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Association of State and Territorial Health Officials (ASTHO) [website]
"The Association brings together the nation's leading public health experts to address issues including pandemic influenza, public health threats from hurricanes and other natural disasters, dangerous trends in unhealthy lifestyles, and access to vaccines and other healthcare. ASTHO's meetings, webcasts, teleconferences, and other events provide forums for sharing best practices and dealing with existing and newly identified public health threats, such as the importation of toys containing lead and the spread of antibiotic resistant infections in communities. ASTHO provides educational, training and leadership development opportunities designed specifically for cabinet-level state health agency leaders." The website includes information about each of ASTHO's activities and programs, which include: Health Reform; Marketing Public Health; Access; Health Equity; Infectious Disease; Environmental Health; Prevention & Health Promotion; Preparedness; Public Health Informatics; State Health Services; Accreditation and Performance Standards; and Workforce Development.
Association of State and Territorial Health Officials (U.S.)
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Mid America Alliance -- Four Years Later
"All states recognize the importance of mutual aid, as evidence d by their participation in the Emergency Management Assistance Compact (EMAC) which allows them to share resources during governor-declared emergencies. Infectious diseases such as mumps and pertussis, natural disasters such as tornadoes, and intentional acts of terrorism are among the many incidents that can stress the capacity of state health agencies. Mutual aid allows states in need to request personnel and other assets to supplement their activities and provide relief to overextended staff. The need for staff augmentation during emergencies is perhaps no greater than in the ten states in Regions VII and VIII. These states comprise nearly a quarter of the nation's land area, yet they contain less than eight percent of the U.S. population. Mounting an effective response with limited resources, often over vast distances, is difficult for any state health agency to do on its own. Adding to this difficulty, EMAC can only be used in governor- declared emergencies; very few public health crises ever rise to that level, no matter how much a state health agency's capacity is stressed. The Mid America Alliance (MAA) was created to address just these challenges."
Association of State and Territorial Health Officials (U.S.)
2007-08
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COVID-19 Pandemic Further Strains Public Health Workforce
From the Introduction: "Prior to the COVID-19 [coronavirus disease 2019] pandemic, investment in public health was declining nationwide. ASTHO's [Association of State and Territorial Health Officials] 2020 Profile of State and Territorial Public Health--the only comprehensive source on public health agency resources and infrastructure trends--showed a nearly 10% reduction in public health workforce between 2019 and 2021 and a 10.3% decrease in state and federal public health funding between 2010 and 2018. Although public health agencies maintained core services despite the reduction in funding, the underinvestment left a tenuous and fragile public health system to respond to the COVID-19 pandemic. The public health workforce weathered extraordinary conditions in responding to the COVID-19 pandemic, including long shifts, potential exposure to the disease, and abuse and threats from the public. These intense conditions negatively impacted the mental and emotional health of the workforce, with 52.8% of public health workers reporting symptoms of anxiety, posttraumatic stress disorder (PTSD), or suicidal ideation in Spring 2021."
Association of State and Territorial Health Officials (U.S.)
2022-02-01?
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Privacy & Pandemic Flu Guide
"The Privacy and Pandemic Flu Guide is designed to aid public health professionals when privacy concerns are raised about activities related to pandemic flu planning and response. The guide describes four steps that will walk a public health professional through an analysis of the activities. The guide was developed as a result of a May 2007 discussion among a small group of experts in privacy and preparedness. This guide is intended to be a dynamic document, and it is hoped that feedback from the field on its utility will inform future iterations. In recent years, much attention has been given to public health legal preparedness, including emergency powers and quarantine and isolation implementation. Public health legal preparedness also involves awareness of federal and state laws that relate to the collection, protection, use, and disclosure of information during public health emergency planning and response. In May 2007, ASTHO convened a group of subject matter experts to discuss privacy issues related to pandemic flu preparedness and response. The group was made of representatives from ten public health jurisdictions, as well as the private sector, national organizations, and federal agencies. This guide is a product of that discussion. It is designed to support public health professionals in protecting the public's health while balancing the need to protect information from wrongful or harmful disclosure."
