TOPEKA, Kansas — County health departments in Kansas lacked the resources and manpower to swiftly ramp up “boots-on-the-ground” work when the coronavirus pandemic hit, new research suggests.
The work by researchers at the University of Kansas School of Medicine-Wichita sheds light on the state’s preparedness for the pandemic. Local health departments do much of the frontline work gathering test samples from sick people and tracking down others who may have been exposed.
“It all comes down to what we can do for the county health departments,” said Talkad Raghuveer, a pediatrics professor and co-author of the Kansas Journal of Medicine article. “They’re our fighting force. It’s like providing funding for the Pentagon.”
KU researchers surveyed local health departments in mid- to late April. Three-quarters of the state’s county health departments responded.
The survey offers a snapshot of local public health resources well into the pandemic and when the coronavirus was spreading quickly. Kansas had been under lockdown for weeks.
County health departments said they needed more protective gear or other critical supplies. On average, they had just five of the specialized nose swabs used for COVID-19 testing when they answered the researchers’ questions.
“It was not very pretty,” Raghuveer said.
Kansas was, at the time, doing less testing per capita than any other state. As the virus ravaged the coasts, Kansas and its health providers struggled to get hold of enough nose swabs, surgical masks and other vital gear from private suppliers and the federal government.
Meanwhile, the virus spread, taking hold in places where Kansans couldn’t avoid close physical proximity to each other — food factories, prisons, nursing homes.
More than a quarter of the state’s more than 10,000 known COVID-19 cases are linked to outbreaks at meatpacking plants. Half of its deaths relate to long-term care facilities.
In the survey, local health officials reported that they typically had to wait three days or more for test results. Some said even if testing supplies were available, they couldn’t afford them.
About 30% of the health departments that responded also had fewer employees working on contact tracing than recommended, the researchers said.
Gianfranco Pezzino is the health officer for the state’s third-largest county, Shawnee. That county quickly pulled its nurses off of other work to focus on coronavirus, and tapped into an existing list of volunteers who could rapidly get to work on contact tracing.
In the meantime, the agency’s typical public health work on things like measles vaccines and sexually transmitted diseases took a backseat.
“I don’t even want to think what our immunization coverage rates are going to look like when we start coming out of this emergency,” Pezzino said. “That’s the price we had to pay to be able to do what we have been able to do in the last few weeks.”
Plenty of Kansas health departments don’t even have an epidemiologist, he said, something he has long argued for changing.
“People want to know trends,” said Pezzino, also a former state epidemiologist. “The age distribution of our cases. The mortality rates. All very legitimate questions.”
Since the publication of the KU paper, state mandates on how to reopen the state’s economy have fallen away. That’s put increased pressure on counties and local health officials to lay out their own rules for keeping people safe, and to get it right.
Long-time struggle
Nationwide, per-capita spending by local health departments shrank by nearly one-fifth over the past decade, according to the National Association of County and City Health Officers. It argues public health departments were poorly positioned to tackle the pandemic.
In the wake of the 2008 Great Recession, state and local health agencies shed tens of thousands of jobs from a workforce that hasn’t yet recovered. Targeted federal funding for them to prepare for public health emergencies dropped, too.
Public health experts worry such losses compounded other major preparedness gaps exposed by COVID-19, ranging from the nation’s inability to swiftly ramp up production of test materials to inadequate supply chains for protective gear.
In Kansas, many local health departments saw their discretionary funding from the state stagnate in recent decades, the Wichita Eagle reported. And America’s Health Rankings puts the state 40th in the country in terms of public health spending.
The KU School of Medicine-Wichita survey found most county health departments hadn’t increased their staff since the onset of the pandemic.
Departments said they needed help ratcheting up testing and educating the public about the coronavirus. They wanted additional staff and help with tracing the contacts of sick people.
A month after their responses, Kansas was still training up hundreds of contact tracers to shore up counties’ efforts.
Those extra hands on deck will become more important if reopening the economy leads to a larger, second wave of COVID-19 cases.
Saline County officials watched the pandemic’s march through other countries, preparing for the possibility it would hit closer to home.
So far, the central Kansas county has 30 known cases of coronavirus, compared to Shawnee County’s 340, and much higher numbers in the Kansas City metro and southwest Kansas meatpacking towns. So it’s within the range of what the Saline health department staff can handle.
“It would have been different had we had a ton of cases in a short period of time,” says Jason Tiller, who has headed the department for more than five years. “But because of the way that our cases landed, which was probably one to two every few days … that workload, while it was time-consuming, wasn’t as extensive.”
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy. Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.
