Public health care an invisible casualty
System neglected, underfunded even before the pandemic
PORT ANGELES, Wash. — As she leaves work, Dr. Allison Berry keeps a vigilant eye on her rearview mirror, watching the vehicles around her, weighing if she needs to take a more circuitous route home. She must make sure nobody finds out where she lives.
When the pandemic first hit the northern edge of Washington’s Olympic Peninsula, Berry was a popular family physician and local health officer, trained in biostatistics and epidemiology at Johns Hopkins University. She processed COVID-19 test kits in her garage and delivered supplies to people in quarantine, leading a mobilization that kept her counties with some of the fewest deaths in the nation.
But this summer, as a delta variant wave pushed case numbers to alarming levels, Berry announced a mask mandate. In September, she ordered vaccination requirements for indoor dining.
By then, to many in the community, the enemy was not the virus. It was her.
Berry should be attacked “on sight,” one resident wrote online. Someone else suggested bringing back public hangings. Protesters showed up at her house, until they learned that Berry was no longer living there.
“The places where it is most needed to put in more stringent measures, it’s the least possible to do it,” Berry said. “Either because you’re afraid you’re going to get fired, or you’re afraid you’re going to get killed. Or both.”
State and local public health
departments across the country have endured not only the public’s fury, but widespread staff defections, burnout, firings, unpredictable funding and a significant erosion in their authority to impose the health orders that were critical to the United States’ early response to the pandemic.
While the coronavirus has killed more than 700,000 in the U.S. in nearly two years, a more invisible casualty has been the nation’s public health
system. Already underfunded and neglected even before the pandemic, public health has been further undermined in ways that could resound for decades to come. A New York Times review of hundreds of health departments in all 50 states indicates that local public health across the country is less equipped to confront a pandemic now than it was at the beginning of 2020.
The Times interviewed more than 140 local health officials, public health experts and
lawmakers, reviewed new state laws, analyzed local government documents and sent a survey to every county health department in the country. Almost 300 departments responded. The examination showed that:
Public health agencies have seen a staggering exodus of personnel, many exhausted and demoralized, in part because of abuse and threats. The Times identified more than 500 top health officials who left their jobs in the past 19 months.
Legislators have approved more than 100 new laws — with hundreds more under consideration — that limit state and local health powers.
Large segments of the public have also turned against agencies, voting in new local government leaders who ran on pledges to rein in public health departments.
Billions of dollars have been made available to public health by the federal government, but most of it has been geared toward stemming the emergency, rather than hiring permanent staff or building long-term capability.
There are already signs that the growing shortfalls in public health could have lasting impacts beyond the pandemic.
More than 220 departments told the Times they had to temporarily or permanently abandon other public health functions to respond to the pandemic, leading to a spike in drug overdoses and a disturbing drop in reports of child abuse. Several health officials pointed to runaway infections of sexually transmitted diseases, with gonorrhea cases doubling and syphilis on pace to triple in one county in Pennsylvania.
During the pandemic, the federal government made tens of billions of dollars available to bolster testing, contact tracing and vaccinations. In May, the Biden administration announced that it would invest an additional $7.4 billion from the COVID-19 stimulus package to train and recruit public health workers.
But while health officials described the money as critical to helping them quickly build out teams after years of budget cuts, many of those new hires were temporary workers and much of the spending went to urgent needs such as testing and vaccinations.
And the funding is not permanent. Many local health officials said they expected that the extra money would peter out over the next two to three years. Dozens of departments said that, in order to be prepared for more surges or a future pandemic, what they truly needed was a higher baseline of qualified, permanent employees. Instead, they bought equipment or, more frequently, hired temporary staff, knowing they would need to let them go when the money dried up.