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 one public health strategy borne 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 how easy it is to use the medicine that can reverse opioid overdoses.
"Hopefully your business would never have to respond to an overdose, but we'd rather have you have some Narcan on hand just in case," Piccolo, director of Park City-County Health Department, said to 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 the nasal spray to the hotel's first-aid kit.
The transaction took less than 10 minutes. It was the third hotel Piccolo had visited that hot July day in Livingston, a mountain town of roughly 8,000, where, as in much of the nation, health officials are worried about a recent rise in the use of the synthetic opioid fentanyl.
It was the first time the local health department 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 in high-risk settings.
"We learned this from covid," said Dr. Laurel Desnick, the county's public health officer. "We go to people who may not have time to come to us."
The pandemic laid bare the gaps and disparities in the U.S. public health system, and often resulted in blowback against local officials trying to slow the coronavirus's spread. But one positive outcome, in part fueled by a boost in federal dollars, is that health workers have started adapting lessons they learned from their covid-19 response to other aspects of their work.
For example, in Atlanta, the county health department planned to mail out at-home kits to test for diseases, a program modeled on the distribution of covid rapid tests. In Houston, health officials announced this month they'll begin monitoring the city's wastewater for monkeypox, a tactic broadly used to gauge how far and fast covid spread. And in Chicago, government agencies have tweaked covid collaborations to tag-team a rise in gun violence.
Some of these adaptations should cost little and be relatively simple to incorporate into the departments' post-pandemic work, such as using vans purchased with covid relief money for vaccine delivery and disease testing. Other tools cost more money and time, including updating covid-borne data and surveillance systems to use in other ways.
Some public health workers worry that the lessons woven into their operations will fall away once the pandemic has passed.
"When we have public health crises in this country, we tend to have a boom-and-bust cycle of funding," said Adriane Casalotti, with the National Association of County and City Health Officials.
Some federal pandemic relief funding is scheduled to last for years, but other allocations have already run dry. Local health workers will be left to prioritize what to fund with what remains.
Meanwhile, historically short-staffed and underfunded health departments are responding to challenges that intensified during the pandemic, including delayed mental health treatment and routine care.
"You're not just starting from where you were 2½ years ago, there's actually a higher mountain to climb," Casalotti said. "But places that were able to build up some of their systems can adapt them to allow for more real-time understanding of public health challenges."
In Atlanta, the Fulton County Board of Health has offered to mail residents free, at-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," Joshua O'Neal, the county's director of the sexual health programs, said in a press release announcing the kits.
The changes go beyond government. University of Texas researchers are trying out a statewide program to crowdsource data on fatal and nonfatal opioid overdoses. Those working on the project are frustrated the national effort to track covid outbreaks hasn't extended to the overdose epidemic.
Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said her team is expanding the covid data-driven approach to track and report neighborhood-level data on opioid drug overdoses. Nonprofits and city agencies that have worked together through the pandemic now meet each month to look at the numbers to shape their response.
Arwady said the city is trying to use the pandemic-driven boost in money and attention for programs that can last beyond the covid emergency.
"Every day, we're having these debates about, 'How much do we continue on? How big do we go?'" Arwady said. "I feel like it's such a moment. We've shown what we can do during covid, we've shown what we can do when we have some additional funding."
Shannan Piccolo, with 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 safety center modeled on its covid-response base to counter gun violence. Employees from across city departments are working together on safety issues for the first time by tracking data, connecting people in highest-risk areas to services, and supporting local efforts such as funding neighborhood block clubs and restoring safe spaces.
Separately, neighborhood-based organizations created to handle covid contact tracing and education are shifting focus to address food security, violence prevention, and diabetes education. Arwady said she hopes to continue grassroots public health efforts in areas with long-standing health disparities by using a patchwork of grants to retain 150 of the 600 people initially hired through pandemic relief dollars.
"The message I've really been telling my team is, 'This is our opportunity to do things that we have long wanted to do,'" Arwady said. "We built some of that up and I just, I'm gonna kick and scream before I let that all get dismantled."
Back in Montana, Desnick said not every change relies 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 gathered 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 broadened to include information on flood levels, federal cleanup assistance, and ice cream socials for people to meet first responders.
Piccolo, the county's health director, spent roughly an hour on that day in July going to hotels in Livingston's core to offer opioid overdose response training and supplies. Three hotel managers took the offer, two asked her to come back later, and one scheduled an all-staff training for later that week. Piccolo plans to extend the program to restaurants and music venues.
It's that kind of adaptation to her job that doesn't require the continuing flow of covid aid. The state supplied the Narcan boxes. Otherwise, she said, "it's just about taking the time to do this."
Images: Katheryn Houghton/KHN
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