Association of State and Territorial Health Officials (U.S.)
2007
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Model Emergency Response Communications Planning for Infectious Disease Outbreaks and Bioterrorist Events, Second Edition
"The first edition of this planning tool was released in May 2000. Following the attacks of September 11, 2001, and subsequent release of anthrax spores, a second edition was warranted. This edition contains updated information and includes Infectious Disease Fact Sheets that can be modified and reproduced for local use. While state and federal agencies have deemed public health preparedness to respond to infectious disease and bioterrorism threats essential to safeguard the nations well-being, the resources needed to support such planning efforts have not always been available. Recent events, however, have yielded compelling arguments to commit the resources necessary to develop and maintain strong public health infrastructures with systems prepared to respond immediately to biologic and chemical attacks that threaten the public health. ASTDHPPHE and its partners hope that the information provided in this document will advance that goal."
Association of State and Territorial Health Officials (U.S.)
2001-10
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Position Statement: Pandemic Influenza Antiviral Stockpiling
"Pandemic influenza poses a tremendous threat to the United States and to the world, with the potential to impact not only the health of the population, but society overall. Antivirals are one of several measures to control the impact of pandemic influenza, and their use must be balanced with other countermeasure and containment options. The Department of Health and Human Services' (HHS) Pandemic Influenza Plan, released in November 2005, calls for stockpiling antivirals to treat 25% of the U.S. population during a pandemic - approximately 81 million treatment courses. This represents a significant investment of resources, including time and money, at both the state and federal levels. The current antiviral stockpiling proposal, announced by the federal government in early 2006, is a joint activity primarily between the states and the federal government, with the federal government purchasing a total of 50 million doses and the states purchasing up to 31 million doses at a subsidized price through federally-negotiated contracts with two drug manufacturers. This countermeasure must be managed and used in the most efficient and equitable manner to ensure maximum impact."
Association of State and Territorial Health Officials (U.S.)
2006
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State Pandemic Influenza Summits: Building Partnerships for Pandemic Preparedness
"All states and territories were asked to hold a pandemic influenza planning summit during the first half of 2006, as part of the national pandemic influenza planning process. U.S. Secretary of Health and Human Services (HHS), Michael O. Leavitt, requested the summits to inform and involve public health, emergency response, political, economic and community leadership in the pandemic planning process and to facilitate coordination among all of these groups. The summits were planned by the states, with input from federal coordinators. While state governors led the summits, state health agencies were most often the lead agency in planning the event. Each state summit was organized differently-some occurred in the morning, some were afternoon summits, and some states had all-day summits with morning or afternoon break-out sessions. This report captures the general trends, experiences, and outcomes of the summits, and highlights innovative planning mechanisms that may be adapted for other health-related purposes. The information in this report comes from debriefing interviews that the Association of State and Territorial Health Officials (ASTHO) conducted with 37 states following their individual summits. ASTHO appreciates the collaborative work being done by HHS, including the Centers for Disease Control and Prevention (CDC), and the Department of Homeland Security (DHS) to ensure the nation is prepared for an influenza pandemic. Their participation in these summits helped raise public, political, and media attention for pandemic preparedness and reinforced on-going planning and preparedness efforts by state and local public health agencies."
Association of State and Territorial Health Officials (U.S.)
2006
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Public Health Legal Authorities to Collect, Use, Share, and Protect Information [fact sheet]
From the Overview: "Public health agencies need to collect, use, and share information to prevent disease and injury and protect the public against natural, accidental, and intentional health threats. Various federal and state laws may impact public health activities regarding such information. Public health agencies may collect and maintain information that identifies an individual or is sensitive in nature, such as information about communications systems or detailed emergency response plans. In these situations, freedom of information (FOI) laws establish parameters for information that must be shared, upon request, and that which may be exempted from public disclosure. In applying the laws, public health agencies may need to juggle competing interests and balance individual privacy against the need to protect or inform the public. Public health agencies face additional challenges when sharing information with law enforcement, especially when conducting a joint investigation where a public health threat may involve criminal activity."
