A new handbook from the Center of Complex Interventions is a practical guide for researchers, local governments, and community organizers on how to design an effective, coordinated strategy to overcome the challenges of a pandemic. The Covid-19 Intervention Manual draws on lessons and outcomes from CCI’s experience leading The Chelsea Project, a collaborative effort that included government entities, local nonprofits, and startups.

Chelsea, Massachusetts had one of the highest COVID-19 transmission rates in New England in the summer of 2020. The Chelsea Project was a coordinated effort to identify the key drivers of disease spread and change behaviors to improve public health. Using research, on-the-ground outreach, and local government resources, the Chelsea Project deployed wastewater analysis, targeted PCR testing and vaccine outreach, and a community-led communications strategy. By summer 2021, Chelsea had one of the highest vaccination rates among cities with comparable demographics in the U.S. 

The manual describes the complexity of COVID as a “wicked problem”—one that has no clear solutions and where all solutions seem to cause additional problems. It then details how CCI identified the key strategies to tackle this complex public health problem, built a diverse team, and learned from successes and failures. 

Included in this manual are practical, evidence-based recommendations for:

• Building and activating a diverse team
• Creating a weekly cycle of data gathering, implementation, and learning
• Working with partners
• Effecting change in a community

We worked with a marginalized city of immigrants, and turned it around from being the epicenter of the pandemic to one of the highest vaccination rates. I believe what we learned from the community and the trust we built together are cornerstones for solving other health disparities. This manual is the “how” for moving public health into the next decade 

Cristina Alonso, DrPH, MPH, CPM – Public Health Director and Lead Author

The Covid-19 Intervention Manual is available for free here. The CCI team will also have hard copies available at their table at the upcoming APHA 2022 Annual Meeting, November 6-9 in Boston, MA.

Chelsea, Massachusetts had one of the highest COVID-19 transmission rates in New England in the summer of 2020. The Chelsea Project was a collaborative effort that included government entities, local nonprofits, and startups that partnered to deploy wastewater analysis, targeted PCR testing and vaccine outreach, and a community-led communications strategy. The strategy helped increase both testing and vaccination rates in Chelsea. As a results of these efforts, by summer 2021, Chelsea had one of the highest vaccination rates among cities with comparable demographics in the U.S. This handbook explains how we identified the key strategies to tackle this complex problem, built a diverse team, and learned from our successes and failures. We applied data, public health and management theories using human centered design to create solutions that were relevant and useful to the people most affected by COVID and persistent inequities in health. The purpose of this handbook is to share what we learned and inspire your innovative complex interventions.

We would love to hear from you and work with you, so please reach out to us.

With the ongoing COVID-19 pandemic, and in response to high demand, a multitude of diagnostic tests for the detection and monitoring of the spread of the SARS-CoV-2 virus have been developed. This living document aims to survey the technical aspects of these diagnostic tests, outline the features and current limitations of their underlying technologies, formulate a modular framework for the assessment of the existing (and upcoming) tests workflows, and help depict a clearer and more comprehensive picture of this rapidly evolving space. With this manuscript as a starting point, we aim to help orchestrate a community effort to identify potential pitfalls and bottlenecks in the existing testing workflows—with the ultimate goal of paving the way to more sensitive, robust, scalable, and widespread tests for maximal social impact.

Read the full paper here

Rapid access to diagnostics for emerging high priority pathogens is of great importance from a clinical, public health and economic point of view. Currently, in the United States there are several technological, regulatory and organisational improvements that might be adopted for the COVID-19 and future pandemics; In this article, we suggest a proposal for increasing the speed of validating SARS-CoV-2 diagnostic tests, suggestions include: a structured EUA data submission process, distributed FDA directed CLIA led validation, and building an open source synthetic patient clinical sample panel. This document is a work in progress, containing some ideas which may be of value to consider and implement. We welcome you to add your name to this proposal or make a contribution of any size and scope. This concept and paradigm will be of utmost importance especially if a new mutant strain begins circulating that evades current diagnostics and vaccines.

Full proposal details can be found here

Read the full report here.

Understanding the effect of mask wearing on COVID-19 health outcomes, and what are the drivers behind increased mask wearing are critically important questions – at least until we have enough people vaccinated. 

Numerous studies have shown that masks have been associated with a reduction in the infection rate among health care workers in a large hospital network, mask mandates have helped reduce the number of cases in the United States and in Germany, and simulations have shown that wearing a mask can protect against droplet infection by preventing the spread of viral particles even when worn imperfectly. Despite this evidence, there has been strong resistance against mask-wearing.

