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With the COVID-19 pandemic in full force, health agencies are ensuring that their focus does not drift from the fight to end the HIV epidemic. Resiliency is key to continue to make progress in this decades-long fight.

The COVID-19 pandemic has impacted pregnant people and infants more severely than some other populations. As such, it is important to pay special attention to this vulnerable group.

Well before COVID-19 hit, an increasing share of American households faced housing challenges. This is a public health concern because stable, affordable, and accessible housing has a direct and well-documented impact on physical and mental health outcomes. The window to act is now. Further, the high number of households with unstable housing and accumulating debt—as well as the stark racial disparities present—mean we must rethink how our systems and institutions operate.

As COVID-19 spread across the country, governors and health officials invoked their emergency powers to order physical distancing measures designed to reduce social interactions and slow the spread of the disease. Several of these measures, such as stay-at-home orders, business and school closures, public gathering limits, face covering requirements, and others, are being challenged in federal and state courts. Many of the legal challenges include claims of executive overreach and misuse of emergency power as well as allegations of violating individual rights protected by the U.S. Constitution.

Toxic stress contributes to a variety of negative outcomes for children. And unfortunately, COVID-19 has increased the likelihood of children experiencing childhood trauma, adverse childhood experiences (ACEs), and toxic stress. States and territories should have programmatic, and policy mechanisms to both prevent and mitigate the lifelong effects. A CDC Vital Signs Report found that preventing or mitigating ACEs could reduce depressive disorder by 44%, smoking by 33%, and unemployment by 15%.

Hispanic Heritage Month takes place annually from September 15-October 15 to celebrate the history, culture, achievements, and influence of the Hispanic and Latinx community in the U.S. In recognition of this month, ASTHO interviewed one of our newest members, José Romero, MD, Secretary of Health at the Arkansas Department of Health. In this blog post, he speaks with us about how his experiences as a Hispanic working in healthcare have impacted him and his leadership style.

Public health data collection and surveillance systems by health departments are in dire need of modernization. Though the public health community began developing a path to modernization over the last decade, attention to this issue from policy makers has sharply increased with the current response to the COVID-19 pandemic. Not only are current systems siloed, they rely on labor intensive processes to detect and facilitate a response to various public health threats.

Though late spring and summer is considered “tick season,” ticks are still a threat in the fall as many areas of the country continue to see temperatures that ticks can thrive later and later in the year, and as people continue to get outdoors and enjoy their state parks.

The COVID-19 pandemic has further amplified the need for strong tobacco prevention and cessation policies. Research indicates that tobacco use is associated with increased rate of COVID-19 disease progression and increased likelihood of death among hospitalized patients, and that e-cigarette use is associated with a greatly increased risk of COVID-19 diagnosis in youth and young adults.

If EMS can change the perception of patients with Substance Use Disorder, they will see that building rapport and encouraging the patient to seek help from resources they provide can be mutually beneficial. For EMS, it reduces the call volume, and often the financial cost, of repeated responses for the same patient—and the patient gets the help they need to break the cycle of substance dependence.

Every state and U.S. territory are at risk of vector-borne diseases. This year, dengue cases are on the rise in Puerto Rico. Florida has also reported locally transmitted cases of dengue this year. We are already seeing record numbers of cases in the Americas and the Caribbean, with 2019 seeing the highest number of cases on record in the Americas. Numbers of tickborne diseases continue to climb this summer, with Lyme disease continuing to be the most reported vector-borne disease in the U.S.

In August 2020, the Big Cities Health Coalition and the Association of State and Territorial Health Officials released a co-produced public service announcement to support public education in our members’ communities. The call to action in the PSA is straightforward: Americans need to put aside our respective differences and, simply, #MaskUp.

The importance of having designated time for staff to connect, grow, develop and share has always been the driving force behind the decision to host “ASTHO Week,” a three-and-a-half daylong all-staff convening every quarter. Given our current work environment, having this time together seems necessary now, more than ever. So in the midst of the pandemic and our full-time telework, here’s what our team learned about planning a 100% virtual ASTHO Week.

As COVID-19 continues to spread across the country, increased attention has been given to how schools, colleges, and universities can safely reopen for the upcoming 2020-2021 academic year. To note, many schools and institutions closed in March and April of 2020 to reduce exposure of the virus among students, teachers, and related personnel, and there has been discourse at all levels of government about the feasibility of in-person academic instruction this Fall. At the center of these discussions have been state, local, and territorial health officials, who are providing their expertise through constant communication and consultation with education officials.

During the early spread of COVID-19, the National Rural Health Association senior vice president Brock Slabach stated: “Before the pandemic, rural hospitals were struggling for survival. COVID-19 has put a spotlight on the fractures that already existed within rural communities in terms of their healthcare delivery.” These fractures also exposed the desperate need for ethical transformational leadership within rural healthcare delivery systems. The time to build these capacities is now.

In order to contain and mitigate the COVID-19 pandemic, widespread, rapid testing is key. Rampant and efficient testing determines who has the virus and who may be at risk of transmitting it, and allows for effective management of isolation and quarantine activities for the infected or exposed. While testing has increased over the past months across the country—by mid-July the number of tests reached between 700,000 to 800,000 per day, double the number of daily tests performed in May. However, that number is still well below the estimated 1.2 million daily tests needed to contain the outbreak and 4.3 million tests per day that would suppress the virus.