Association of State and Territorial Health Officials (U.S.)
2020
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Addressing Communication Challenges During an Infectious Disease Emergency Response: State Experiences from the H1N1 Pandemic
From the Introduction: "Communication overload can be a major challenge during an emergency response as large amounts of information are directed at federal, state, and local health agencies from multiple sources. Risk communication principles dictate that one must be first, be right, and be credible, but it may be difficult to balance these principles in a time when information is rapidly changing. During the 2009 H1N1 [swine flu] pandemic, data and guidance changed quickly. States found it difficult to keep up with and take action on all of the information they were receiving. After the pandemic, they were able to reflect on what worked well during the response and what areas could be improved. This document draws from state experiences during the H1N1 pandemic response and discusses potential ways to address communication challenges that state health agencies (SHAs) may face when responding to an infectious disease outbreak, including tools available for more effective and efficient communications. These suggestions were compiled from evaluations of communications during the H1N1 pandemic, including three state after-action reports (New Jersey, Kentucky, and Iowa) funded by ASTHO [Association of State and Territorial Health Officials]."
Association of State and Territorial Health Officials (U.S.)
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Infectious Disease Policy - Fact Sheet: Recent Examples of Emerging Zoonotic Diseases
"Diseases that are transmitted from animals to humans are called zoonotic diseases, or zoonoses. It is estimated that 60% of human diseases and 80% of potential bioterrorism agents are zoonotic in nature. Zoonotic diseases can be transmitted through food or drink, insect bites, skin wounds, mucous membranes and inhalation. Oftentimes, animals infected with zoonotic disease organisms often do not show obvious signs of illness. Instances of zoonotic diseases are increasing worldwide."
Association of State and Territorial Health Officials (U.S.)
2007-07
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ASTHO Survey of State and Territorial Pandemic Influenza Antiviral Purchase and Stockpiling
"In October 2006, ASTHO [Association of State and Territorial Health Officials] conducted a survey of the states and territories to provide a point-in-time picture of the states' antiviral purchasing and stockpiling activities and plans. This survey is a follow-up to a survey that was conducted in April 2006, the results from which are available on ASTHO's web site. ASTHO received a total of 54 responses from 50 states, the District of Columbia, and 3 territories. State and territorial responses reflect activities as of October 1, 2006."
Association of State and Territorial Health Officials (U.S.)
2006-10
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Social Distancing Law Project: Legal Consultation Meeting Template
This guide from the Association of State and Territorial Health Officials provides a template and an influenza outbreak scenario that allows key stakeholders to test a jurisdiction's ability to implement coordinated social distancing measures.
Association of State and Territorial Health Officials (U.S.)
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Coordinated, National Approach to Scaling Public Health Capacity for Contact Tracing and Disease Investigation
From the Document: "As the nation looks to restart the economy and recover from the COVID-19 [coronavirus disease 2019] pandemic, reopening entirely will depend on expanded public health testing and contact tracing efforts, sustained healthcare system capacity to respond to new outbreaks, and public compliance with existing and new containment and mitigation efforts. More specifically, decisions and plans to restart, recover, and reopen local and state economies rest on three things: (1) local and state COVID-19 testing capacity, (2) the ability of the public health and healthcare system to quickly contain future outbreaks and associated healthcare surges, and (3) public understanding of and compliance with localized stay-at-home orders and other prohibitions on mass gatherings as these restrictions are safely and gradually reduced and eliminated."
Association of State and Territorial Health Officials (U.S.)
Fraser, Michael R.; Lane, J. T.; Ruebush, Elizabeth . . .
