Hot on our minds is ending the current pandemic while continuing our community and work lives.
For example, Active Implementation science provides an evidence-based approach to testing, containment, and treatment of pandemics. Early detection and testing require that we have a way to collect information about the presence of a virus or disease, and that we have a prompt way to obtain the results. Testing requires competent testers who know how to administer the test properly, how to interpret the results correctly, and what to do when the results are positive or negative. To be effective, testing must be done for everyone so that the contagion can be contained and treated.
Those who test positive for a virus/disease can be isolated and treated with current and future effective interventions. Just as important, social tracing needs to occur to identify people who have come into contact with those who test positive. Those who test negative for the virus can go to work, interact with family and community members, and maintain their lives and livelihoods. Business owners, together with health systems, can assure testing of employees every week or so to assure customers and coworkers of their safety.
The Case of COVID-19
In the absence of universal testing to find those who have COVID 19, the alternative is to isolate everyone. Thus, the current recommendation (mandate) is to stay at home and keep your distance. Isolation and social distancing may inhibit the spread of COVID 19 but it shuts down family, business, and community interactions with dire consequences. A more targeted approach is needed.
While COVID 19 is a new virus and smallpox is an historic virus, there are applicable lessons from the eradication of smallpox:
- To eradicate smallpox, testing was done by “surveillance teams” made up of medical and paid staff who were selected, trained, and coached (implementation best practices for competency development) to prepare them to respectfully and effectively follow the testing protocols.
- In India, with a population four times greater than the US, several hundred thousand individuals were carefully prepared to staff the smallpox surveillance teams.
- Active surveillance made a big difference. In one state in India, the official incidence of smallpox using government reporting methods was 437 cases. In the same month in the same state, active surveillance teams found 5,989 new cases.
Current public health and health care systems were not set up to conduct universal testing. To create this capacity, individuals without a medical background must be recruited and taught how to be competent testers. To accomplish this, Implementation Teams are needed in every state to support the use of effective testing and containment methods as well as treatment methods.
Why Implementation Teams?
Scientific American contributing editor W. Wayt Gibbs summarized information gained from computer simulations of COVID 19 spread. In these simulations, infections start to shoot up quickly as soon as we let people congregate once again. The model predicts that within a few weeks of lifting the restrictions, we’re pretty much back where we started. Developing and sustaining Implementation Teams can have a continuing role in assuring public health and well-being now and in the future. a contrasting background to draw attention to this content.
Active Implementation practice and science has developed effective methods to create and sustain Implementation Teams. Once developed, these Teams can help end the coronavirus pandemic and can be available to support the full and effective use of other public health initiatives in the future. Implementation Teams are a crucial and missing component of current health and other human service systems. The time for creating an implementation infrastructure on a useful national scale is now! This implementation infrastructure can be developed now as the medical community works to develop efficient testing methods and effective vaccines. One without the other is insufficient: testing and administration of vaccines for everyone requires the support of Implementation Teams to assure the full and effective use of testing and vaccinations.
Some additional resources:
- “Without testing, San Miguel County’s health workers would be unable to track the virus’s spread. They would be…fighting a fire blindfolded.” Read more about universal testing in San Miguel County in Colorado: https://www.theatlantic.com/science/archive/2020/03/coronavirus-tests-everyone-tiny-colorado-county/608590/
- In Iceland, “contact tracers” work to identify those with COVID 19 and those who are also “invisible and unwitting carriers” through detective work and testing: https://www.nbcnews.com/news/world/iceland-employs-detective-work-testing-quarantine-coronavirus-fight-n1170166
- How does readiness fit into fighting the spread of the coronavirus? Head over to the Wandersman Center’s blog to find out: https://www.wandersmancenter.org/blog/using-implementation-science-to-flatten-the-coronavirus-curve-the-time-is-now