Commentary: California needs to expand access to prevention and treatment of STDs - CALmatters

Posted: 30 Apr 2020 05:25 AM PDT

While California's health system is focused on the COVID-19 pandemic, our state's capacity to test, treat and conduct community tracing activities for sexually transmitted diseases has been dramatically reduced.

With already limited public health resources shifting away from STD prevention activities, rates are expected to surge. According to a recent survey by the National Association of City and County Health Officials, many local health departments have already experienced an increase and are discussing the risk for an outbreak during or following the COVID-19 crisis.

California has the unfortunate distinction of having the most reported cases of STDs in the nation. According to statistics released by the California Department of Public Health, nearly 340,000 Californians contracted an STD in 2018 – a 30-year high. In recent years, gonorrhea rates have increased by 211% and chlamydia rates by 56%. Since 2010, both syphilis and congenital syphilis rates have skyrocketed by 265% and 600%, respectively. Although California's STD epidemic is affecting regions across the state, many counties including Los Angeles, San Francisco, Sacramento, Kern, San Joaquin, and Fresno have numbers much higher than state and national averages.

Health inequities also persist. Approximately 50% of all STDs in our state are experienced by youth ages 15-24. People of color, low-income populations and our LGBT communities are also disproportionately impacted.

Left unaddressed, STDs can lead to serious health consequences. Since many STDs don't have obvious symptoms, they often go undetected and untreated. This can lead to long-term health problems including infertility and cancer. STDs also increase the transmission and acquisition of HIV, particularly among gay and bisexual men.

Although we have made great strides in expanding access to health care since the passage of the Affordable Care Act, coverage gaps remain for STD services.

This has caused too many Californians to forego care or be forced to be resourceful when they are ready to take control of their health. One client sought STD services at the Los Angeles LGBT Center in Hollywood because the center's patient assistance program allowed him to get tested without paying any out of pocket costs. Getting tested not only allowed him to know his STD status, his blood work also revealed that he had leukemia. Although his diagnosis was scary, early detection allowed him to work with his care team to beat his leukemia.

We must ensure that all Californians can get the care they want and need to support their health and well-being. No one should be left without essential services because of their sexual orientation and who they love.

That's why we are calling for California's Family PACT (Planning, Access, Care and Treatment) program to be leveraged to provide a pathway to no-cost STD services for low-income and uninsured LGBT patients.

Family PACT has a network of trusted providers that have long been a resource for high quality, non-judgmental contraceptive and STD care for income-eligible women, men and teens. However, the program is restricted to individuals at-risk for experiencing or causing an unintended pregnancy. This means LGBT patients who need no-cost STD care are excluded from Family PACT services and benefits, and California does not have an alternative program to serve them.

We know the state's economy will continue to be hit hard by the COVID-19 pandemic. Our state spends approximately $1 billion annually on health costs associated with STDs. Expanding access to STD prevention and treatment to all Californians is not only in line with California values, it is fiscally responsible. We cannot afford or accept inaction any longer.

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Julie Rabinovitz is president and CEO of Essential Access Health, a nonprofit organization that promotes sexual and reproductive health care, [email protected] Aaron Fox is the director of government relations at the Los Angeles LGBT Center, a nonprofit provider of LGBT services, [email protected] They wrote this commentary for CalMatters.

Pierce County recruiting health inspectors, STD investigators to ramp up contact tracing - MyNorthwest.com

Posted: 30 Apr 2020 09:55 AM PDT

Pierce County's contact tracing team. (Tacoma-Pierce County Public Health)

Health experts have often emphasized the need for contact tracing as a means to curbing the spread of COVID-19 once states reopen. In Pierce County, officials have a head start in that department, with 15 investigators already on the job, and many more on the way.

Pierce County's 'nimbleness' has kept it functioning during shutdown

The county's contact tracers essentially work as detectives, collecting information, following leads, and reaching out to people who may have been in direct contact with a confirmed coronavirus case. That's all part of a method with a long track record of success in our nation's history.

"Contact tracing is a disease control method that has been used in the U.S. since the 1940s, and it really is effective," Kim Steele-Peter told MyNorthwest. "This is the way that we're going to flatten the curve, and it's our best way of stopping the spread of this disease."

Steele-Peter works as an investigation group supervisor in Pierce County, managing a team of 15 tracers working 10-14 hour days.

Tracing is often paired with testing as one of two ways to limit the spread of the virus once social distancing measures are relaxed. While administering and processing tests requires medical expertise, the work of contact tracing covers a different set of skills.

"It can be challenging to elicit information from someone without sounding judgmental," Steele-Peter pointed out. "It is a definite skill set, and we know who has that."

In March, the county began recruiting employees whose day jobs revolve around that skill set, gradually transitioning their roles within the health department.

"We have staff here — our disease investigators who work in our STD, HIV program or the food investigators from our food program — who have some of the skill set already, and also the institutional knowledge to bring into this," Tacoma-Pierce County Public Health Communications Specialist Steve Metcalf detailed.

"Our disease investigators who work with sexually transmitted diseases, that's what they do all day, is talk to people about their diseases, and then who they've been in contact with," Steele-Peter added.

Between that and the "disease knowledge and background" health inspectors bring to the table, the county has a team of investigators whose previous training has uniquely prepared them for the crisis at hand.

"They're able to bring those other skills to bear to this response to be effective," Metcalf said.

The process

While the team's current caseload is "manageable," the county is prepared to ramp up to between 150 and 200 total contact tracers should it become necessary.

That all comes as part of an ambitious — and ultimately crucial — goal.

"We are attempting to speak with every person who tests positive in Pierce County," Steele-Peter stated.

To that end, an investigator will reach out to a confirmed case, and get the names of every person they've been in close contact with over the last 14 days.

Meanwhile, the meticulous work of following that tree of contacts ensues. Each person is tracked down and asked if they are exhibiting symptoms. If they are, they're advised to act as though they have the virus themselves and self-isolate. During that process, investigators will work with them on the logistics of what that quarantine should look like.

"Sometimes it's figuring out how they can (self-isolate) in place," Steele-Peter described. "Do they live with somebody who is medically vulnerable that maybe they shouldn't be around? Do they need to stay in their room? Do they have a separate bathroom? Does somebody need to bring them meals? There's a lot of 'how do they get supported in that request to stay home?'"

A unique position for Pierce County

While contact tracing is a crucial facet in responding to the coronavirus crisis, Pierce County's strategy is unique. A similar plan has yet to fully take shape in King County.

"The plan for wide-scale contact tracing is still in development with the state in the lead; our role is still being worked out," Seattle-King County Public Health Communications Director James Apa told MyNorthwest.

Being prepared for COVID-19 is now 'part of daily life' at EvergreenHealth

Pierce County, though, has been able to mobilize largely on its own, with the help of both state and local funding.

"Our investigators know this community," Steele-Peter noted. "And Pierce County is really kind of in the sweet spot — we're not a huge county, but we still have a good infrastructure where we have enough staff and enough capacity that we can do it faster."

Washington currently has 565 contact tracers working to track the spread of the virus. By May 11, the state Department of Health hopes to increase that number to 1,500.

It's certainly not glamorous work, but, as many health officials have stated, it's also vital to any state's path to reopening.

"I am really proud of the work that we're doing," Steele-Peter said.

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