US public health meets COVID-19 head-on: Pandemic squeezes long-underfunded public health system

Forty miles from the state capital, Jackson County, West Virginia, is home to about 29,000 people and 25 hospital beds. Like much of the state, the rural county is reeling from the opioid epidemic.

That vulnerability was top of mind as the county readied for the arrival of COVID-19, according to Wendy Staats, emergency preparedness coordinator at the Jackson County Health Department.

In the weeks before West Virginia confirmed its first case of novel coronavirus on March 17, the county agency activated a range of outreach and preparedness efforts, such as working with local school officials to send fact sheets home with students, partnering with senior centers to educate older residents about social distancing, and hosting its first Facebook Live forum to take questions from the community.

Emergency hospital sites and stockpiles of medical supplies were readied to care for a surge of patients — plans put in motion more than a decade ago when U.S. pandemic planning took on new urgency in the wake of the H5N1 influenza outbreak.

But the ongoing opioid crisis and its aftermath present special challenges for the county, Staats said. For example, the opioid epidemic has left many more older and vulnerable residents raising their grand-children, which could impact their risk of exposure to the novel coronavirus.

Diseases that typically accompany high rates of injection drug use, such as HIV and hepatitis C, put people at greater risk of complications from COVID-19. And the opioid epidemic has left many people without stable housing and a permanent address, which makes isolation and quarantine especially difficult. To help bridge those gaps, Staats said the agency is depending on the trust it has built up through its syringe services program to keep vulnerable residents educated and engaged in the community’s COVID-19 response.

“We’re a close-knit community and so there’s not a lot of panic when a crisis happens,” Staats, an APHA member, told The Nation’s Health in March. “We’re starting to get an influx of calls, but it’s nothing we didn’t expect. Right now, we’re just taking it one day at a time.”

Continue reading this story from the May 2020 issue of The Nation's Health.

Photo courtesy Adam Calaitzis, iStockphoto