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As cities and counties across the U.S. struggle with questions about how to reopen the economy safely, one Duke Sanford School of Public Policy expert has joined an effort to establish an interdisciplinary, community-based model at the local level.

On May 12, the START Coalition, an alliance of experts from academia, healthcare, business, and technology announced a new pilot program aimed at arming communities with accurate data and customized testing, reporting, and prevention strategies to combat COVID-19.

The coalition’s work will begin in Oklahoma City but the group hopes to quickly expand to communities across the U.S.

One of the coalition leaders is DCID associate in research Tom Nicholson MIDP ’14. An expert in public health policy, Nicholson is a member of the steering committee.

Nicholson says that so far, the uncoordinated national government response has fallen short of what it will take to protect communities and livelihoods.

Man, smiling
Tom Nicholson MIDP ’14

“In terms of interventions, we haven’t see sufficient contact tracing, increasing and varied forms of testing, use of effective germicidal techniques, and financial and housing support for people who are unable to work or be with their family due to disease,” Nicholson says.

“In order to do all these things at once, there has to be a comprehensive coalition-building approach that brings in the public sector, universities, research institutes, non-profits and commercial enterprises in a way that considers how people actually gather as they live, work and study.”

Pulling together this kind of approach requires investments of capital, time and effort, and of course, a shared vision that values the perspective of each sector. Nicholson says that’s exactly what the START coalition is working to create.

“While we wait for effective therapeutics and vaccines, we are embarking on a journey that will use all the tools we do have on hand. It’s really about doing whatever it takes to make one community at a time a place where COVID-19 transmission is increasingly less likely.”

Nicholson’s nonprofit, Advance Access and Delivery, has been working on city-based infectious disease programs for years – with a particular expertise in tuberculosis. He says there are lessons from the fight against TB that can be applied to develop a more effective response to COVID-19.

While Americans grow increasingly weary of isolation, and states are feeling pressure to “reopen,” the START coalition is hoping to provide an alternative plan of action that draws from some of these lessons. Nicholson says TB was largely wiped out in wealthy countries after the 1950’s because of a coordinated, community-based strategy of “search, treat, and prevent” that specifically aimed at making homes, schools, and workplaces progressively safer- not keeping them on hold indefinitely.

There are other public health benefits of moving beyond quarantine and hospitalization as the only strategy. Nicholson and other TB experts are gravely concerned about what will happen in poor and developing countries with extended  lockdown- not just the economic devastation, but the risks of developing and dying from untreated tuberculosis, which has no vaccine for adults.

According to a recent article in The Guardian citing research from the Stop TB Partnership, “up to 6.3 million more people are predicted to develop TB between now and 2025 and 1.4 million more people are expected to die as cases go undiagnosed and untreated during lockdown. This will set back global efforts to end TB by five to eight years.”

Nicholson says that a holistic local approach to COVID-19, like the one spearheaded by the START coalition, will get people back to work and school, and will build the resilience of communities to address other health crises like TB.

“We want to end COVID-19, but we should do it through an active approach that doesn’t leave the vulnerable in the dust. A holistic approach that puts collaboration and community first could help us ensure that doesn’t happen.”