The epidemiology and surveillance workforce among local health departments in California: mutual aid and surge capacity for routine and emergency infectious disease situations

A scoping review of strategies to support public health recovery in the transition to a "new normal" in the age of COVID-19

Background

During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pandemic, public health systems need to re-start the delivery of core public health programming alongside COVID-19 activities. The purpose of this scoping review was to identify strategies that support the re-integration of core public health programming alongside ongoing pandemic or emergency response.

Methods

The Joanna Briggs Institute methodology for scoping reviews was used to guide this study. A comprehensive search was conducted using: a) online databases, b) grey literature, c) content experts to identify additional references, and d) searching reference lists of pertinent studies. All references were screened by two team members. References were included that met the following criteria: a) involved public health organizations (local, regional, national, and international); b) provided descriptions of strategies to support adaptation or delivery of routine public health measures alongside disaster response; and c) quantitative, qualitative, or descriptive designs. No restrictions were placed on language, publication status, publication date, or outcomes. Data on study characteristics, intervention/strategy, and key findings were independently extracted by two team members. Emergent themes were established through independent inductive analysis by two team members.

Results

Of 44,087 records identified, 17 studies were included in the review. Study designs of included studies varied: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Included studies were from North America (n = 10), Africa (n = 4), and Asia (n = 3) and addressed various public health disasters including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1). Five emergent themes were identified on strategies to support the re-integration of core public health services: a) community engagement, b) community assessment, c) collaborative partnerships and coordination, d) workforce capacity development and allocation, and e) funding/resource enhancement.

Conclusion

Emergent themes from this study can be used by public health organizations as a beginning understanding of strategies that can support the re-introduction of essential public health services and programs in COVID-19 recovery.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13663-2.

Epidemiology Surveillance and Capacity Improvement: A Characterization of Texas, 2017

OBJECTIVES

In response to increasing caseloads of foodborne illnesses and high consequence infectious disease investigations, the Texas Department of State Health Services (DSHS) requested funding from the Texas Legislature in 2013 and 2015 for a new state-funded epidemiologist (SFE) program.

METHODS

Primary cross-sectional survey data were collected from 32 of 40 local health departments (LHDs) via an online instrument and analyzed to quantify roles, responsibilities, and training of epidemiologists in Texas in 2017 and compared to similar state health department assessments.

RESULTS

Sixty-six percent of SFEs had epidemiology-specific training (eg, master's in public health) compared to 45% in state health department estimates. For LHDs included in this study, the mean number of epidemiologists per 100 000 was 0.73 in medium LHDs and 0.46 in large LHDs. SFE positions make up approximately 40% of the LHD epidemiology workforce of all sizes and 56% of medium-sized LHD epidemiology staff in Texas specifically.

CONCLUSIONS

Through this program, DSHS increased epidemiology capacity almost twofold from 0.28 to 0.47 epidemiologists per 100 000 people. These findings suggest that capacity funding programs like this improve epidemiology capacity in local jurisdictions and should be considered in other regions to improve general public health preparedness and epidemiology capacity.

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community's needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent's capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

Emergency Physician Twitter Use in the COVID-19 Pandemic as a Potential Predictor of Impending Surge: Retrospective Observational Study

Background

The early conversations on social media by emergency physicians offer a window into the ongoing response to the COVID-19 pandemic.

Objective

This retrospective observational study of emergency physician Twitter use details how the health care crisis has influenced emergency physician discourse online and how this discourse may have use as a harbinger of ensuing surge.

Methods

Followers of the three main emergency physician professional organizations were identified using Twitter’s application programming interface. They and their followers were included in the study if they identified explicitly as US-based emergency physicians. Statuses, or tweets, were obtained between January 4, 2020, when the new disease was first reported, and December 14, 2020, when vaccination first began. Original tweets underwent sentiment analysis using the previously validated Valence Aware Dictionary and Sentiment Reasoner (VADER) tool as well as topic modeling using latent Dirichlet allocation unsupervised machine learning. Sentiment and topic trends were then correlated with daily change in new COVID-19 cases and inpatient bed utilization.

Results

A total of 3463 emergency physicians produced 334,747 unique English-language tweets during the study period. Out of 3463 participants, 910 (26.3%) stated that they were in training, and 466 of 902 (51.7%) participants who provided their gender identified as men. Overall tweet volume went from a pre-March 2020 mean of 481.9 (SD 72.7) daily tweets to a mean of 1065.5 (SD 257.3) daily tweets thereafter. Parameter and topic number tuning led to 20 tweet topics, with a topic coherence of 0.49. Except for a week in June and 4 days in November, discourse was dominated by the health care system (45,570/334,747, 13.6%). Discussion of pandemic response, epidemiology, and clinical care were jointly found to moderately correlate with COVID-19 hospital bed utilization (Pearson r=0.41), as was the occurrence of “covid,” “coronavirus,” or “pandemic” in tweet texts (r=0.47). Momentum in COVID-19 tweets, as demonstrated by a sustained crossing of 7- and 28-day moving averages, was found to have occurred on an average of 45.0 (SD 12.7) days before peak COVID-19 hospital bed utilization across the country and in the four most contributory states.

Conclusions

COVID-19 Twitter discussion among emergency physicians correlates with and may precede the rising of hospital burden. This study, therefore, begins to depict the extent to which the ongoing pandemic has affected the field of emergency medicine discourse online and suggests a potential avenue for understanding predictors of surge.