The COVID-19 pandemic strained the capacity of local health departments across Virginia. While CI/CT has always been a vital part of protecting the public and providing actionable information, LHDs struggled to meet the demands of CI/CT given the high volume of cases and contacts. Data entry was backlogged, impacting the ability of public health professionals to act on real-time information. Lack of complete COVID-19 surveillance data limited public health’s ability to inform their local communities of the actual burden of COVID-19 disease in their area. Congregate settings, like long-term care facilities and schools, were requesting local health department assistance from already overburdened public health staff. Exacerbating the staffing problem were high turnover rates at the local level as the stress and demand of the job took its toll on the workforce. The Virginia Department of Health recognized the need to increase and coordinate support for local health departments. Local health agencies needed scalable staffing flexible to current needs. The staffing needed to be rapidly available and tailored to the needs of the local agency. Not only would this enable a better response from local health departments, it would enable a better public health response for all Virginians.

The Virginia Department of Health facilitated the hiring of five regional surge teams (RSTs) by conducting initial screening of applicants and disseminating their information to regional staff. Virginia Regional Epidemiologists, who provide technical consultation and guidance to local health departments, completed interviews and hiring. The surge staff were required to have a background in biology, public health, or epidemiology, with preference given to those with a Master of Public Health or clinical care degree. Regional Containment Advisors were specifically hired to oversee the RSTs and arrange for their training. Their training required work with a local health department to ensure competency around specific local requirements. When the capacity of a local health district to respond to a rise in COVID-19 cases was exceeded, they requested RST support. The request specified the number of staff needed, the specifics of the work, the location (remote or in-person), after-hours requirements, and language skills. Assignments could be as short as a day or as long as 9 months. While RSTs were mainly deployed to local health districts within their region, if the need arose, they could deploy them to any region across the state, even aiding Central Office.

The RSTs provided a rapid, flexible, highly trained staff to support public health departments across the state of Virginia during times of intense demand. Local public health staff commended their commitment and competence. As just one example of their capabilities, four RST members started work within 3 days of the LHD request, conducted CI/CT for a month working 595 hours, completing 384 case investigations, and reaching 154 contacts. RSTs provided personalized investment, care, and support to thousands of Virginians during the pandemic. Residents of the Commonwealth praised their professionalism, abilities, and personal attention. One resident acknowledged “their ability to often turn their public health hats into a hat of a social worker when needed, as well as the patience and compassion that was put into each phone call.” Another case said she had never received such kindness and there were no words to describe how thankful she was. With a decrease in CI/CT, RSTs are focusing on investigating hospitalized cases, conducting community and congregate setting testing events, working outbreak investigations, ensuring data quality, and assisting with special projects. Their competencies enable a seamless transition to other public health work.

A major success of this program was the competence of the RSTs. In contrast to hiring individuals who could be trained in specific procedures, RSTs were hired because they were looking to advance or continue a career in public health. This focus on public health professionals limited turnover among staff and increased their aptitude. Adjusting to demand in workflow was a constant challenge. RSTs worked long days, holidays, and weekends during periods of intense demand, but a policy change impacting CI/CT would abruptly decrease their workload. Fortunately, their capabilities enabled them to transition to data quality projects, community testing events, and outbreak investigations. The RSTs presented an additional opportunity for best practices to be shared among districts and regions. Surge team staff would share interesting or efficient procedures they observed in their assigned district with others. However, a lack of a standardized way to disseminate this knowledge meant best practices were not circulated as effectively as they could have been. The RSTs were a successful interplay of state and local public health implementing a sustainable, flexible system to assist overburdened public health staff and provide a better response to the residents of Virginia.