2020
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Leading Through Crisis: Supporting Workforce Resilience
From the Overview: "Health department staff are right in the center of COVID-19 [coronavirus disease 2019] response efforts. In addition to their regular roles, many have taken on additional responsibilities such as contact tracing, establishing alternative care sites, administering testing, and risk communications, while also reacting to changes in their personal lives. Agency leadership must therefore work to maintain staff morale and ensure that health department staff are mentally and physically equipped to play their roles in the public health response. Leaders are now prioritizing workforce resiliency to eliminate or decrease employee stress, burnout, job dissatisfaction, or an inability to sustain mission-critical public health activities. Therefore, health agency leaders should prioritize maintaining or improving organizational culture and workforce resilience infrastructure to ensure staff are poised to respond during this and any future emergency."
Association of State and Territorial Health Officials (U.S.)
2020-04-27
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Healthcare Surge Capacity Planning--Modeling as a Decision-Making Tool for Public Health Officials
From the Overview: "Modeling allows health officials and policymakers to make decisions based on future projections. States are using an array of COVID-19 [coronavirus disease] modeling tools to inform community mitigation and hospital response strategies; however, differences in the inputs, assumptions, and data systems may result in different forecasts. This brief will help states understand how projections are calculated across several models, each of which have been cited by the media and used or developed by state/territorial health officials and ASTHO [Association of State and Territorial Health Officials] alumni. Although there are at least a dozen models in use across the nation, the four cited in this brief represent a sample that is designed to forecast hospital capacity at the regional or state level."
Association of State and Territorial Health Officials (U.S.)
2020-04-03
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Coronavirus Disease 2019 (COVID-19) Response Hub [webpage]
From the Webpage: "The Association of State and Territorial Health Officials (ASTHO) is working with our members, federal agencies, and association partners to ensure that state and territorial agencies have the resources and information they need to effectively respond to the coronavirus (COVID-19) outbreak. ASTHO created this hub as a way to share mapped data requested by members. Data displayed and map visualizations will continue to be updated in subsequent versions."
Association of State and Territorial Health Officials (U.S.)
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Emergency Supplemental Funding to State, Local, Territorial, and Tribal Governments
From the Document: "In response to the 2019 novel coronavirus (COVID-19), President Trump signed three separate emergency supplemental funding packages into law to support efforts to prevent, prepare for, and respond to COVID-19 domestically and internationally. This brief highlights the total amount of supplemental funding from all three bills directed to state, local, territorial, and tribal governments."
Association of State and Territorial Health Officials (U.S.)
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Preparing for and Responding to Hospital and Intensive Care Unit (ICU) Surge
From the Overview: "In a pandemic response, hospitals and ambulatory centers may reach capacity and must enact emergency surge plans. Many hospitals have surge plans that involve transfer or diversion to other nearby hospitals not experiencing surge. COVID-19 infection and its rapid onset could quickly overwhelm any local and/or state healthcare system. State public health agencies may be asked to provide guidance and policy direction for emergency hospital surge. The following policy actions and resources offer information for public health officials to address this surge during a pandemic."
Association of State and Territorial Health Officials (U.S.)
2020-03-23
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Lessons from the Trenches: Leading During a Public Health Crises [podcast]
From the Website: "In just a matter of weeks, the situation around COVID-19 in the United States altered dramatically. Now, dozens of states have called for non-essential businesses to close and for residents to stay at home. It's an evolving situation that's testing many aspects of American life. On this episode, we speak with two public health veterans who led state health departments during times of public health uncertainty--like H1N1 and Ebola. Our guests discuss the lessons they learned during trying times, the advice they'd give the public health workforce, and their thoughts on the situation surrounding COVID-19."
Association of State and Territorial Health Officials (U.S.)
Sharfstein, Joshua M.; Devlin, Leah
2020-03-27
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Childcare Services for Essential Workforce Personnel
From the Overview: "As the COVID-19 case count climbs nationally, states are prioritizing childcare services to assist parents who are participating in pandemic relief efforts, including frontline medical professionals, emergency responders, and law enforcement. ASTHO [Association of State and Territorial Health Officials] has compiled the following list of state plans and resources for jurisdictions looking to ensure continuity of childcare services to essential personnel for the duration of the outbreak."