Scientists are working quickly to develop a safe and effective vaccine to provide immunity to COVID-19. Once a vaccine is approved, it will likely be imperative for states to authorize as many health care professionals to administer it, since the demand is expected to be extremely high. In addition, legislation authorizing alternative providers within the immunization neighborhood (e.g., pharmacies, schools, workplace, and other clinical sites) can expand the places where vaccines are available and increase access to vaccination among vulnerable populations. By recognizing that not every person is reliably linked to a healthcare provider, these policies can allow for timely and consistent immunization services.

The New Frontier of Digital Proximity Tracing Association of state and territorial health officials, astho, public health, covid-19, contact tracing, case investigation, public health surveillance, infectious disease, proximity tracing, exposure notification, public health agencies, data privacy, public health official, state legislature, geolocation, health data, test positive for covid-19, personal data, data collected, health departments Jeffrey Ekoma Digital proximity tracing is the cutting-edge for tracking outbreaks of COVID-19, but many have concerns about data privacy. States have proposed legislation to balance the two. As state, local, territorial, and tribal (SLTT) health departments continue to cautiously reopen parts of their economy, they also continue to take necessary measures to prevent the spread of COVID-19. A major component of this work is traditional contact tracing, a staple of public health surveillance where public health workers track down and notify anyone who might have contact with someone who tested positive for an infectious disease. However, new strategies that would supplement traditional tracing have been gaining momentum. Google and Apple collaborated to create an application programming interface (API) platform for public health agencies interested in a new type of “proximity tracing” or “exposure notification.” The platforms are expected to assist in the creation of apps between software developers and public health jurisdictions. It specifically utilizes Bluetooth technology —readily available in cellular devices—to randomly generate temporary keys on a user’s device when a user downloads an exposure notification application. This then enables the application to alert an individual if they have been or potentially exposed to someone who also uses the application and who tested positive for COVID-19. It’s worth noting the platform created by Google and Apple does not collect location information or information of users who do not voluntarily mark themselves as being positive for COVID-19. There are other notable exposure notification apps being used by SLTTs including Care19, an app developed by ProudCrowd that’s currently being used in North Dakota and South Dakota. Also, CommCare, which is currently being used in New Jersey and was developed by Dimagi. As expected, the introduction and potential influx of these types of apps have brought many different concerns, primarily centered around data privacy and how the platforms and applications would protect, store, and safely discard information that it collects. This issue became of interest to Sen. Maria Cantwell, current ranking member of the Senate Committee on Commerce, Science, and Transportation. In response she drafted S. 3861 Exposure Notification Privacy Act, which proposes assistance to public health jurisdictions exploring exposure notification applications and technologies. The act would ensure that such platforms have the necessary capacity to protect the personal data of consumers, limit the type of data collected, as well as the type of entities that would have access to such data. In addition, the legislation also: reaffirms the role of public health officials in requiring their involvement in the development and deployment of exposure notification systems; requires that participation from individuals be on a voluntary basis and with consumer consent; limits the collection and use of data; prohibits commercial use of data; and permits participants to delete their data at any time; among other things. The legislation was recently co-introduced with Sens. Bill Cassidy and Amy Klobuchar, and received support from the Washington State Department of Health, Council of State and Territorial Epidemiologists, and the National Coalition of STD Directors. This legislation is currently pending in the Senate and it is unclear if it will be considered in the upcoming months. There is also movement in state legislatures to address the use of technology. In California, legislation (AB 660) was introduced that would require any state agency contract that uses a mobile device’s geolocation data for exposure notification to a communicable disease to include provisions requiring the contractor to inform the app user of the authorized purposes of the app and collected data. Another bill (AB 1782) introduced in the state would require public health entities and businesses offering exposure notification services to allow users to revoke consent for the collection, use, maintenance, or disclosure of the user’s information. Businesses that provide exposure notification services but are not affiliated with a public health entity would be required to disclose its non-affiliation. The bill would also require the encryption of data collected by the technology, limit the use of the data as well as the amount of time the data can be maintained, and require reported exposures be verified by a healthcare provider before notifying logged contacts of their potential exposure. In New York, companion bills were introduced (A 10583A and S 8448B) that would establish requirements for the collection and use of emergency health data and the use of technology for collecting data during the COVID-19 emergency. Specifically, the bill requires the disclosure of certain information to those who install and use data collecting apps on mobile devices, including information about the right to opt-in, the right to privacy, the app’s privacy policy, time limitations for maintaining the data, and the individual’s right to access the data. Unlike the bills in California, individuals in New York would be able to sue for violations of the law. Several SLTT’s are currently either exploring, developing, or implementing proximity tracing applications within their respective jurisdictions. It remains critical that SLTT health departments evaluate the implementation of any proximity tracing option, while concurrently evaluating pertinent data and privacy related issues that may arise with the collection and sharing of information from individuals. In the coming days, ASTHO plans to release a guide to assist health officials as they think through the critical functionalities, technological options, and implementation of these emerging technologies. ASTHO will continue to track and monitor legislation that seeks to address data and privacy concerns with proximity tracing and exposure notification applications. website yes

Dental care and the oral health workforce have also been tremendously impacted by the COVID-19 pandemic. In the midst of stay at home orders, nationwide closures, and related employment loss, people have largely put their oral health on the back burner.

This Health Policy Update is an overview of state legislative activity addressing access to and support for breastfeeding or lactation practices.