Dr. Laurel Desnick prepares to deliver boxes of Narcan to local hotels. The free distribution of Narcan, the brand name of the drug naloxone, which can reverse opioid overdoses, is a public health strategy born out of the COVID-19 pandemic.
LIVINGSTON, Mont. – Shannan Piccolo walked into a hotel with a tote bag full of Narcan and a speech about the ease of use of the drug that can reverse opioid overdoses.
“I hope your business never has to respond to an overdose, but we prefer that you have some Narcan on hand just in case,” Piccolo, director of the Park City-County Health Department, told the hotel manager.
The manager listened to Piccolo’s instructions on how to use Narcan, the brand name of the drug naloxone, and added four boxes of nasal spray to the hotel’s first aid kit.
The transaction took less than 10 minutes. It was the third hotel Piccolo visited on this hot July day in Livingston, a mountain town of about 8,000 people, where, like much of the country, health officials are worried about a recent increase in the use of the synthetic opioid fentanyl.
It was the first time the local health department had offered door-to-door training and supplies to prevent overdose deaths. The underlying strategy was forged during the pandemic when public health officials distributed rapid tests and vaccines to high-risk settings.
“We learned this from covid,” said county public health officer Dr. Laurel Desnick. “We go to people who may not have time to come to us.
The pandemic has laid bare gaps and disparities in the US public health system and often brought backlash against local officials trying to slow the spread of the coronavirus. But one positive result, fueled in part by an increase in federal dollars, is that health workers have begun to adapt the lessons they have learned from their response to covid-19 to other aspects of their work.
For example, in Atlanta, the county health department planned to mail home disease-testing kits, a program modeled after the distribution of rapid covid tests. In Houston, health officials announced this month they would begin monitoring the city’s sewage for monkeypox, a tactic widely used to gauge how far and how quickly covid is spreading. And in Chicago, government agencies have tweaked covid collaborations to team up with an increase in gun violence.
Some of these adaptations should cost little and be relatively simple to incorporate into departments’ post-pandemic work, such as the use of vans purchased with covid relief money for vaccine delivery and disease screening. Other tools cost more money and time, including updating covid data and monitoring systems to use in other ways.
Some public health workers worry that the lessons learned from their operations will disappear once the pandemic passes.
“When we have public health crises in this country, we tend to have a bumpy funding cycle,” said Adriane Casalotti, of the National Association of County and City Health Officials.
Some federal pandemic relief funds are expected to last for years, but other allocations have already run out. Local health workers will need to prioritize what to fund with what remains.
Meanwhile, historically understaffed and underfunded health services are responding to challenges that have intensified during the pandemic, including delayed mental health treatment and routine care.
“You’re not just starting from where you were 2 and a half years ago, there’s actually a higher mountain to climb,” Casalotti said. “But places that have been able to build some of their systems can adapt them to allow for a more real-time understanding of public health challenges.”
In Atlanta, the Fulton County Board of Health offered residents mail-in free home tests for sexually transmitted diseases. The state has historically had some of the highest rates of reported STDs in the nation.
“This program has the power to demonstrate the scalable effects of equitable access to historically underserved communities,” said Joshua O’Neal, director of sexual health programs for the county, in a press release announcing the kits.
The changes go beyond government. University of Texas researchers are testing a statewide program to collect data on fatal and nonfatal opioid overdoses. Those working on the project are frustrated that the national effort to track covid outbreaks has not extended to the overdose epidemic.
Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said his team is expanding the covid data-driven approach to tracking and reporting neighborhood-level data on opioid overdoses. Nonprofits and city agencies that have worked together during the pandemic are now meeting monthly to review the numbers to shape their response.
Arwady said the city is trying to use the increased money and attention brought on by the pandemic for programs that can last beyond the covid emergency.
“Every day we have these debates about ‘How much do we go on? How far do we go?'” Arwady said. “I feel like this is such a moment. We’ve shown what we can do during covid, we’ve shown what we can do when we have additional funding.”
Shannan Piccolo of the Park City-County Health Department in Montana talks with a hotel manager about how to use Narcan nasal spray to reverse a drug overdose.
The city also opened a new security center modeled after its covid response base to counter gun violence. Employees from all city departments are working together on safety issues for the first time by tracking data, connecting people in the highest-risk areas to services and supporting local efforts such as fundraising for clubs neighborhoods and the restoration of safe spaces.
Additionally, neighborhood organizations created to manage covid contact tracing and education are focusing on food safety, violence prevention and diabetes education. Arwady said she hopes to continue grassroots public health efforts in areas with longstanding health disparities by using a patchwork of grants to retain 150 of the 600 people initially hired with pandemic relief dollars.
“The message that I’ve really given to my team is, ‘This is our opportunity to do things that we’ve wanted to do for a long time,'” Arwady said. “We built some of this up and I’m just gonna, I’m gonna kick and scream before I let it all come apart.”
Back in Montana, Desnick said not all changes depend 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 pandemic to send updates to schools, churches and businesses.
Desnick posts regular public health video updates that began with covid case counts and expanded to include information on flood levels, federal cleanup assistance and ice cream socials for people to meet first responders.
Piccolo, the county health director, spent about an hour that day in July visiting hotels in central Livingston to provide opioid overdose response training and supplies. Three hotel managers accepted the offer, two asked him to come back later and one scheduled a training for all staff later in the week. Piccolo plans to expand the program to restaurants and music venues.
It’s that kind of adaptation to his job that doesn’t require the continuous stream of covid help. The state provided the Narcan boxes. Otherwise, she says, “it’s just about taking the time to do it.”