As the burden of the novel coronavirus (COVID-19) plateaus into a perpetual state of public health emergency for 2020, examining the United States’ forgotten epidemic of sexually transmitted infections (STIs) offers insight to a COVID-19 solution. STIs are the long-neglected contagious disease that echo many of the same socioeconomic, political, racial, and structural problems feeding the recursive tragedy of COVID-19. Targeted investments are of critical importance as there is a narrow window of increased public attention and potential federal funding.

A matter of health equity: the need for more targeted funding

Reexamining COVID-19 solutions through the lens of STIs is even more urgent as Congress continues to debate provisions of a second pandemic relief package.  The first pandemic relief- the Coronavirus Aid, Relief and Economic Security (CARES) Act, and the Paycheck Protection Program distributed $175 billion to health care entities and other response efforts. However, funding allocation raises concern for health equity. Disproportionately Black communities with higher health and financial needs received similar relief funds as other counties, reflecting the funding distribution’s disparate impact.

The second round of funding can rectify the first round’s equity issues and fund key features necessary to a functional public health system.  The already record-high rates of STIs are escalating during COVID-19, another uniquely American crisis precipitated by the years of decreased funding weakening the CDC STD prevention budget by 40 percent.  Moreover, antibiotic resistance in gonorrhea continues to rise and now are considered an “urgent threat” by the CDC.  To address the alarming STI problem while also establishing a stronger local public health system, the next pandemic relief package should contain a specific allocation of money to the CDC to support these dual prevention efforts: 1) increasing contact tracers, 2) improving electronic health record systems for data monitoring, sharing and reporting; and, 3) supporting local efforts in public health messaging.

Building a battalion of contact tracers

Many COVID-19, as well as STI carriers are asymptomatic, complicating control efforts and highlighting the need for contact tracers. Contact tracing has been the staple of STI prevention and has often been cited as one key measure for COVID-19 control. A recent report from the Johns Hopkins Center for Health Security calls for an increase in the public health workforce from the current 2,200 contract tracers used for STI and TB to 100,000. Instead of reverting to the thin staffing of the health department contact tracers who were reassigned from their STI tracing responsibilities to COVID-19, permanent investments in this public health workforce infrastructure can provide the increased manpower needed to address STIs while also having staff on standby for future contagious disease outbreaks.

Breaking down technological barriers

The beginning of any public health response begins with timely epidemiological data; however, this has been a historical challenge for STI care and has faced public criticism during COVID-19. The CDC’s mandates on delivering STIs information as a reportable disease are a time-consuming process requiring extra forms and compliance. Now, tech innovations used for STIs are serving as the framework for COVID-10 reporting. Using the Fast Healthcare Interoperability Resources (FHIR), which shares data between clinics and health departments, the CDC has developed electronic case reporting to give public health officials more detailed COVID-19 epidemiology information. Improving electronic systems that automate and facilitate data sharing of contagious diseases is a key addition to both our STI and COVID-19 response.

Public health messaging

Specific strategies to improve STI care involve targeted local communication campaigns to increase awareness of the STI epidemic. Just as there has been incomplete compliance with mask-wearing, Americans, and especially youth, have had declining condom use. Prioritizing awareness efforts in the Federal STD Plan uses social media and creative communications to reach youth audiences and engage faith communities. Research shows that behavior change is more readily accepted when proposed by local, trusted messengers. There is a broad opportunity to increase public health messaging through these methods for both COVID-19 and STI related awareness and healthy behavior changes for topics such as safe sexual practices during COVID-19 and social distancing.

Conclusion

The threat of COVID-19 remains as salient and urgent as ever, but just underneath the surface, the STI epidemic rages on unchecked and underfunded. Making real public health infrastructure investments on a federal, state, and local level is the only chance we have to turn the course on these dual epidemiological disasters.

Rachel Solnick is an emergency physician and can be reached on Twitter @RachelSolnickMD. Cornelius Jamison is a family physician and can be reached on Twitter @CDJamisonMD.

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