CAMI on COVID-19: What States are Doing

We live in unprecedented times. Since the outbreak of COVID-19 in the United States earlier this year, more than 60,000 people have died from the virus, almost 30 million have filed unemployment claims just over the last six weeks, and the country as a whole is attempting to learn how to carry on normal life from our homes, assuming one has an Internet connection. Increasingly, the focus is on how to safely and responsibly reopen a currently stalled economy.

Every person, every state and every industry has been impacted by the pandemic. States are on the frontline of crisis response, reacting to new guidance and billions in funding from the federal government to provide services to their citizens: unemployment benefits, food stamps and Medicaid coverage, among a multitude of others. If there were ever a time that called for repeatable solutions to enhance accountability, modernization and innovation, it is now.

As states begin the difficult process of reopening their economies, it is essential that their governments and the private sector work together to meet the challenges identified in the federal “back to work” guidelines, many of which require an unprecedented scaling of the public health system. There is an urgent need to get Americans safely back to work and school, but first we must be confident that this can be done in a way that also protects Americans as much as possible. Government officials and public health experts agree that the best way to do so is with a robust, comprehensive system to identify and diagnose COVID-19 cases, in conjunction with public health education and managed treatment and vaccine distribution once either or both become available.

Former Food and Drug Administration Commissioner Scott Gottlieb echoed this sentiment, noting in his recommended national roadmap for reopening: “To strengthen our public-health surveillance system to account for the unprecedented spread of COVID-19, we need to harness the power of technology and drive additional resources to our state and local public-health departments, which are on the front lines of case identification and contact tracing…we must expand our investments in pharmaceutical research and development into COVID-19 and promote the rapid deployment of effective diagnostics, therapies, and eventually a vaccine.”

What do states need to know now to meet the enormous challenges ahead and operationalize the task before them?

  • All stakeholders agree that testing capacity needs to be increased in order to create the safest environment to reopen the U.S. economy. Testing capacity right now is 150,000 per day across the country, but estimates of need are as high as 750,000 per day. Additionally, as states reopen, it will be more important than ever to ramp up contact tracing to locate, isolate, test and educate individuals who are either infected or have been put at risk. Due to the nature of our economy, it is essential that this effort be coordinated across state lines, and that a national contact tracing and testing system be available to collect and consistently manage data. State and local health departments will need to rapidly expand their workforce and capacity to stand up this sort of effort.
  • This is a daunting task, even when not in the middle of a global pandemic. States will be receiving over $15 billion to support additional testing and contact tracing (with more funding possible in the future). As the availability and need for testing becomes larger, more positive cases will be identified, creating an even greater need for contact tracing. Some states will be able to manage these large increases in calls; however, some states will need assistance.Moreover, states will need to work together to optimize their own responses and capabilities.
  • As Josh Sharfstein, Vice Dean of Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Health noted in a recent conference call with the Council on Foreign Relations: “In scaling up a good contact-tracing effort that is going to be fast enough to get as many cases as possible is going to be a real challenge, which is a challenge that is necessary to embrace in order to be able to have more options as a society.

What is an efficient, scalable solution?

  • We are at a transformational moment in history—attempting to stand up a strong public health system over 180,000 strong in a matter of weeks. Public-private partnerships and the use of private sector talent and expertise are essential to meeting that enormous challenge. These partnerships offer the potential for consistent best practices across multiple states and the federal government; provide critically needed human capital to augment deeply stressed state and local capabilities; and provide a vital method to quickly bridge gaps and break down barriers across silos. Private sector partnerships will allow state and local governments to quickly access the workforce, as well as fast and efficient training, that is needed in short order to most safely reopen state economies.
  • History has already demonstrated that a contact center operated by the private sector in conjunction with state and federal governments can assist in scheduling appointments at local testing centers, as well as coordinating the reporting of test results. This partnership could also support contact tracing efforts in the state and capitalize on the best technology to reach those who are most at risk due to their exposure.The center should also partner closely with state and local health departments—sharing results and helping to ensure the database of those who have had the virus is updated in real time. That database will then provide a ready-made contact list when a vaccine for COVID-19 becomes available to the public. The partnership can also become a key source for expanding education to all individuals about the importance of following public health guidelines and social distancing during the pandemic.

Importantly, this effort can also be scaled up to assist in what will need to be a national system; as the economy opens back up, travel across states will increase and the need to track any infected individuals across state lines.

Finally, all of these capabilities exist today and have, in various forms, already proven their worth. They are, in short, in place and available. The private sector is already prepared with an existing workforce (including many working remotely) and infrastructure to quickly respond to the challenges that face us. The very capabilities that are central to determining the success of state efforts to manage pandemic response and reopen their economy exist.

The private sector has a proven track record of providing governments at all levels with services and capabilities that greatly enhance operational efficiency and improve performance. At a time of crisis, there can be no excuse for allowing arcane policies to constrain government’s ability to capitalize on those capabilities. This must indeed be an “all hands on deck” moment. That means freeing up all qualified hands to ensure the best possible service to the American people, and new, higher levels of accountability, modernization and innovation.

The Center for Accountability, Modernization and Innovation (CAMI) provides thought leadership designed to help government work better for the American people.

We advocate for policies enabling public/private partnerships that drive innovation in and enhance the performance of federally funded public assistance programs, while also improving the quality of service to beneficiaries.