learning community. And to date, participants have been reporting increased knowledge of strategies to turn data into action. They've also been reporting increased competence to communicate effectively using some of the latest and greatest communication practices, as well as really increased engagement and coordination across jurisdictions for COVID-19 and beyond.



You can access these resources and read an article about the project in the latest issue of Health Affairs. The links are in the show notes.


The public health emergency declared in response to the COVID-19 pandemic expires on May 11th. We sat down to talk about the end of the declaration with ASTHO President and Alaska Chief Medical Officer Dr. Anne Zink, during her recent visit to Washington, DC. How're you feeling about that? What are you hearing from your members who are gathered here at this meeting in Washington, D.C. now?



Yeah, I think that we all struggled with how we enter into a public health emergency. And I think we're all trying to figure out how we come out of a public health emergency. So there is the kind of very logistical and structural and honestly, bureaucratic parts that we have to unwind. And there's also making sure that we are thinking about the whole person that we're serving in our states and making sure that no one's really left behind.


Again, this looks very different depending on which state you're in. If you oversee Medicaid, or if you're really in that public health sphere alone, I think regardless, the interface between public health healthcare and these administrative regulations all play a critical role. At end of the day, that person in that city in that state in that county, and what their perception is, or their ability to access care, be at home testing, insurance, pay for testing, access to therapeutics, making sure that they're still enrolled with Medicaid, if they had Medicaid, and are still qualified and eligible and kind of that turning within the system.


So, a lot of different parts and pieces about it, but it's been a fantastic conversation so far, working with states. Again, a lot of variety amongst the states and how involved they are or how not involved they are, but it touches all of us in one way or another.



This emergency has been in place long enough to the point that many of the changes almost feel permanent in a way there's going to be a lot of disruption as this starts to unwind.



Yeah, that's a great question, I think, you know, from, you know, like, in my role serving as the chief medical officer in the state, and really very focused on the health consequences and thinking about testing and treatment access. That was very much my focus, but underneath that grew a whole bunch of regulatory changes that supported the work that we did, be it access to telehealth, be it not having anyone lose their Medicaid coverage. And those kind of mechanical things are one of the things that need to unwind to be able to move forward.


Many states have ended their state public health emergency, but not all. So, we're all in kind of different phases of what this looks like. And if you ended your state public health emergency, it may have impacted things like data sharing agreements, or Supplemental Nutrition Assistance Program (SNAP) pandemic Electronic Benefit Transfer (EBT) benefits that we saw during that time. So, what this looks like in states is very different depending on what the state looks like. I really would love that all states, not think about how can I as quickly as possible, get back to pre-pandemic, but what were the lessons learned? And how can I take the gems that we did learn from that and build that into our regular system moving forward. So, unwind the things that are no longer needed, but take the new things that are going to help to improve the health and well-being of the people we serve moving forward.



You live in two different worlds, but they're connected. You live in the policy world with all of this work as the chief medical officer there in Alaska, but also the provider world, in the emergency room. How does all of this that's about to happen that is happening that will be happening through the course of this year? How does it have affect the people that you see?



Yeah, I mean, I think that part of the reason why I maybe have more anxiety about this space than some others is, you know, I think about the person. And we'll take my mom, for example, you know, she tested positive for COVID, she had a home COVID test, she was able to do a telehealth appointment. And she was able to have delivered Paxil that the next day, she never went to the emergency department, she was able to be started on medications within 24 hours of her symptoms beginning she recovered very quickly and did really well.


But if you don't have access to at home testing, if you don't have access to telehealth, if we don't have access to treatment, all of those things could have really inhibited her ability to do that. And so, then that's going to limit someone's interest. I mean, she wouldn't have gone to the emergency department on day one, because she had very mild symptoms. So are we just going to get elderly at risk people presenting to the emergency department on day seven, when they're starting to get really sick, and then you got to think about their co-pays. And you got to think about bankruptcy, and you got to think about overall costs. So, I am particularly worried about the lack of the at home testing space, where people could self-identify quickly test to be able to get access to therapeutics and are people going to wait until those treatment options really aren't there in the same sort of way. And then outside of that, you know, the number one reason for bankruptcy in this country as health care costs. 20% of our GDP goes to health care, but we still have these huge gaps in people being able to access care. And so I am really concerned about when I see people in emergency department who then can't pay for their hospitalization, can't pay for treatment, and are going to wait until they're much sicker.


 And that's the fundamental focus of public health is how do we move upstream? And we've had a lot of tools that have led us to move upstream and I'm worried about those going away.



Did you know that about six to 10% of women admitted to the US prison system are pregnant? ASTHO has a new report about improving breastfeeding resources for this population. O'Keyla Cooper has more.



Breastfeeding is an important resource for promoting health equity and reducing infant and maternal mortality rates. But there are currently no federal policies in place to guarantee incarcerated mothers can provide breast milk for their infants. Alabama, Michigan and New Mexico are working to ensure perinatal care, skilled lactation support and equipment to birthing and lactating persons. Read the full blog using the link found in the show notes.



Also, Dr. Umair Shaw from Washington state is part of a national panel discussion today about new solutions to improve bio surveillance and data modernization in response to bio threats. The event is hosted by the Bipartisan Commission on Biodefense. It is not available online.


Finally, this morning, ASTHO's Health Equity Summit is happening in April. The event called a "Movement for Justice" is scheduled for April 25th and 26th in Atlanta. You can get more information using the link in the show notes. You also can listen to our recent conversation about the event with ASTHO's Dr. Kimberly Wyche-Etheridge. The link to that edition of the newscast is in the show notes as well.


That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information. I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Alyssa Boyea MPH CPH

Director, Infectious Disease Preparedness, ASTHO

Anne Zink MD FACEP

Chief Medical Officer for the State of Alaska