Read the full paper here

We extend previous studies on the impact of masks on COVID-19 outcomes by investigating an unprecedented breadth and depth of health outcomes, geographical resolutions, types of mask mandates, early versus later waves and controlling for other government interventions, mobility testing rate and weather. We show that mask mandates are associated with a statistically significant decrease in new cases (-3.55 per 100K), deaths (-0.13 per 100K), and the proportion of hospital admissions (-2.38 percentage points) up to 40 days after the introduction of mask mandates both at the state and county level. These effects are large, corresponding to 14% of the highest recorded number of cases, 13% of deaths, and 7% of admission proportion. We also find that mask mandates are linked to a 23.4 percentage point increase in mask adherence in four diverse states. Given the recent lifting of mandates, we estimate that the ending of mask mandates in these states is associated with a decrease of -3.19 percentage points in mask adherence and 12 per 100K (13% of the highest recorded number) of daily new cases with no significant effect on hospitalizations and deaths. Lastly, using a large novel survey dataset of 847 thousand responses in 69 countries, we introduce the novel results that community mask adherence and community attitudes towards masks are associated with a reduction in COVID-19 cases and deaths. Our results have policy implications for reinforcing the need to maintain and encourage mask-wearing by the public, especially in light of some states starting to remove their mask mandates.

Read the full paper here

The small city of Chelsea, Massachusetts had one of the highest COVID-19 transmission rates in New England in the summer of 2020. Many factors contributed to the spread of COVID-19 in Chelsea including overcrowded living conditions, a high proportion of residents working in essential jobs, and misinformation about COVID-19 and testing. 

The Center of Complex Interventions, a nonprofit organization that specializes in applied scientific research, initially started The Chelsea Project to address testing hesitancy in Chelsea. The Chelsea Project is now a collaborative effort that includes government entities in Chelsea, local nonprofits, and startups that have partnered to deploy three different interventions: city-wide wastewater analysis, targeted PCR testing, and a community-led communications strategy. The unique combination of these interventions helped increase both testing and vaccination rates in Chelsea. As of November 2021, Chelsea has one of the highest vaccination rates among cities with comparable demographics in the U.S. 

Key learnings from The Chelsea Project include: 

• Health equity is an attainable goal. The Chelsea Project is an example of health equity in action. Improving quality of care and access to healthcare in vulnerable communities is extremely challenging because of language barriers, lack of trust and lack of resources. However, taking the time to understand these specific barriers in Chelsea and how trust networks in the community operate enabled The Chelsea Project to implement interventions that actually addressed these barriers and improved access to health resources.
• Understanding the reality on the ground is essential for effective intervention and adoption. The Chelsea Project team carefully considered how Chelsea’s unique challenges would impact adoption of potential interventions. 
• The ultimate impact should be long-term change. In systems with many moving parts and different actors, connecting existing entities in new ways is more likely to result in long-term change. The new partnerships and funding opportunities enabled by the Chelsea Project will ensure that this public health work will continue even if CCI and The Chelsea Project no longer operate in Chelsea. 
• An iterative approach will produce better outcomes. The Chelsea Project went through many cycles of research, development of interventions, implementation, and synthesis. Taking the time to synthesize the outcome of each intervention we attempted to implement helped the team reevaluate the problem and develop more effective interventions. This iterative approach resulted in three different focus areas—wastewater, testing, and communication—that, when combined, were extremely effective at increasing testing and vaccination rates. 
• Flexible funding is necessary for an iterative approach. Flexible funding allowed the Chelsea Project the time necessary to tailor interventions to current obstacles and enabled the team to adapt in real-time to unpredictable on-the-ground developments. This iterative approach would not have been possible without flexible funding. 

Despite higher vaccination rates and a decrease in COVID-19 infections, our work is not done. The next phase of the Chelsea Project focuses on providing education and tools that will empower Chelsea residents and city policy makers to prevent future outbreaks of COVID-19 and address other health issues in the city.

In this project, we show that mask mandates at the country-level (USA) had a significant positive effect on COVID outcomes (cases, hospitalizations and deaths), and that mask wearing (in 69 countries) similarly has a beneficial effect. This research was just published in the June issue of PLOS ONE, an open-access journal for multidisciplinary research in medicine and the sciences.