After shutdowns that devastated local economies, cities and towns across the country are at various stages of reopening since the second week of May. While COVID-19 transmission is declining in many states the highest transmission rates have moved from big cities to the heartlands. This is likely from large crowds that congregated over Memorial Day weekend in various locales and differences in the degree to which populations are practicing physical distancing and wearing masks. As of mid-June, more than 20 states, mostly in the Sun Belt and the West, are reporting alarming surges of COVID-19 cases requiring hospitalization. Since the brutal murder of George Floyd in Minneapolis national protest and uprisings have occurred with calls for racial justice. This is likely to lead to more people contracting COVID-19 and needing health care. Hospitals and ICU bed capacity that are already being stretched may be pushed past the breaking point.
In cities of all sizes, thousands of people have taken to the streets in a collective demand for racial justice. Demonstrators of diverse race, age and socioeconomic groups seized the moment to call out the centuries-old pandemic of institutional and systemic racism that continues to harm Black, Indigenous, and People of Color (BIPOC), especially Black communities. Public Health experts including Dr. Anthony Fauci voiced concerns about coronavirus spreading amid the nationwide protests and stressed that protective measures can reduce the risk of subsequent surges in infection.
As cities gird up for more businesses to open and to support peaceful protests, local leaders have critical roles to play by ensuring their communities:
- Promote public health guidelines and promote safe practices with city residents – particularly in view of mass protests and gatherings.
- Increase capacity for widespread testing to track spread, with data disaggregated by race, ethnicity and socioeconomic status.
- Support robust contact tracing to identify, trace and safely isolate people who are infected and quarantine for those exposed to them.
- Track surge capacity in hospital and ICU beds to treat people who need hospitalization.
- Manage expectations and be prepared to enact selective measures to mitigate illnesses and deaths based on local conditions and pending patterns of spread through the summer into the fall and winter months.
Public Health Guidelines: Reducing Risk of Protests and Business Reopening
Prevention is the first and primary step. CDC released new guidelines on June 12 for people considering going out and resuming daily activities such as attending events and gatherings. First, people with symptoms of COVID-19, or people who had been in close contact with someone who has COVID-19, should stay away from other people. To reduce the risk for those who do venture out, the same practical recommendations apply: physical distancing, hand-washing, and wearing of face coverings when we are in public. These guidelines also include specifics on activities e.g., eating at restaurants, hosting cook-outs, going to gyms, visiting libraries and traveling overnight. Face coverings are especially vital in mass protests where physical distancing is not feasible and shouting elevates the potential for spreading the virus.
- Local officials can communicate these guidelines and mutual responsibility to residents: consistently taking these measures means each person protects themself and each other. By speaking to people’s hearts as well as minds, city leaders can instill a sense of collective interest and responsibility.
Testing combined with safe isolation and contact tracing can help jurisdictions manage the viral spread and the impact of mass protests, reduce risk to lives, and allow a reasonable level of economic activity. Today testing is much more available across the country, but access to testing goes beyond the availability of testing kits and labs. Even jurisdictions with abundant tests are finding them to be underused. The location of testing facilities or the testing times may not be aligned with residents’ schedules, and the cost of testing is often a barrier.
- City leaders can work with healthcare organizations and neighborhood pharmacies to establish testing sites in communities of color; address location and cost issues; and ensure sufficient outreach to reach people in vulnerable neighborhoods. Prioritize people at greatest risk to contract COVID-19: Black, Indigenous and People of Color in low-income communities, front line workers and the elderly.
Robust Contact Tracing
To ensure cities can make safe, confident progress toward returning to work and school, contact tracing must go hand-in-hand with access to diagnostic testing in every community. Fortunately, many states currently seeing a surge (e.g., Arizona, North Carolina and Oklahoma) start from a relatively low base in number of cases. Contact tracing can help contain the spread and avert a second shutdown that can be even more devastating to the economy.
Each municipality needs a comprehensive system to identify all COVID-19 cases and trace all close contacts of each identified case. Cases must be persuaded to safely isolate, supported by referrals to services/resources (e.g., meals) to do so. Contacts should quarantine for 14 days to ensure they have not contracted COVID-19 and risk further transmissions. Health Departments are experts in training, deploying, analyzing and overseeing the contact tracing workforce, procedures and technology, though they might need support if there are large outbreaks. Effective contact tracing program must respond to the unique circumstances of state and local health departments. The CARES Act provided very limited dollars for public health surveillance, and currently many states are falling short of hiring and deploying sufficient contact tracers.
Mathematica offers Five Tips to Ensure Success of Effective Contact Tracing, including the following insights for cities:
- Human-centered practices alleviate fear, build trust with individuals, and ensure compliance with safe isolation to contain spread.
- Secure and reliable data build understanding of patterns of spread and conditions that led to them.
- Agile response mechanisms support decisions to anticipate and prevent spread.
- Engage with communities, build trust and partner closely with local organizations.
“Each city’s needs vary by its political and economic status, social capital, networks of resources for referrals, relationships between sectors across the city, and the demographics of the residents.”
Candace Miller, Senior Researcher, Mathematica
The pandemic is still circulating among the U.S. population. To date it has not leveled off in the hotter weather, and may come back with a vengeance in the cooler months. In a landscape of uncertainty, city officials bring credibility and relationship at the local level to ensure residents have the most current guidance grounded in science to preserve the public’s health. Equally important, local leaders can manage expectations and be prepared to enact selective measures to mitigate illnesses and deaths based on local conditions and patterns of spread through the summer into the fall and winter.
Testing and Contact Tracing for the Path to Recovery, CitiesSpeak, 4/30/2020
What’s the Difference Between Shelter in Place, Safer at Home, and Stay Home Orders? – CitiesSpeak, 3/30/2020
Contact tracing is “best” tool we have until there’s a vaccine, health experts say – Washington Post, 6/14/20
NACCHO Position Statement – Building COVID-19 Contact Tracing Capacity in Health Departments to Support Reopening America Society Safely
About the Author
Kitty Hsu Dana is the Program Director for Health & Wellness at the NLC Institute for Youth, Education, and Families.