Urgent Action Needed to Contain the Spread of COVID-19 Nationwide

November 19, 2020

ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) today released the following statement urging immediate action to contain COVID-19 spread.

As the United States experiences an exponential increase in new infections of COVID-19 nationwide, government officials will have to significantly adjust their response activities to prevent new infections and control the pandemic. State and territorial health leaders are extremely concerned about the rise in COVID-19 cases and the significant preventable morbidity and mortality that will result.

In several weeks, if not sooner, many healthcare systems are projecting that they may need to implement “crisis standards of care.” This action will limit or ration the allocation of healthcare resources within a community and could mean the withholding or withdrawing of life-sustaining treatment from some patients based on risk and survivability criteria. We need to avoid this impending healthcare crisis. In order to do so and prevent further transmission of COVID-19 across the United States, ASTHO recommends immediate consideration of the following five tactics in every state and territory:

1. Direct Leadership Communication and Messaging

It is critical that health officials continue urgently informing elected and appointed leaders to emphasize the importance of preventing COVID-19 infection with simple, evidence-based public health actions. This includes the need for individuals to protect themselves and others by wearing face coverings, physical distancing, practicing hand hygiene, and avoiding indoor crowds.

Local leadership from all sectors, including faith community leaders, business leaders, non-governmental organization leaders, and many others should be enlisted at every opportunity to emphasize messages being shared by public health and healthcare leaders and lead by example. Public acceptance of preventive actions can be increased by leaders modelling desired behaviors to prevent COVID-19 transmission.

2. Deploy Case Investigation and Contact Tracing Resources to Identify Populations Most at Risk

Given the scale and spread of COVID-19 in every state and the current nationwide trends, health departments will most likely not have the capacity to investigate every COVID-19 case and/or follow-up with that case’s contacts for the foreseeable future.

While every effort should be made to investigate all cases possible and encourage full voluntary cooperation by everyone involved to greatly assist in this effort, health officials may have to prioritize case investigation and contact tracing efforts among populations that are at highest risk for infection. This includes individuals living in congregate settings such as nursing homes or homes for the developmentally disabled, essential workers, and their families. Similarly, public communication delivered by state and local communities should stress the need to “Answer the Call,” download exposure notification apps if the state has deployed one, and participate in disease investigation efforts to help prevent the spread of COVID-19.

3. Increase Supports for Isolation and Quarantine Compliance

Health officials have observed a decrease in individual adherence to quarantine recommendations upon receiving a positive COVID-19 test. It is recommended that individuals isolate if they are awaiting a pending COVID-19 test or are a close contact of an individual who has tested positive. However, we are concerned individuals may not be adhering to these guidelines.

Health officials should intensify efforts to support compliance with isolation and quarantine recommendations by helping assure that individuals and families have the social and economic supports to maintain isolation and quarantine for the required duration. Without these crucial supports—such as paid leave time for the entire quarantine period or assistance isolating in an alternative setting to avoid exposing others in the household—public adherence to quarantine and isolation orders will be difficult.

4. Expand State and Territorial Capacity for Rapid COVID-19 Testing

Federal and state partners must collaborate more effectively to align and deploy limited COVID-19 testing resources nationwide and develop shared recommendations on the settings in which rapid antigen testing modalities should be used. In addition, health officials must continue to stress that testing is necessary but not sufficient to prevent infection.

Testing is the first step in isolation and containment measures, but case investigation must follow positive test results. If an individual receives a positive test, they must adhere to isolation orders to avoid infecting others. This means that testing capacity has to be expanded alongside efforts to increase disease investigation.

5. Consider the Implementation of Stay-at-Home Orders and Temporary Closures in COVID-19 Hot Spots

Public compliance with stay-at-home orders and reductions or closures in services provided by certain kinds of businesses or facilities is difficult to enforce. Elected leaders and health officials should consider the benefits of preventing transmission by introducing stay-at-home orders and business closures in areas with high COVID-19 positivity rates.

Closures of in-person services should focus on the settings in which COVID-19 is the most likely to be transmitted, which include places were people congregate for long periods of time and may remove their face coverings. Priority settings include restaurants, bars, places of worship, and gyms where sustained contact between an infected individual and others may be difficult to prevent. Blanket stay-at-home orders may be necessary for containment in the future if more localized efforts are not adhered to and viral transmission continues. Efforts to support businesses that are required to temporarily close and their employees should be implemented by local, state, and federal governments whenever possible.

These five tactics will help stop the spread of COVID-19 and prevent needless suffering and death. Even with the possibility of a vaccine being delivered to healthcare workers and other high priority populations by the end of the year—and potentially to all Americans by spring or summer 2021—the need for prevention and control of COVID-19 through the tactics above will remain urgent. Action must be taken now to avoid further infections and help reduce the need for hospitalization and other demands on the health care system.

Additional information about ASTHO and its members may be found on the ASTHO website.


ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories and freely associated states, and Washington, D.C., as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice.