Response to the Covid-19 Pandemic: Looking Back and Looking Forward from the Perspective of Local Health Departments in Nebraska

Abstract

Context: The scale and complexity of the COVID-19 pandemic response has revealed some significant successes and limitations of our public health system. Objective: Focused on the pandemic response from the viewpoint of local health departments (LHDs) in Nebraska, this study aimed to identify successes, barriers, lessons learned, and changes needed to improve the local response for future pandemics. Methods: A mixed-methods approach was used to gather information from LHDs in Nebraska. In June 2021, a survey was sent to all LHD directors (n=19), and 17 (89%) participated in the survey. To supplement the survey results, four LHD directors from different areas of the state were interviewed. Results: Successful efforts of the pandemic response included developing stronger partnerships with K-12 schools, distributing the COVID-19 vaccines, and expanding the number of people reached through contact tracing. Barriers included a shortage of staff with the competencies and expertise to respond to a crisis, the lack of funding prior to the pandemic, inconsistent guidance, the politicization of the COVID-19 response, resistance to masking, and misinformation about COVID-19. Conclusions: This pandemic taught many lessons, including the importance of timely and frequent communication with all partners and the public, the need to share accurate data broadly and frequently as possible, the lack of knowledge of public health’s authority to implement emergency public health measures (e.g., quarantine and isolation), and the persistence of staff burnout and retention. Looking forward, baseline funding for LHDs should be expanded to strengthen capacity to hire additional staff, particularly in the areas of epidemiology and communications. Additional investments in common information technology platforms are also essential. Finally, more creative staff resilience solutions are needed to address staff burnout. While essential for LHDs during times of pandemic, such investments can also benefit LHDs when pandemics don’t rage.