Association of State and Territorial Health Officials (U.S.)
2020-03-23
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Postponing Elective Procedures to Increase COVID-19 Healthcare Capacity
From the Overview: "The rapid spread of COVID-19 [coronavirus disease 2019] in the United States indicates an imminent surge of health facility visits that could overwhelm the U.S. healthcare system. In preparation for this influx of patients, jurisdictions and institutions can start applying crisis standards of care (CSC) principles, which encourage suspending or postponing non-emergency or elective procedures in order to devote staff, time, supplies, and other resources to COVID-19 cases. Below are recent state policy actions, contextualized considerations, and resources to inform future policy decisions."
Association of State and Territorial Health Officials (U.S.)
2020-03-23
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COVID-19: Simple Answers to Top Questions; Risk Communication Field Guide Questions and Key Messages
From the Introduction: "In February 2020, ASTHO [Association of State and Territorial Health Officials] sponsored the development of 'COVID-19: Simple Answers to Top Questions' with risk communication experts and a working group of State Health Officials using the science-based, risk communication message mapping development process.ii 'Message Maps' are risk communication tools used to help organize complex information and make it easier to express current knowledge. The development process distills information into clear and easily understood messages. [...] In the following pages, you will find 45+ top questions about COVID-19 answered with detailed message maps. ASTHO recommends that you review the Appendix 'Media Interviews: Tips and Pitfalls' before you engage with the media."
Association of State and Territorial Health Officials (U.S.)
Covello, Vincent T.; Hyer, Randall N.
2020-03-25
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Ventilator Use and Allocation: Key Considerations and Examples
From the Overview: "Mechanical ventilation is a life-saving measure for people experiencing respiratory distress from trauma or severe respiratory conditions and diseases affecting lung function. Hospitals, acute care settings, and other skilled nursing facilities maintain an inventory of ventilators, however, the demand for these resources is likely to increase due to the COVID-19 response. When hospital surge capacity is reached, state public health officials may be asked to provide guidance or enact emergency standards of care to provide direction to hospitals and health care providers."
Association of State and Territorial Health Officials (U.S.)
2020-03-23
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COVID-19 Intervention Actions: Supporting Individuals Experiencing Homelessness
From the Overview: "The spread of COVID-19 [coronavirus disease 2019] in U.S. communities presents unique challenges for people experiencing homelessness. As nationwide mitigation efforts for COVID-19 are implemented, strategies to prevent the spread of COVID-19 within the homeless population - which already experiences increased risks and challenges for disease prevention (e.g. limitations to frequent handwashing, crowding in shelters) - should be considered. The U.S. Department of Housing and Urban Development (HUD) and the U.S. Interagency Council on Homelessness (USICH) provide policy and programmatic guidance and resources for homeless and housing services across the country, as well as coordinate housing and the care of homeless people."
Association of State and Territorial Health Officials (U.S.)
2020-03-19
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COVID-19 Intervention Actions: Providing Medication-Assisted Treatment for Opioid Use Disorder
From the Overview: "This document summarizes recent guidance for providing medication-assisted treatment (MAT) for opioid use disorder during the COVID-19 [coronavirus disease 2019] outbreak. This summary was compiled by ASTHO [Association of State and Territorial Health Officials] staff at a specific point in time and will be updated periodically as new information is available. The COVID-19 pandemic comes at a time when the United States is still grappling with the opioid epidemic. Along with concern for populations traditionally vulnerable to infectious disease, those who use substances are now considered particularly vulnerable to COVID-19 (especially if their substance use is through smoking). In order to provide continuity of care and reduce the severity of the potential intersection of these two epidemics, federal and state agencies have begun to relax restrictions around take-home medications like methadone and explore telemedicine options."
Association of State and Territorial Health Officials (U.S.)
