Objective:Research on COVID-19’s effect on substance use is mixed, and few studies havefocused on adolescents. We assessed whether implementation of the COVID-19lockdown affected substance use and changed perceptions of psychoactivesubstance availability in middle and high school students.Methods:We assessed self-reported use and perceived availability of alcohol, tobaccocigarettes, electronic cigarettes, marijuana, synthetic marijuana,nonprescribed prescription drugs, and illicit drugs (heroin, inhalants)among middle and high school respondents aged 11-18 years to the RhodeIsland Student Survey (N = 17 751). An administrative pause because ofCOVID-19 lockdowns allowed us to divide results into surveys completedbefore (January through March 2020; n = 13 259) and after (November 2020through May 2021; n = 4492) the lockdown implementation. We determined theeffects of the COVID-19 lockdown using logistic regression models, adjustingfor age, gender/sexual orientation, middle/high school level, and city/townclassification.Results:After the COVID-19 lockdown implementation, the odds of respondents usingpsychoactive substances decreased, with the largest decreases occurring forprescription drugs (odds ratio [OR] = 0.39; 95% CI, 0.28-0.54) and inhalants(OR = 0.37; 95% CI, 0.26-0.53). The odds of respondents perceivingdifficulties in obtaining psychoactive substances significantly increasedafter lockdown implementation, with the largest increases occurring forprescription drugs (OR = 1.53; 95% CI, 1.39-1.69) and illicit drugs (OR =1.65; 95% CI, 1.44-1.88).Conclusions:COVID-19 lockdown implementation was associated with a decreased perceptionof availability of psychoactive substances and use of psychoactivesubstances. Decreases in substance use may be because of decreased perceivedavailability and increased parental support and oversight. Interventionsthat focus on parental oversight and strengthened policies to disrupt thelicit and illicit drug markets are needed.

Objective:Community of Hope Health Clinic (CHHC), a free and charitable clinic inShelby County, Alabama, developed a screening protocol to identify patientswith asymptomatic COVID-19 with the goal of minimizing infection risk forother patients, health care providers, and staff. We sought to determinewhether the use of the CHHC screening protocol identified asymptomaticcarriers of SARS-CoV-2 before their scheduled clinic visits.Methods:The CHHC screening protocol included the use of an adapted Centers forDisease Control and Prevention questionnaire via telephone 48-72 hoursbefore a scheduled clinic appointment, coupled with a second administrationof the questionnaire and a temperature check immediately before thepatient’s scheduled visit. Patients with positive responses to any questionsor whose temperatures were greater than 100.4 °F were refused entry to theclinic, their appointments were rescheduled, and a SARS-CoV-2 test wasrecommended. SARS-CoV-2 laboratory testing was conducted on all patientswith an appointment from October 26, 2020, through February 18, 2021, toverify whether the screening protocol was effective.Results:Of 298 patient encounters, 20 patients screened positive on the SARS-CoV-2patient screen. Another 278 patients screened negative, were seen forpatient care, and received a SARS-CoV-2 test via nasal swab; 274 (98.6%)patients received a negative test result, and 4 (1.4%) patients received apositive test result.Conclusions:The CHHC SARS-CoV-2 screening protocol, as validated by SARS-CoV-2 assay, waseffective in screening out asymptomatic patients infected with SARS-CoV-2before they were seen in clinic. As clinics and office practices return toprepandemic volumes, the use of such a screening protocol can help mitigatethe risk of serious COVID-19 infection, especially for unvaccinatedpatients, health care providers, and staff.

In the United States, the public health response to control COVID-19 required rapid expansion of the contact tracing workforce from approximately 2200 personnel prepandemic to more than 100 000 during the pandemic. We describe the development and implementation of a free nationwide training course for COVID-19 contact tracers that launched April 28, 2020, and summarize participant characteristics and evaluation findings through December 31, 2020. Uptake of the online asynchronous training was substantial: 90 643 registrants completed the course during the first 8 months. In an analysis of a subset of course participants (n = 13 697), 7724 (56.4%) reported having no prepandemic public health experience and 7178 (52.4%) reported currently serving as case investigators, contact tracers, or both. Most participants who completed a course evaluation reported satisfaction with course utility (94.8%; 59 497 of 62 753) and improved understanding of contact tracing practice (93.0%; 66 107 of 71 048). These findings suggest that the course successfully reached the intended audience of new public health practitioners. Lessons learned from this implementation indicate that an introductory course level is appropriate for a national knowledge-based training that aims to complement jurisdiction-specific training. In addition, offering a range of implementation options can promote course uptake among public health agency staff. This course supported the emerging needs of the public health practice community by training a workforce to fill an important gap during the COVID-19 pandemic and could serve as a feasible model for enhancing workforce knowledge for future and ongoing public health threats.

