When the coronavirus pandemic made its way to Indiana in March of last year, Dean Paul Halverson of the IU Richard M. Fairbanks School of Public Health took immediate action to help with the response. Efforts led by him and researchers at Fairbanks have made an impact at the university, city and state levels, and have served as a guidepost for national leaders on COVID-19 emergency response.
Dean Halverson was asked to join IU’s executive leadership team under President Michael McRobbie’s direction that focused on incident management guidance for IU.
“We were happy to provide the public health perspective to IU as they began their quest to manage the current crisis, which ultimately resulted in our campuses closing.”
He has also worked closely with IU School of Medicine’s Dean Jay Hess and IU School of Public Health’s Dean David Allison on the university’s Restart Committee appointed by President McRobbie to provide public health guidance and medical direction for the university’s reopening.
In addition to serving the IU community, Dean Halverson and researchers at the Fairbanks School of Public Health have served as resident experts for local organizations. Dean Halverson’s team worked closely with IU Health to assist with their planning efforts for the impending national crisis.
“We created a modeling team, led by Dr. Brian Dixon and Thomas Duszynski, that focused on ultimately developing a model that could be used by hospitals, but also our public health colleagues to anticipate likely caseloads and resource needs,” said Dean Halverson, who was also joined on the team by Drs. Nir Menachemi, Constantin Yiannoutsos, and William Fadel.
Using an existing model for influenza from the Centers for Disease Control and Prevention as a framework, the researchers built an Indiana-specific COVID-19 model.
“We used what we knew from other countries and earlier experiences in this country, Washington state most notably,” he said.
“We started working pretty collaboratively with the Indiana Hospital Association, offering webinars and assistance to all of the hospitals in the state related to doing modeling for their hospitals,” Dean Halverson said. “We also provided the state health department on a weekly basis with updated models for each of the ten preparedness districts.”
Citywide Impact and Contact Tracing
The Indiana COVID-19 model opened the door for Fairbanks researchers to begin working with the Marion County Public Health Department (MCPHD) and Dr. Virginia Caine, director of the MCPHD, to provide forecasting and modeling for all of Marion County, its hospital systems and health department.
Under the leadership of Dr. Joshua Vest in the Center for Health Policy, the school provides continuing guidance to the MCPHD on matters such as reopening plans, guidance for k-12 schools and higher education institutions, and contact tracing.
As the need for contact tracing became more apparent, the MCPHD and city of Indianapolis asked to work with Fairbanks to implement contact tracing. Aiming to make contact with hard-to-reach populations within Indianapolis, the team – led by principle investigator Shandy Dearth – recognized that simply doing contact tracing by phone would not be effective.
“It was with that in mind that we entered into an agreement with the city of Indianapolis for about $10 million to actually hire up to 300 contact tracers and mount that effort,” Dean Halverson said. “My thanks to IU because they were very supportive. The people in human resources and finance, in particular, bent over backwards to accommodate our need to bring on a lot of people in a hurry to support this effort. We appreciate that.”
Statewide Prevalence Testing
Wanting to understand the potential for additional testing in Indiana, Governor Eric Holcomb also reached out to Fairbanks.
“We brought up the idea of developing randomized prevalence testing for the state where we proposed a model that would allow us determine how many people on a scientific basis actually had contracted the disease,” he said.
Within roughly three weeks’ time, the dean’s team received the governor’s buy-in and conducted the first randomized COVID-19 test.
“We were the first state in the country to actually conduct random sample testing – that’s a big deal,” Dean Halverson said. “We were the first to estimate the people who were not necessarily patients in hospitals, but who had the disease.”
The study’s first publication has aided greatly organizations such as the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS) in their forecasting and estimating.
Phase three of the statewide prevalence study wrapped in mid-November and results have been released.
Advocacy for Vulnerable Populations
During the statewide testing initiative, Dean Halverson’s team advocated for testing in vulnerable populations. They worked collaboratively with churches and other faith based organizations to provide testing for more diverse populations.
“That’s one of the ways in which we discovered the disproportionate positivity of populations of color, many of whom fill the roles of essential workers,” Dean Halverson said. “That was really, really important for us – to document the disparities and to recognize the special needs of populations of color.”
Dean Halverson said his team recognizes the many ways in which people of color are disenfranchised or not benefitted by mainstream public health services and how important it is to improve health equity for all.
“Public health has always been focused on health equity, but we need to continue to focus on highlighting the importance of addressing disparities.”
Amidst the pandemic, social unrest within Black communities across the nation grew, and Indiana was no exception. What started as one national emergency, quickly escalated into multiple. After protests began in Indianapolis, a resolution was brought by the chairman of the Indianapolis City-County Council to designate racism as a public health emergency and Dean Halverson spoke in strong support of the resolution.
“The importance of the resolution is that it highlights the differences in life experience and the importance of closely keeping track of progress (or lack of progress) in addressing some of the disparities that we in public health care deeply about.”
Modernization of Public Health as a Whole
In the midst of a pandemic and national emergency, the nation is recognizing that there is a need for public health attention, funding and support. Dean Halverson said the pandemic points out the vulnerability of the public health system in this country, and specifically in Indiana, and how unprepared we’ve been.
“We’ve seen almost a 30 percent reduction in public health funding for emergency preparedness and response since 2001. This is a pattern. We have a national emergency, we invest in public health, everything is over and then we begin disinvesting and reducing our commitment to public health. And when something else arises, we are surprised that our system is not as prepared as it should be.”
In a new article published by Dr. Brian Dixon, Dean Halverson and Dr. Virginia Caine, the team suggests a new organization for public health that conceptualizes health in all policies and a long-term permanent commitment to public health by our policymakers.
The researchers wrote that while public health agencies were challenged when trying to coordinate efforts during the pandemic, the lack of integrated data and the inability to rapidly analyze the data contributed to the slow response to COVID-19.
“We do not have to reinvent the wheel; a framework to address these problems already exists,” said Dean Halverson. “The Public Health 3.0 model supports a transformation of our current public health system by developing multisector coalitions, integrating health into all policies and expanding the public health workforce.”
In addition to utilizing the structure of the Public Health 3.0 framework, the researchers call for advancing U.S. public health information systems by adopting the use of interoperable electronic health records with health care organizations.
In another report, Fairbanks researchers provide an actionable framework for improving public health in Indiana that includes four recommendations to improve the system’s capacity and effectiveness.
The report, “Indiana Public Health System Review,” was led by Paul Halverson, professor and founding dean of the Fairbanks School of Public Health, and Valerie Yeager, associate professor of health policy and management with the school. They designed the report to suggest recommendations for achieving better health for Hoosiers through a more robust public health system that ensures core public health services are provided to all communities.
“COVID-19 sounded the alarm for the shortcomings of our public health system,” Dean Halverson said.
“Indiana ranks 41st of the 50 states for overall health, which is the result of our public health system being chronically underfunded and undervalued. This is the first systemwide report that comprehensively covers a wide range of best practices for state and local health departments and steps for implementation.”
Dean Halverson and researchers at the Fairbanks School of Public Health continue to share their learnings and advice to other states and universities, participating in local media interviews, international panels and forums. They are involved in countless briefings and press conferences for the governor’s office, the state and county health departments, state medical society, and chamber of commerce.
The team plans to continue working closely with local leaders, as many of the school’s researchers are involved with the state’s vaccine planning efforts.