2020-03-19
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Using Telehealth to Reduce Healthcare Worker and Patient Exposures -- Considerations for State and Territorial Health Leaders
From the Overview: "With increased efforts to advance community mitigation of COVID-19 [coronavirus disease 2019], public health and healthcare sectors should consider utilizing or leveraging telehealth services. Given the trends in strained healthcare capacity observed in Italy, and healthcare worker transmission of COVID-19 observed in China, telehealth could be a viable option to enhance social distancing measures and reduce healthcare worker and patient exposure of COVID-19 in healthcare settings. The use of telehealth during the COVID-19 public health emergency can be used for screening, testing, and treatment of COVID-19, as well as the provision of other clinical services in order to reduce the risk of transmission in healthcare settings."
Association of State and Territorial Health Officials (U.S.)
2020-03-18
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Social Distancing Law Project: Legal Assessment Template
The purpose of this guide is to assist jurisdictions in identifying the full range of laws, regulations, policies, and plans available to public health agencies related to social distancing measures against an influenza pandemic or a similar, highly virulent infectious disease.
Association of State and Territorial Health Officials (U.S.)
2010-05-10?
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Using Telebehavioral Health to Increase Access to Care for Rural and Vulnerable Populations Amid COVID-19
From the Document: "There are an estimated 11.4 million adults living with a serious mental illness and 20.3 million people aged 12 or older with a substance use disorder in the United States. Pandemics and infectious disease outbreaks such as COVID-19 [coronavirus disease 2019] can increase fear-induced behaviors and trigger or worsen psychiatric disorders such as depression, anxiety, post-traumatic stress, and substance use. Compounding this burden are the pre-existing disparities that rural and vulnerable populations face, including higher rates of poverty, absent or inadequate health insurance coverage, and limited public transportation options. During this time, it is critical to consider strategies that maintain and expand effective behavioral healthcare services to these already-stressed populations. Federal agencies and states have temporarily expanded access to telehealth services to increase access to care. One strategy that states and territories are leveraging to deliver behavioral health services and reduce health disparities during this pandemic is telebehavioral health, a form of telehealth that utilizes virtual communication technologies to provide mental health and substance use services."
Association of State and Territorial Health Officials (U.S.)
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Preparedness Planning for State Health Officials: Nature's Terrorist Attack: Pandemic Influenza
"Almost a century after the Spanish flu, the United States remains unprepared for pandemic influenza, an event which could affect an extraordinary number of people and last more than a year. It remains a challenge to convey the potential severity of a pandemic to key law and policymakers, as well as individuals in the medical and public health communities...The following checklist provides state health officials with a preliminary means of assessing their jurisdictions' readiness to respond to a pandemic. The checklist is not exhaustive, but identifies major issues that each state will need to address during a pandemic. The list also differentiates between issues that are specific to pandemic influenza and those that have broader utility for public health emergency preparedness. The overlap demonstrates why state health officials have an unprecedented opportunity, using their bioterrorism assessments and plans as scaffolding, to help create strategies that will improve their states' response to future pandemics. The full report offers a more comprehensive description of the challenges involved in pandemic planning and response."
Association of State and Territorial Health Officials (U.S.)
2002-11
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Administrative Preparedness: Strategies for Managing and Streamlining COVID-19 Response and Recovery
From the Overview: "A strong COVID-19 [coronavirus disease 2019] response requires state and territorial health departments to be nimble and aggressive to quickly mobilize manpower and resources. In order to provide necessary surge capacity, health departments must carry out accelerated administrative processes to ensure a timely public health response. Administrative preparedness encompasses a broad range of processes that may include emergency fund management, service contracting, critical supply and equipment purchasing, fiscal reporting, staffing, and volunteer management. This brief will provide leaders with considerations to support their administrative response, including examples of state policy actions that facilitate efficient pandemic response and recovery efforts."
Association of State and Territorial Health Officials (U.S.)
2020-04-14