The World Health Organization has identified excessive COVID-19 pandemic–relatedinformation as a public health crisis, calling it an “infodemic.” Social mediaallows misinformation to spread quickly and outcompete scientifically groundedinformation delivered via other methods. Dear Pandemic is aninnovative, multidisciplinary, social media–based science communication projectwhose mission is to educate and empower individuals to successfully navigate theoverwhelming amount of information circulating during the pandemic. This missionhas 2 primary objectives: (1) to disseminate trustworthy, comprehensive, andtimely scientific content about the pandemic to lay audiences via social mediaand (2) to promote media literacy and information-hygiene practices, equippingreaders to better manage the COVID-19 infodemic within their own networks. Thevolunteer team of scientists publishes 8-16 posts per week on pandemic-relevanttopics. Nearly 2 years after it launched in March 2020, the project has acombined monthly reach of more than 4 million unique views across 4 social mediachannels, an email newsletter, and a website. We describe the project’s guidingprinciples, lessons learned, challenges, and opportunities. DearPandemic has emerged as an example of a promising new paradigm forpublic health communication and intervention. The contributors deliver contentin ways that are personal, practical, actionable, responsive, and native tosocial media platforms. The project’s guiding principles are a model for publichealth communication targeting future infodemics and can bridge the chasmbetween the scientific community and the practical daily decision-making needsof the general public.

IntroductionLinking emergency medical services (EMS) data to emergency department (ED) data enables assessing the continuum of care and evaluating patient outcomes. We developed novel methods to enhance linkage performance and analysis of EMS and ED data for opioid overdose surveillance in North Carolina.MethodsWe identified data on all EMS encounters in North Carolina during January 1–November 30, 2017, with documented naloxone administration and transportation to the ED. We linked these data with ED visit data in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. We manually reviewed a subset of data from 12 counties to create a gold standard that informed developing iterative linkage methods using demographic, time, and destination variables. We calculated the proportion of suspected opioid overdose EMS cases that received International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for opioid overdose in the ED.ResultsWe identified 12 088 EMS encounters of patients treated with naloxone and transported to the ED. The 12-county subset included 1781 linkage-eligible EMS encounters, with historical linkage of 65.4% (1165 of 1781) and 1.6% false linkages. Through iterative linkage methods, performance improved to 91.0% (1620 of 1781) with 0.1% false linkages. Among statewide EMS encounters with naloxone administration, the linkage improved from 47.1% to 91.1%. We found diagnosis codes for opioid overdose in the ED among 27.2% of statewide linked records.Practice ImplicationsThrough an iterative linkage approach, EMS–ED data linkage performance improved greatly while reducing the number of false linkages. Improved EMS–ED data linkage quality can enhance surveillance activities, inform emergency response practices, and improve quality of care through evaluating initial patient presentations, field interventions, and ultimate diagnoses.

ObjectivesUsing the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)–associated confirmed and probable deaths in Puerto Rico during March–July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period.MethodsWe described data on COVID-19–associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention’s National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics.ResultsDuring March–July 2020, 225 COVID-19–associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19–associated deaths could have occurred during the study period, up to 413 more COVID-19–associated deaths than originally reported.ConclusionsIncluding probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19–associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.

Objective.The Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has developed instruments to measure the performance of local and state public health departments on the 10 "Essential Services of Public Health," which have been tested in several states.This article is a report of the evaluation of the content and criterion validity of the local public health performance assessment instrument, and the content validity of the state public health performance assessment instrument.Methods.Health department performance is measured using a set of indicators developed for the 10 Essential Services of Public Health and a model standard for each indicator.Content validity of each model standard in the local instrument was addressed by community partners along the following dimensions: the importance of each standard as a measure of the associated Essential Service, its completeness as a measure, and its reasonableness for achievement.All standards for each Essential Service were then judged in terms of their completeness in measuring performance in that service.Content validity of the state instrument was evaluated in a group interview of health department staff members from three states.Criterion validity of the local instrument was assessed for a sample of eight public health departments in Florida and six in New York by examining documentary evidence for selected responses.Criterion validity was also evaluated for a sample of Florida local public health departments and one Hawaii public health department by comparing state health department staffs' judgments of performance against the instrument score.Results.Criterion validity was upheld for a summary performance score on the local instrument, but was not upheld for performance judgments on individual Essential Services.The NPHPSP standards based on the Essential Services have validity for measuring local public health system performance, according to community partners.The model standards are valid measures of state performance, according to state public health departments in three states.Conclusions.