Coronavirus threat gives strapped state health agencies a new crisis

Officials across the country are trying to avoid such scenarios and scrambling to prepare without a clear sense of what they’re up against.

Washington state officials, who responded to the first coronavirus case on U.S. soil, are spending more than $50,000 a day on masks and other medical supplies and specialized training. New York Gov. Andrew Cuomo wants the legislature to approve $40 million to staff and equip a coronavirus response. Dallas health workers are figuring out where they would put patients who need to be quarantined. In Huntington, W.Va., the epicenter of the opioid crisis, officials are preparing to postpone some of their health department’s long-term work on drug addiction if a surge of cases hits.

The officials say it’s part of a longstanding pattern in both red and blue states: agencies that routinely are the stepchildren in state government being suddenly thrust into a new emergency with tight budgets and multiple missions.

“When it’s functioning properly, you’re not really sure what public health is doing. But then when there’s a crisis, you realize that it’s so important,” said Vit Kraushaar, the Southern Nevada Health District’s medical investigator.

The official diagnosis of the California woman has prompted a rapid response against a moving target. Officials are tracing anyone in the small hospital in Vacaville who may have had any contact with the patient — a figure they put at “dozens” but “less than a hundred” people. But hospital officials keep identifying more people monitored on camera who may have come near the patient or close to the room she stayed in. All providers who directly treated the patient have been notified.

Funding for disease surveillance and other measures hasn’t kept up with needs in recent decades.

John Auerbach, CEO and president of Trust for America’s Health and a former CDC associate director, said the emergency preparedness cuts affected funds used to hire experts to staff emergency operations centers, ensure there were enough medical supplies and that people were adequately trained.

Congress recently established a new infectious disease rapid response fund and is using the $105 million to address the coronavirus response. HHS also is reprogramming $136 million of department funds from other health pressing issues, like addiction, to address the virus.

But some states and localities are still moving on their own to try to make up the shortfall: Besides Cuomo’s $40 million request in New York, five California counties have declared emergencies, an effort to more quickly and easily get reimbursed for funds.

“The general trend nationwide has been lower funding for local health departments over the last 10 years or so,” said Robert Amler, a former HHS regional health administrator. “The paradox is not unlike the state of a fire department: When there is no fire you don’t need a fire department. When there is a big fire, you need all the help you can get.”

And while state and local health departments across the country regularly drill for emergencies, the fast-changing nature of a viral outbreak means staff are pulled from other crucial public health efforts.

In a place like West Virginia, that could mean scaling back efforts to fight addiction.

“When you’re dealing with finite resources, we might have to pull back on some of the work on opioids,” said Michael Kilkenny, executive director of the Cabell-Huntington Health Department, noting that the county’s work is just a slice of the state’s broader efforts to combat the drug epidemic. He added that his department’s top priority, addressing the county’s HIV outbreak, would not be deterred.