The entire nation is grappling with the extent of social distancing during the COVID-19 pandemic, and WIC providers are no exception. Since March, WIC providers have been able to offer remote services to reduce exposure and minimize risk for participants and clinic staff. As WIC traditionally provides in-person services at clinic-based settings, the rapid integration of remote services was only made possible through short-term waivers pressed by the National WIC Association and granted by the U.S. Department of Agriculture (USDA), consistent with the Families First Coronavirus Response Act passed in March 2020. These waivers are set to expire on September 30, 2020.
As each state assesses its rate of COVID-19 infection, state and local health departments are evaluating the appropriate precautions needed for in-person interactions – including at WIC clinics – often within the context of state and local politics that may not be responsive to public health risks. Enacting a statewide policy can be challenging, especially when different parts of a single state are facing very different infection rates. Nebraska WIC Director, Peggy Trouba shared the challenges.
"The state is moving to final stages of reopening, but yet there are areas where we are seeing increases in COVID-19 cases," she said. "Both WIC participants and staff are concerned about coming back into clinics."
Nebraska is now moving towards its fourth phase of reopening, where social distancing is now considered a recommendation, not a requirement. This decision allows for increased capacity of outdoor and indoor venues, slowly reopening businesses and encouraging greater social interaction. Public health officials continue to recommend mask-wearing outside of the home.
Most WIC agencies and public health services in Nebraska were not open in earlier phases, but on Friday, the Loup Basin Public Health Department became the first local agency to move towards Phase 4 and open its doors. Some rural clinics in Nebraska remained open throughout the pandemic as these areas often experience a lack of access to reliable technology. Providers anticipated barriers to the WIC program if remote service had been implemented in rural communities.
Lisa Boeke, the Community Health Supervisor of Nebraska’s Central District Health Department, is working with her clinic staff to plan operations as they approach reopening in September. Local WIC providers are having to quickly restructure their clinics, procure personal protective equipment (PPE), establish plans if staff or families contract COVID-19, and develop individualized clinic policies around distancing and face coverings to protect staff and families and make sure all feel comfortable coming into clinics. Although the state has been supporting local WIC staff in procuring PPE, there are concerns that the availability of PPE as well as cleaning product supply may be an issue as this pandemic continues or even a casualty of the press to reopen.
While Nebraska is currently using the remote service waiver in some areas, it is unclear if the state will continue to do so and whether Congress will extend USDA’s authority for waiver expansion into 2021. Staff members are concerned that as clinics reopen, participants may not feel comfortable coming into clinics and, therefore, drop off of the program and lose critical WIC nutrition and public health supports. Lisa Boeke is confident in her "cohesive and strong team" and their ability to adapt services based on the guidance released, however, her utmost priority is the health and safety of her staff and their ability to provide families crucial nutrition and public health services.
The National WIC Association and the Nebraska WIC Association urge Congress to extend WIC waivers nationwide until September 30, 2021, to allow states to make decisions on necessary waivers that align with their reopening plans and the health and safety of both WIC staff and the mothers and young children they serve.