The job description for a COVID-19 community health worker - and how this could fight US unemployment

There are more than 780,000 confirmed cases of COVID-19 reported worldwide as of March 31. Continued sharp increases in infections may overwhelm health systems in any country, but especially places that are facing shortages of nurses, doctors, and other frontline health providers.

The pandemic is also dealing an economic blow. People around the world are losing their jobs, as large gatherings are cancelled and people undertake social distancing, making it impossible for many businesses to continue. Earlier this week it was reported that the pandemic could drive unemployment up to 20%, a rate not seen since the Great Depression, leaving 32 million Americans without a job. In New York, the state’s unemployment website temporarily crashed when the number of unique users rose fivefold in one day.

What if Americans who are unemployed by the pandemic could be hired to fight it? Around the world, local residents without a medical or nursing degree have been rapidly trained, hired, and equipped to respond to other epidemics that have spiralled out of control.

An epidemic anywhere can be a threat to people everywhere. That’s true now with COVID-19, and it was true in 2014, when the Ebola virus was spreading like wildfire across Liberia and West Africa. At that time, scientists projected the virus could infect more than 1 million people – and the majority of them would die – if nothing more was done.

When Ebola threatened to bring us to our knees, community health workers did not surrender to fear. They did what they had always done: they answered the call to serve their neighbours. Community health workers teamed up with outreach nurses to go door-to-door to prevent virus transmission through promoting hand-washing and social distancing. They learned the signs and symptoms of Ebola and helped detect patients. And they helped respond by encouraging Ebola patients to seek care early at hospitals.

This same community-based strategy is critical once again in our global response to COVID-19. As cases grow exponentially, so does all this work to prevent, detect, and respond to the pandemic. Healthcare teams cannot keep up. Doctors, nurses, and officers in underfunded public health departments are overwhelmed by the tasks at hand. It might be time to share these tasks with others. We could rapidly expand our healthcare teams by investing in the people closest to the problem – hiring and training the millions of people put out of work by the epidemic.

This is happening now in Liberia, where previously unemployed residents are working as community health workers to implement prevention and control measures, like organizing social distancing and hand hygiene stations. To help detect cases, nurses are making plans to work with community health workers to identify signs and symptoms of COVID-19 among their neighbours. The country is considering engaging community health workers to coordinate testing for people who may have COVID-19.

This same strategy could work in the United States, too. Here’s what the job description of a COVID-19 community health worker might look like:

1. Prevent

2. Detect

3. Respond

How would they be trained?

The US Centers for Disease Control and Prevention and state health departments can work with universities to develop rapid online programmes to train the millions of Americans currently out of work in their own homes. Last Mile Health has launched similar online and mobile training programmes globally. There is also a proposal for a large-scale emergency programme in the UK to train community health workers (CHWs) to support people in their homes, initially the most vulnerable but with potential to provide a long-term model of care.

Who would hire them?

State and city health departments can request funds from federal economic relief packages and charities, and companies can support hospitals and non-profits to hire them locally. After the COVID-19 pandemic is stopped, some of these individuals might return to jobs in their old industries. Others will find new careers in healthcare, such as home health aides or paramedics. If done right, the value of this investment could grow with time. Countries like Liberia, Ethiopia, and Malawi and states like Alaska have trained community health workers to address one epidemic, only to redeploy them in subsequent epidemics.

Today’s COVID-19 community health workers could become our epidemic response corps of the future – always ready to help us fight the next epidemic.