Investigating the Role of Local Board of Health Governance on Local Health Department Policymaking Behavior.

OBJECTIVES: This study sought to identify groupings of policymaking behavior among local governmental health departments (LHDs) across the country and assess whether such groupings were associated with the governance activity of their board of health (BOH). DESIGN: We conducted latent class analysis (LCA) to identify possible classes of policymaking behavior among LHDs. Once classes were identified, we used multinomial logistic regression (MLN) to estimate the association between an LHD's policymaking behavior and the governance activity of their BOH. SETTING: 2019 wave of the National Association of City and County Health Officials (NACCHO) Profile Survey. PARTICIPANTS: All LHDs with BOHs in the 2019 NACCHO Profile Survey (n = 1003). OUTCOME MEASURES: Within our MLN, our primary outcome of interest was the association between an LHD's policymaking class (the main dependent variable) and the governance activity of its BOH (the main independent variable). RESULTS: Based on our LCA, we determined our sample to be composed of what we characterized as "Limited Policy-Involvement," "Average Policy Involvement," and "Expanded Policy Involvement" LHDs. Those in the Expanded Class were more likely to be involved across all policy areas compared to the Limited and Average class, especially among social determinants of health (SDOH)-related areas. Our MLN estimated that having a BOH active in legal authority was associated with an 86% increased chance that an LHD would be in the "Average Class" compared to the "Limited Class" and having a BOH active in partnership engagement was associated with an 86% more likely chance that an LHD is in the "Expanded Class" compared to the "Average Class." CONCLUSION: Using nationally representative data on LHD activity, we found distinct groups of policymaking behavior, including a quarter of LHDs that are highly active in traditional and SDOH-related policy areas. We also found that groupings of policymaking behavior, as indicated by class designation, are strongly associated with the BOH's governance activity.

Local Health Department Values and Organizational Authorities Guiding Cross-Sector Work During COVID-19.

OBJECTIVE: The COVID-19 pandemic highlighted the role that local health departments (LHDs) have in cross sector can address alone, including the work of value alignment and the strategic use of organizational authorities. The practices by which LHDs used their authorities to conduct cross-sector work during the pandemic need exploration. METHOD: We conducted semi-structured interviews with 19 public health leaders from metropolitan LHDs across the United States. Our interview guide assessed the values that LHD leadership prioritized in their cross-sector work as well as the range of organizational authorities they leveraged to influence external decision-making in other sectors. RESULTS: We found that LHDs approached cross-sector work by leaning on diverse values and authorities, each with unique implications for their work. The LHDs emphasized their approach to value alignment on a sector-by-sector basis, strategically using diverse organizational authorities-economic, political, moral, scientific, and logistical. While each authority and value we assessed was present across all interviewees, how each shaped action varied. Internally, LHDs emphasized certain authorities more than others to the degree that they more closely aligned with prioritized core values. CONCLUSION: Our findings highlight the ongoing need for LHD leadership to improve their ability to effectively communicate public health values and the unique authorities by which health-supporting work can be facilitated, including how this message must be adapted, depending on the specific sectors with which the LHD needs to partner and the governance arrangement in which the LHD is situated.

Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020.

