美国数百万失业人员何去何从？专家建议充实社区卫生队伍

As COVID-19 cases escalate across the U.S., so do the desperate calls for personal protective equipment for health workers, and the pleas for ventilators they could deploy to save lives. Companies and individual Americans have taken to sewing and 3D-printing face masks, and manufacturing floors are being repurposed to make ventilator parts. There appears to be, at long last, a slow churning of public and private sector activities to produce and distribute that essential gear. Whether health workers can access gear in time before the entire health system gets overwhelmed, we don’t yet know.

But as we cling to a faint hope that masks, ventilators, and other necessary equipment might be coming in relief—who will support and relieve the caregivers who will wear and use that gear? With a growing health worker shortage nationwide, doctors, nurses, and physician’s assistants are already being reallocated from other departments, drafted out of retirement, and allowed to graduate early from medical schools. But who will support them?

Help could come from a neighbor. In many countries, including the U.S., community health workers—local residents without professional medical degrees, hired and trained to support patients—have been a first and last line of defense for epidemics. As a community health worker, a neighbor could help stem the tide of the pandemic by offering prevention tactics, aiding in the detection of new cases, and supporting patients in accessing the care they need.

Other countries have shown how vital community-based strategies are to achieve viral suppression. For instance, South Korea, which reduced COVID-19 transmission from its peak of nearly 1,000 cases per day to less than 100 per day, has shown that getting closer to zero cases requires widespread community-based testing, rapid isolation, care for the sick, and rigorous tracing of contacts. Community health workers were also an essential part of the Ebola response in Liberia, where they teamed up with doctors and nurses to find the sick and get them into care.

And now, with more than 3 million Americans having lost their jobs last week, those unemployed as a result of the virus can help fight it as community health workers. The U.S. had about 56,000 community health workers in 2018, according to the U.S. Bureau of Labor Statistics. But, based on a task force report that showed that countries should have at least one community health worker per 650 people, the U.S. needs at least 500,000 more. They should be hired, trained, and equipped to prevent, detect, and respond to COVID-19, and support patients with health and social care needs. Some could do this work from the relative safety of their own homes, and others, with the right protective gear and training, can go door-to-door in their neighborhoods to identify the sick and help them get medical care.

And by hiring unemployed people already feeling the dire economic impact of this pandemic—from restaurant servers and bartenders to people who staffed hotel check-ins and airline gates—the U.S. could bolster the ranks of local health departments, nonprofit organizations, and national initiatives like the Medical Reserve Corps involved in fighting COVID-19.

While the idea of viewing neighbors as caregivers and health care support might stretch the imagination, there is much that Americans without prior medical expertise could be quickly hired and trained to do in the fight against COVID-19.

First, they could help with prevention by organizing and carrying out social media campaigns that promote social distancing. The implementation of social distancing remains uneven across the country, especially in communities that are most marginalized. Training the people from those communities as community health workers would result in an uptake of following the recommended practices. They could also encourage and outline strategies that promote mental and physical health and resilience.

Second, community health workers could aid in detection. They can be trained to learn the signs and symptoms of COVID-19 to help staff the hotlines run by hospitals and public health departments and refer possible COVID-19 patients to testing centers.

Third, community health workers can support the response by calling people with COVID-19 who are in self-isolation with mild symptoms and, with supervision, monitor them for worsening symptoms and support rapid referral of people who require hospitalization. In addition, in concert with public health officials, they could support rapid home-based testing (once available) while wearing personal protective gear, following up with those who’ve been exposed to a COVID-19 patient to monitor their symptoms and ensure they get tested.

Others have shown what’s possible. The University of Pennsylvania’s Center for Community Health Workers IMPaCT program hires and trains residents to act as first responders to the social needs of those in low-income neighborhoods. These community health workers are now being mobilized to help patients and affected communities deal with the economic fallout from the virus by providing telesupport and helping to arrange food delivery, while reinforcing public health messaging that’s critical for prevention. And in other COVID-19-affected countries, health care leaders have a vision of how this could be implemented at a national scale. Last week, in an opinion piece for The Lancet, health care leaders in the U.K. proposed a national program to train a community health workforce to deal with testing, surveillance, and active case finding. This community health workforce would also provide social care for the 1.5 million elderly and vulnerable populations.

Funds from the government’s coronavirus relief bill could be channeled to health departments, nonprofits, and health care systems to start training and hiring unemployed Americans as community health workers immediately. The philanthropic sector could also support training programs. And corporations, such as those in the hospitality and airline industries, with furloughed workers who want to volunteer their time, can adapt existing training content and deliver it online through their corporate training platforms. Workers could complete the onboarding programs in days.

Hiring unemployed Americans as COVID-19 community health workers today would have lasting effects. A U.S. community health corps could provide economic salvation and form the backbone of a future health system that is always ready to fight the next epidemic. And we wouldn’t have to look far for help—we’d only have to look next door.

Dr. Raj Panjabi is CEO of Last Mile Health and an assistant professor at Harvard Medical School.

Mitchell Weiss is a professor of management practice at Harvard Business School and author of We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems.