In 2020, then Purdue University President and former Indiana Governor Mitch Daniels worked with Vice Provost Cherise Hall and her team to use the school’s campus-wide data system to keep the school open for in-person learning. By combining testing data with readily available information on student movements, the university was able to identify outbreaks and isolate infected groups from the rest of the student body. “Eventually, we could almost instantly pinpoint where any COVID outbreak was happening and address it at the source,” Hall said. She and her colleagues created a “Severity Index” to keep the school community abreast of how the virus was affecting the campus. Through a combination of widespread testing, the Severity Index, and continuous communications with parents and teachers, school officials were able to continue in-person learning with a minimum of severe COVID infections.

Parent physicians at Duke University, including Dr. Kanecia Zimmerman, established The ABC Science Collaborative to provide flexible tools for K-12 schools to safely re-open classrooms. The Collaborative published data on COVID-19 spread in schools, devised strategies for safe reopening, and engaged with educators across the state through listening sessions. “We saw our job as providing the information – and trusting that people knew their local circumstances better than we did, such that they could adapt that science and apply it to their situations,” Zimmerman said. The Collaborative’s work fed into state legislation for school reopening and continues today, addressing issues from vaping to teacher resiliency.

Businesses of all sizes stepped up during the pandemic, using their resources to protect both the health of their employees and the larger community. In one example, leaders at Microsoft instigated the creation of a playbook to help businesses safely bring employees back to the office. “There weren’t practical playbooks on how to address an airborne illness in a workplace, particularly when you’ve moved to lots of open space offices,” said Teresa Hutson, vice president, technology and corporate responsibility. “It was really hard to know what to do when we didn’t know what was scary. Everything was scary!” Once completed, they shared findings and procedures with state, local, and community leaders and worked with schools to help them reopen. The software giant also used its resources to help schools track cases and maintain data dashboards and helped coordinate a vaccine site on its campus and helped staff through employee volunteers a site with capacity of 20,000 people a day, both of which were open to the larger community.

The 1,200 employee Lincoln Premium Poultry, a subsidiary of Costco, created an internal disaster response team to help workers through the pandemic, arranging transportation, grocery delivery, and homework support for school aged children. “If you had COVID and you were at home, we checked on you every single day. If you needed medicine, we brought you the medicine, we helped find doctors, we made sure you got to a hospital if that meant one of us took you there ourselves,” said Jessica Kolterman, the company’s director of administration. In partnership with the state, the company organized hotel stays and food for sick individuals so they could isolate themselves, as well as onsite vaccine services for employees and their families.

Using a newly configured statewide 211 information hotline, Indiana developed a unified call center to schedule vaccinations and perform contact tracing. The center evolved with the pandemic, eventually becoming a one-stop shop for state residents seeking health information and resources, child care, and rental aid. “It was like the Easy Button for the Indiana 211 service to be a part of a human service delivery agency that could quickly collaborate with the Indiana Department of Health at a time when it was critical for people to have a place to call where they could, in five minutes, schedule their vaccine and then receive a follow-up text message or email confirmation,” said IN211 Executive Director Tara Morse.

The Nebraska Department of Education partnered with a local foundation’s Community Collaboratives to better understand the unique needs of schoolchildren in different areas. In addition to tangibles such as PPE and hand sanitizer, the Collaboratives uncovered a huge need for mental health services. “There was a significant amount of fear and uncertainty, obviously,” said Lane Carr of the Education Department’s Office of Policy and Initiatives. “We used a big chunk of our first set of pandemic relief funds to provide technology and make sure that kids had access and connectivity. But then the second big piece was focused on additional mental health support and support for counselors to be able to meet with students virtually, because we heard loud and clear that folks were feeling really isolated.”

Challenge Seattle, a business coalition headed by former Washington Governor Christine Gregoire, engaged locally based corporations including Starbucks, Nordstroms, Boeing, Alaska Airlines, and Microsoft to develop data platforms, manufacture PPE, provide transportation, and organize logistical support for mass vaccination. Gregoire told us, “The private sector had immense capability and never asked for a thing in return. They saw it as a humanitarian crisis, and they were called for action, and nobody said no. Everyone instead said, ‘We’re on it’ and ‘When do you need it?’” She elaborated, “We issued reports on how to reopen businesses after they had closed, how to function while closed, and the ramifications for businesses, as well as how to reopen the schools and how to focus on the kinds of problems that had been caused by the closures…Government did what only government can do. And the private sector offered up and did what only the private sector can do, and the combination of the two was really stunning.”

Then Alaska Chief Medical Officer Anne Zink and her team identified locally prevalent communications including Zoom, radio, and Facebook pages to amplify information while engaging trusted local elected, tribal, and community leaders to encourage hyper-local decision making for the state’s fiercely independent residents. “Ensuring as much sovereignty as possible for individuals, communities, tribes, and localities was critical to people feeling they had at least some control and could make choices over how they protected themselves,” Zink said.

Leadership consultants McChrystal Group worked with cities and states across the country to develop fusion cells to coordinate across sectors and organize their 24/7 response operations. “COVID-19 was not a medical problem. It was an organizational challenge. It came down to whether we could get organized, make clear decisions, and implement those decisions across communities,” said General Stanley McChrystal. “We created a more refined understanding about the evolving crisis for our network, so that folks making policy at the federal and senior state levels could get that feedback from the people that actually had to implement it,” added Barrett Moorhouse, a Senior Principal for the group.

As her city grappled with the first COVID case to hit the United States, then-Seattle Mayor Jenny Durkan established a team – a “pandemic kitchen cabinet” – of local and national experts to provide regular counsel and used national mayors’ networks to consult with officials across the country and find supplies, including test kits. “The lack of access to testing in the beginning left us flying blind to the spread of the disease and limited options for slowing that spread,” Durkan said. “It set us on a path that was unnecessarily difficult and required too many innovations and pivots. It also created a kind of a ‘Hunger Games’ competition for resources among cities and states.” Regular channels to access national experts and local data modelers gave Durkan the added crucial information she needed to “see around corners,” understand transmission, and better protect her constituents. She also enlisted globally renowned disease modeling experts. Their data provided models that gave Durkan a realistic picture of what lay ahead for Seattle, “Ongoing access to modeling is critical. Public health officials were constrained because their hard data was limited to the known few dozen cases. Dr. Trevor Bedford’s research and model indicated we likely could have at least 1,100 cases at that time, doubling every 6 days. That changed everything…We were facing a tsunami if we did not act.”

Concerned about her crews as they transported severely ill COVID-19 patients in Texas with minimal guidance and protective gear, Lesley Osborn helped developed a playbook to protect everyone from pilots to mechanics. “There was so much unknown to my EMS providers, flight nurses, and flight paramedics,” said Osborn, medical director of Memorial Hermann’s Life Flight program, one of the busiest hospital-based air medical companies in the United States. “They were very concerned about flying these patients in an aircraft where you can’t filter anything out.” The blueprint she published guided other air medical companies in safely approaching patient care during the COVID-19 pandemic. Portions are still being used in transporting highly infectious patients in the greater Houston area.

Drawing on biocontainment infrastructure and clinical science and operational research capacities established with the help of federal grants over the years, the University of Nebraska Medical Center’s Global Center for Health Security cared for patients returning from Wuhan and passengers from the Diamond Princess, one of the first cruise ships to report infections. It also aided the U.S. Centers for Disease Control and Prevention in developing working test kits, conducted clinical trials for treatments, and published more than a dozen playbooks for infection control that were used from schools to multiple collegiate athletic conferences and professional sports. “We had a number of tools in the tool chest that were sort of locked and loaded,” said UNMC Chancellor Dr. Jeff Gold. “I would characterize the time of critical decision making by simply saying that we leaned in. We tried to fill a broad and deep void.”

Dallas County Judge Clay Lewis Jenkins, the highest elected official in the county, developed multiple advisory groups to better understand and respond to the concerns of businesses, community activists, and faith groups. He also worked across party lines and jurisdictions—sometimes in opposition to the governor—to secure vaccines and develop public health protocols. “The career professionals, many of them are Republican, many are Democrats, all worked very well together,” he said. “It was a very low-ego response here. Nobody’s really talking politics here. We’re just trying to get people well, get them vaccinated, get them informed.”

In Utah, the state worked with retailers and used data to assess economic impacts of the pandemic. State legislators, “were very sensitive to business owners and people who were impacted by public health decisions, and they helped us recognize that the decisions could not be purely based on public health–there was  an economic consequence, too,” said Gordon Larsen, senior advisor to Utah Governor Spencer Cox. “If you don’t account for the economic consequences, even if you think it’s purely a public health decision, then politics will have an impact on public health.” On masking, the state worked to drive collective action. Economic behavioral modeling showed that a masking mandate for retail settings might increase store traffic because more people might feel comfortable shopping if they knew others were wearing a mask. “As the pandemic went on…we recognized that we couldn’t only be getting information from the public health community. There is an economic component,” said Larsen. “We designed a matrix that was based on hospitalization rates, case counts, and other factors, which created a way for our legislature and others to say masking requirements or restrictions on large group gatherings weren’t arbitrary but based on data and had the ultimate goal of protecting our hospital capacity.”

Governor Roy Cooper relied on then State Secretary of Health and Human Services Mandy Cohen and Chief Deputy Secretary and COVID-19 Operations Lead Kody Kinsley, who had authority over public health as well as the overall health system across the state. They had previously built strong relationships through the state’s multi-year efforts to expand Medicaid, which engendered trust – including through a regular Executive Roundtable with health system Chief Executive Officers –  as they coordinated across North Carolina’s health systems and worked to bridge the Republican-controlled legislature and Democratic administration. North Carolina also created statewide networks of individuals serving in similar positions across the state, including Chief Medical Officers of hospitals, physicians, and hospital leaders.

In 2020 U.S. Senator Pete Ricketts –  then former Nebraska Governor – consulted regularly with leadership of the University of Nebraska Medical Center and convened a statewide coalition of state public health leadership that met regularly. Ricketts explained the importance of communicating a plan and sticking to  it, “We started off with a very clear goal to preserve hospital capacity. That was going to be our North Star. We communicated that goal. We were transparent about the goal. We showed how we were measuring it. We communicated that out through press conferences,” Ricketts outlined. “We got on the phone weekly with hospital CEOs to bring them on board. The entire state of Nebraska became one big hospital system.”

Governor Mike Dunleavy worked closely with then Chief Medical Officer Anne Zink and other officials behind the scenes to find pragmatic solutions. Zink said, “The governor never tried to be the scientist, but he also never asked me to be the governor…I really appreciated that he never said to me what I had to say, what I could say, what I couldn’t say.” Even without a mandate, the state promoted masks’ value in reducing transmission. “…he let me speak to it: ‘The mask is going to help you, it’s going to help me.’ He would just say, ‘I don’t think it’s the government’s role to tell you how to live your life.’ Ultimately, I decided that messaging together about the value of masking was more important than a mandate – dividing our messages would have made it even harder to communicate.”

University of Nebraska Medical Center’s Chancellor Dr. Jeff Gold used a national TV program, Rural Health Matters to respond to the specific needs of rural Americans during the pandemic. Because rural populations were older, and often had more underlying health issues and lower vaccination rates, rural infection and death rates outstripped those of urban areas as the pandemic wore on. “All we do during our broadcasts is just provide the most up to date information, and as it changes, be humble about the fact that it’s going to change, and that we have to recognize what the science currently tells us, and make our best decision-making on that science,” Gold said. “We get call-ins, emails, and letters all the time, saying we are the most trusted source of information for the viewing audience in rural America.”

Responding to the surge of Latino COVID patients in the state’s emergency rooms, clinicians, community leaders, and community members that were part of LATIN-19, including researchers Andrea Thoumi and Dr. Gabriela Plasencia, identified cultural and language barriers to testing, treatment, and vaccinations and worked with policy makers and community health workers to address them. “Trusted messengers were the number one way to combat misinformation…and it was vital for messages to come directly from Latino physicians or providers, Latino community health workers, and Latino community-based organizations,” Plasencia explained. “They felt that the message coming from, for example, a White doctor may not be as trustworthy because a White doctor wouldn’t understand what they’re going through, wouldn’t understand what their preferences are.” Latin-19 is advocating to create sustained support for Latinos.

Indiana deployed the National Guard’s strong logistical capabilities to identify and fill gaps in the state’s beleaguered nursing homes. After starting with an initial 25 facilities, the Guard grew its operation to place 1,700 guardsmen in over 550 nursing homes. The move provided critical support to exhausted nursing home staff and a keen sense of purpose for Guard personnel. Shane Hatchett, former Deputy Health Commissioner and Chief of Staff said, “I just don’t think we would have been able to be as successful as we were without that ability to tap into a transforming, dynamic workforce. A lot of that goes straight up to our National Guard’s Adjutant General, who from the very beginning told Dr. Box and others, ‘I’m here to stand in the gap for you.’ They were a reassuring presence to say, ‘we’ll get there, but let’s do it the right way.’” Training for guardsmen included, “…how to push someone in a wheelchair, how to care for someone…how to wipe down surfaces, how to take temperatures, how to screen people before they came in, how to do routine admin logs of people that come in…how to maintain your PPE…,” recounted Indiana’s Adjutant General Dale Lyles, “Our soldiers and airmen…really thought that they were saving humanity. When you have a purpose that’s bigger than yourself, it really drives the soldiers and the airmen to perform well, and that’s what they did.”