IMPORTANCE: Reported cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimate the prevalence of infection in affected communities. Large-scale seroprevalence studies provide better estimates of the proportion of the population previously infected. OBJECTIVE: To estimate prevalence of SARS-CoV-2 antibodies in convenience samples from several geographic sites in the US. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study performed serologic testing on a convenience sample of residual sera obtained from persons of all ages. The serum was collected from March 23 through May 12, 2020, for routine clinical testing by 2 commercial laboratory companies. Sites of collection were San Francisco Bay area, California; Connecticut; south Florida; Louisiana; Minneapolis-St Paul-St Cloud metro area, Minnesota; Missouri; New York City metro area, New York; Philadelphia metro area, Pennsylvania; Utah; and western Washington State. EXPOSURES: Infection with SARS-CoV-2. MAIN OUTCOMES AND MEASURES: The presence of antibodies to SARS-CoV-2 spike protein was estimated using an enzyme-linked immunosorbent assay, and estimates were standardized to the site populations by age and sex. Estimates were adjusted for test performance characteristics (96.0% sensitivity and 99.3% specificity). The number of infections in each site was estimated by extrapolating seroprevalence to site populations; estimated infections were compared with the number of reported coronavirus disease 2019 (COVID-19) cases as of last specimen collection date. RESULTS: Serum samples were tested from 16 025 persons, 8853 (55.2%) of whom were women; 1205 (7.5%) were 18 years or younger and 5845 (36.2%) were 65 years or older. Most specimens from each site had no evidence of antibodies to SARS-CoV-2. Adjusted estimates of the proportion of persons seroreactive to the SARS-CoV-2 spike protein antibodies ranged from 1.0% in the San Francisco Bay area (collected April 23-27) to 6.9% of persons in New York City (collected March 23-April 1). The estimated number of infections ranged from 6 to 24 times the number of reported cases; for 7 sites (Connecticut, Florida, Louisiana, Missouri, New York City metro area, Utah, and western Washington State), an estimated greater than 10 times more SARS-CoV-2 infections occurred than the number of reported cases. CONCLUSIONS AND RELEVANCE: During March to early May 2020, most persons in 10 diverse geographic sites in the US had not been infected with SARS-CoV-2 virus. The estimated number of infections, however, was much greater than the number of reported cases in all sites. The findings may reflect the number of persons who had mild or no illness or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population.

First Case of 2019 Novel Coronavirus in the United States.

An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient's initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.

Succession Planning and Management Practice in Washington State Local Public Health Agencies.

CONTEXT: Turnover of top local public health officials is expected to be great, with 23% being 60 years of age or older, and another 42% being 50 to 59 years of age. Yet, we know little about the use of succession planning in public health agencies. OBJECTIVE: Describe succession planning practices in local public health agencies. DESIGN: We conducted a Web-based, cross-sectional survey of succession planning practices and followed the career paths of public health officials for 40 months. SETTING AND PARTICIPANTS: The top local public health officials from Washington State's 35 local governmental public health agencies. MAIN OUTCOME MEASURES: Twenty-five succession planning best practices. RESULTS: All 35 agencies responded, resulting in a 100% response rate. Our study found evidence of succession planning practices in Washington State local public health agencies: 85% of agencies selected high-performing high potential employees for development, 76% sent them to formal technical and management/leadership training, 70% used cross-functional team projects, and 67% used stretch assignments to develop their employees. Impetuses to implement succession planning were discovering that large percentages of employees were able to retire soon and that national accreditation requires workforce development plans. Barriers to implementing succession planning included other competing demands for time, belief that the agency's workforce was too small for a formal program, and concerns that there would be union barriers. In 2012, 50% of the officials surveyed said that it would be at least possible that they would leave their current jobs within 5 years. Forty months later, 12 (34%) had left their positions. CONCLUSIONS: We were encouraged by the level of succession planning in Washington State and recommend creating a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation. Developing the public health leaders of tomorrow is too important to be left to chance.

Lessons learned from a policy decision to coordinate a multijurisdiction H1N1 response with a single incident management team.

This case review describes the creation of a single incident management team by 5 independent local public health agencies to respond to the 2009 H1N1 influenza pandemic. It focuses at the policy level, describing relationship building between local public health agency leaders and the conditions required to support such a response. Readers will understand the precursors that allowed for this regionalized response, how the response was implemented, the lessons learned, and recommendations for future responses. As local health jurisdictions and tribes review and update their emergency response plans, they should consider forming a regionalized public health incident management team to conserve overhead resources and to ensure coordinated policies and public messaging for public health incidents that cross geopolitical boundaries.

Rethinking volunteer management using a centralized volunteer staging and training area.

Public health agencies simply do not have enough trained staff or volunteers to effectively respond to a large-scale disaster. Training volunteers "off the street" will be crucial--but time consuming--in a public health emergency. A centralized volunteer staging and training area can help to efficiently register, credential, and conduct just-in-time training of volunteers, while reducing stress, confusion, traffic congestion, and security issues at various mass dispensing clinics.