Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.

The Diversity of Challenges in the Control of Measles Outbreaks.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org .

Physician training rotations in a large urban health department.

Hospitals are the normal setting for physician residency training within the United States. When a hospital cannot provide the specific training needed, a special rotation for that experience is arranged. Linkages between clinical and public health systems are vital to achieving improvements in overall health status in the United States. Nevertheless, most physicians in postgraduate residency programs receive neither training nor practical experience in the practice of public health. For many years, public health rotations have been available within the Los Angeles County Department of Public Health (and its antecedent organizations). Arrangements that existed with local medical schools for residents to rotate with Los Angeles County Department of Health hospitals were extended to include a public health rotation. A general model for the rotation ensured that each resident received education and training relevant to the clinician in practice. Some parts of the model for experience have changed over time while others have not. Also, the challenges and opportunities for both trainees and preceptors have evolved and varied over time. A logic model demonstrates the components and changes with the public health rotation. Changes included alterations in recruitment, expectations, evaluation, formal education, and concepts related to the experience. Changes in the rotation model occurred in the context of other major environmental changes such as new electronic technology, changing expectations for residents, and evolving health services and public health systems. Each impacted the public health rotation. The evaluation method developed included content tests, assessment of competencies by residents and preceptors, and satisfaction measures. Results from the evaluation showed increases in competency and a high level of satisfaction after a public health rotation. The article includes examples of challenges and benefits to a local health department in providing a public health rotation for physicians-in-training and how these challenges were overcome.

Reinvigorating performance evaluation: first steps in a local health department.

The ability of a local health department to assess and improve employee performance through an effective evaluation process is critical to overall organizational success. A constructive performance evaluation process not only provides meaningful feedback on work performance but also provides opportunities to reinforce work behaviors that support the organization's mission, to recognize exceptional work, and to guide future growth and learning. The Los Angeles County Department of Public Health is creating a new approach to performance evaluation that recognizes 3 distinct components of work performance: standard business practices, competencies, and standards of practice. This multidimensional perspective acknowledges that the expectations of workers are complex and that evaluations of performance are not easily captured with single-dimension assessment tools. This report describes the conceptual relationships of these 3 components and how they integrate to form a single performance evaluation process. Key elements within this structure include a base document of competencies for all workers, expanded competency sets for professional staff, role-specific duty statements for workers who perform similar work, and standards of competent practice related to the mission of units to which individuals are assigned. Key first steps are to define the terminology of performance evaluation and to create role-specific duty statements.

The quality improvement experience in a high-performing local health department: Los Angeles County.

Quality improvement in public health is a key element in the movement toward accreditation. Multiple national, state, and local initiatives are under way to define quality in a public health context and to develop tools and promising practices to support quality-improvement efforts in local health departments. Until recently, efforts to improve quality at the local level have largely focused on performance measurement to assess the relationship between inputs, outputs, and outcomes. The Los Angeles County Department of Public Health has developed its own unique approach to quality improvement. This approach includes focusing on three overlapping areas (professional practice, performance improvement, and public health science) that align closely with essential public health services 8 (competent worker), 9 (evaluation), and 10 (research). Broadening the focus of quality-improvement efforts to include these three areas (rather than performance improvement alone) provides additional opportunities to address key infrastructure issues that may affect the quality of services that are provided to the public and, thus, health outcomes. While the experience in Los Angeles County parallels other efforts, it includes unique elements that will be of use to public health professionals in other agencies.

Laboratory-measured pregnancy rates and their determinants in a large, well-described adult cohort.

OBJECTIVE: To measure the pregnancy rate directly, to describe the characteristics of women who become pregnant, and to identify the predictors of pregnancy. No recent studies have estimated population pregnancy rates using objective, laboratory-based criteria. Furthermore, none have characterized predictive factors of pregnancy. METHODS: Population-based prospective cohort study of 5578 women, ages 18 to 44, on active duty at Fort Lewis, Washington, from 1995 to 1997. Main outcome measures were standardized pregnancy incidence rate and predictive factors for pregnancy. RESULTS: In the cohort, 887 pregnancies and 597 births occurred during the study period. The age- and race-standardized pregnancy rate was 108.1 per 1000 person-years. When compared with the 1995 U.S. population, the pregnancy rate ratio was 1.05 (95% confidence interval, 0.96-1.14). Factors that significantly affected the likelihood of pregnancy included age (=0.87/year), marital status (3.0, married versus single), race (1.2, African American versus Caucasian), Pap smear during study period (0.6), educational level (1.8, graduate training versus high school), and at least one prescription for oral contraceptives during the study period (0.8). CONCLUSIONS: Standardized pregnancy rates in the study population were statistically indistinguishable from United States estimates. Use of health care services was an important independent determinant of pregnancy occurrence.