As COVID’s unequal impacts became evident, Mecklenburg County Public Health quickly mobilized public, private, and “direct resident” partnerships to identify and address obstacles to vaccination, testing, and treatment. In one effort, the department engaged leaders at Village HeartBEAT, a network of more than 60 churches, to reach Black residents. The group held education sessions for pastors, provided churches with masks, and had health care partners conduct on-site mobile testing at houses of worship. “Everything from the Latino grocery store to the corner store to the Hindu temple, every corner of the county where we were seeing disparities in outcomes or access – we were mobilizing on the ground teams.” said Raynard Washington, then Mecklenburg County Public Health deputy director, now director. Continuing those connections is vital to “ensure that people are healthy before we have a crisis, that we are doing everything possible to create neighborhoods and communities where people have an equal fair opportunity to be healthy,” he added.

Former Chief Medical Officer Gary Anthone and his team helped create approaches to designate hospitals with empty floors as COVID-specific surge units and to establish decompression facilities throughout the state to help with hospital discharge – ultimately allowing Nebraska to more effectively manage an influx of COVID patients. In the early days of the pandemic, the team built new infrastructure to collect case and hospital data, working through phone calls to each of the 21 hospitals across the state. “At first, we did not have the infrastructure in place to track, collect, and use the data that we really needed. I don’t think we were the only state in that situation,” said Anthone. “Our state developed a public dashboard that the public could see on a daily basis…Once we were able to do that, I think the public just became much more confident in how we were making decisions.” By Fall 2020, officials were able to digitize and automate case reporting, eventually standing up a knowledge center to inform decision-making and resource deployment and to tie capacity restrictions and business closures to hospitalization rates.

Through strategic investments in data integration, the state connected formerly siloed systems into a central database, reducing inefficiencies and automating processes to enable rapid data-sharing with partners. “We built pipelines with every hospital facilitated by trust and huge dollars that we had to invest in technology to be able to get near-hourly reports about bed utilization and then be able to break it down – so we could actually learn from the information, not just monitor utilization,” said North Carolina Secretary of Health and Human Services Kody Kinsley. “We had Medicaid data, and we had vaccine data and we had testing data, and we had syndromic surveillance data and we had bed utilization data and never should these systems ever talk to each other. And so then we started building pipes between them…to make sure that we know who the people are that we’re serving and that we’re asking them at the point of service as little as possible to help them move through the process fast.”

Former Chief Medical Officer Gary Anthone and his team helped create approaches to designate hospitals with empty floors as COVID-specific surge units and to establish decompression facilities throughout the state to help with hospital discharge – ultimately allowing Nebraska to more effectively manage an influx of COVID patients. In the early days of the pandemic, the team built new infrastructure to collect case and hospital data, working through phone calls to each of the 21 hospitals across the state. “At first, we did not have the infrastructure in place to track, collect, and use the data that we really needed. I don’t think we were the only state in that situation,” said Anthone. “Our state developed a public dashboard that the public could see on a daily basis…Once we were able to do that, I think the public just became much more confident in how we were making decisions.” By Fall 2020, officials were able to digitize and automate case reporting, eventually standing up a knowledge center to inform decision-making and resource deployment and to tie capacity restrictions and business closures to hospitalization rates.

Through strategic investments in data integration, the state connected formerly siloed systems into a central database, reducing inefficiencies and automating processes to enable rapid data-sharing with partners. “We built pipelines with every hospital facilitated by trust and huge dollars that we had to invest in technology to be able to get near-hourly reports about bed utilization and then be able to break it down – so we could actually learn from the information, not just monitor utilization,” said North Carolina Secretary of Health and Human Services Kody Kinsley. “We had Medicaid data, and we had vaccine data and we had testing data, and we had syndromic surveillance data and we had bed utilization data and never should these systems ever talk to each other. And so then we started building pipes between them…to make sure that we know who the people are that we’re serving and that we’re asking them at the point of service as little as possible to help them move through the process fast.”