An experienced AzPHA member working in state government recently developed the action plan below to more effectively respond to the COVID situation in Arizona. Because of the nature of the person’s they wish to remain anonymous. I’m posting the person’s ideas here in hopes that it builds the inventory of ideas to enhance Arizona’s response.
Create clear criteria for discharge from an inpatient setting and leverage alternate care sites for Persons Under Investigation or asymptomatic/low symptom burden cases who require support to effectively isolate. quarantine. While such alternate care sites (e.g. “quarantine hotels”) have developed, their clinical oversight is variable, and they are not being utilized in a systematic or organized manner at present. When utilized with appropriate clinical oversight and proper technical assistance and support, they can be an effective tool in bending the curve.
ALL congregate settings, including non-healthcare settings – such as prisons and detention centers – should have – a)routine screening and periodic testing procedures in place for all personnel working in the facility, b) strict standards for infection control c) guaranteed supply and use of appropriate PPE, d) personnel and pay policies that support those who are exposed or infected to stay home. Home care/ direct care workers, who serve vulnerable populations, should receive similar support from county/state agencies. One-time testing drives are insufficient.
The governor’s office should ensure more robust inter-agency collaboration in directing the response to COVID-19. ADHS should better leverage the academic workgroups that they have convened for modeling to help inform solutions. The modeling effort and disease response effort, clinical and operational functions should not remain as silos.
All counties should transparently state their contact tracing process. ADHS should set up clear standards for contact tracing, isolation/quarantine, case management and follow up by counties to include close contacts, primary AND secondary contacts beginning from 48-72 hours prior to onset of symptoms of the index case and through the infectious period. Because of the significant impact of pre-symptomatic spread, merely tracing close contacts would be an insufficient response.
Designate healthcare facilities as Covid versus non-Covid. Concentrate testing, PPE, training/technical assistance, manpower, funding and monitoring into the Covid accepting facilities. This will allay anxiety among the public and allow people to seek the routine care that is so desperately needed, including childhood immunization.
Create a plan to ensure the control of vaccine preventable infections: including flu/ pneumonia, measles, newborn and childhood vaccines. Participation in the VFC program needs to be encouraged. Flexibilities for this program administration should be sought from the CDC to ensure the infrastructure for vaccine distribution is sustained through the emergency. This infrastructure will be essential should a COVID vaccine emerge.
Most important: ensure CLEAR, CONSISTENT, PROACTIVE messaging at each stage of the pandemic across state agencies. This has been a gap that leadership can correct.
