Public Health 3.0 In Action: Pandemic Response Officers Expedite Prevention and Response
Building on decades of research on the benefits of systems-integration, the concept of Public Health 3.0 emerged in 2016, challenging America to focus on cross-sector collaboration and engagement to improve the determinants of health as a step to achieving health equity. In 2020, the country was put to the test as COVID-19 emerged and rocked the status quo. Public health and healthcare systems—and their workforce—were tested and tried in new ways. In our case, that meant catalyzing collaboration and innovation as we developed and deployed “Pandemic Response Officers: and Integration Between Medical, Public Health, and Higher Education Systems to Expedite Prevention and Response.”
The Importance of Integration: how collaboration is optimized with aligned systems
Our team comprised representatives from a county public health department (@TCWholeHealth), local healthcare system, and an institution of higher education (@Cornell) that planned to reopen in Fall of 2020, when vaccination was not yet available, and when protocols were required to ensure compliance with isolation and quarantine mandates. Expecting an influx of some 25,000 students and 10,000 employees to a small rural county (104,000 people), we sought to develop processes to limit viral transmission on and around campus and minimize impact of COVID-19 on community residents. Through frequent and open engagement, we developed collaborative methods to prevent and detect viral transmission, and to support case investigation and care of people diagnosed with COVID-19.
Our Pandemic Response Officer (PRO) program grew out of necessity, but also because of opportunity and ability to strategize at a systems level to support population well-being via task-sharing. Our specific goals were to minimize COVID-19 cases, limit academic and employment disruption via expedient case and contact support, and alleviate strain on county public health system. Given the potential for rapid COVID-19 transmission on college campuses, including between students and employees, the necessity was thus: rapid case notification, case investigation, isolation support, contact tracing, contact notification, and quarantine support. To alleviate strain on county public health workers and health systems staff, the PRO program extended some county public health responsibilities to trained university staff, expanding the workforce available to meet COVID-19 prevention and response needs.
Our Intervention: an entrepreneurial start with inspiring growth toward shared goals
The intervention was active January-to-December 2021, first serving only employees, and then expanding its reach to students, encompassing the entire university community. As cases were identified (on-campus diagnostics testing, self-report), PROs loaded case information into a shared HIPPA-compliant, electronic record which collected information for case notification. PROs used the system to contact cases, ensure that they were well supported with the resources needed, ensure that they understood isolation orders, gathered information of close contacts and possible area points of exposure, and in some cases, contacting close contacts and initiating quarantine support. During this time, the PRO program grew from an initial team of eight staff volunteers to a cadre of 25 staff and student team members, linking various units and expertise including occupational medicine, student health, county public health, human resources, and student services. This program was a meaningful example of cross-sector collaboration, bringing resources together from multiple organizations and institutions, united people around a shared goal of interrupting the spread of transmission on campus and in the community.
The Results: swift case notification to interrupt transmission, reduced redundancy, saved person-power for already overworked medical and public health professionals
From January 1 to December 31, 2021, PROs managed 773 employee and 2,943 student cases. During the Omicron surge (November 28-December 31, 2021), PROs saved the public health department and estimated 2,797 hours of effort, equating to over 10 professionals working full time and weekends to process cases and contacts during this interval. By sharing efforts between a university and public health agency, we believe this intervention minimized SARS-CoV-2 transmission, and alleviated strain on public health systems by expanding the public health workforce.
Inspiring the Future Public Health Workforce: teaching public health skills, modeling institutional collaboration
The COVID-19 pandemic created an opportunity to re-envision roles in cross-sector collaboration to achieve public health system integration. By taking on the public health responsibilities for a defined population, PROs were able to preserve TCHD’s case investigation and public health response capacity for the county’s more vulnerable populations. This partnership reduced redundancy of work effort, resulting in efficient, rapid case investigation and decreased transmission rates.
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Furthermore, the PROs are now trained and experienced professionals who are equipped to go into the workforce of medical, public health, and social settings with an eye for public health skills, processes and protocols. The PROs, many who were involved in the early, entrepreneurial birth of this program, now know what it takes to build integrated systems, are now also inspired to look for opportunities for institutional collaboration in their future professional roles.
As public health systems are building back, we should draw on lessons from the COVID-19 pandemic, including the “Pandemic Response Officers and the Integration Between Medical, Public Health, and Higher Education Systems to Expedite Prevention and Response” to integrate roles of IHE and public health departments to improve health outcomes for the larger community and to inspire the future public health workforce.
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Gen Meredith, DrPH, OTR is Professor of Practice and Associate Director of the Master of Public Health program at Cornell University in Ithaca, New York. During the COVID pandemic, she served on the Cornell COVID Response Team and co-led the Pandemic Response Officer program.
Frank Kruppa, MPA, MPH is currently Commissioner of Tompkins County Whole Health (TCWH) based in Ithaca, New York. TCWH represents the integration between the Tompkins County Public Health and Mental Health Departments to build a healthy, equitable community in Tompkins County by addressing the root causes of health disparities and integrating mental, physical and environmental health.
Anne C. Jones, DO, MPH is currently Assistant Professor of Family Medicine and Director of Student Affairs at Rowan-Virtua School of Osteopathic Medicine. Previously, she served as Director of Medical Services at Cornell Health and COVID Public Health Officer at Cornell University.