The first call comes from the lab. State law requires each one to notify the Alabama Department of Public Health every time a specimen tests positive for the novel coronavirus.

From there, a staff member reaches out to the county health department where the person lives. As of Tuesday, the Jefferson County Department of Health had fielded 90 such calls in the last week and a half. Each one triggers a mandatory quarantine for patients – 14 days, enforceable by law.

Then the case heads to the disease detectives, public health employees who try to track down every individual who spent at least 15 minutes within a 6-foot radius of an infected person. They start with the usual suspects, like family, and go from there.

“We build a possible network by tracing the person’s movements,” said Dr. Wesley Willeford, medical director of disease control for the Jefferson County Department of Health. “Then we start branching out from there.”

Much of the work happens over the phone. Calls to employers, co-workers, family, friends and acquaintances identify possible vectors of the fast-spreading illness. These people must stay home, check their temperatures and report back to public health.

With each new case, staff members try to build a perimeter around the pandemic to keep it in check. But each time it stretches, they need more hands to hold the line. Already the effort has borrowed staff who usually monitor tuberculosis and sexually transmitted infections.

“We’re okay on manpower right now and we can flex up,” Willeford said. “The concern with this is the exponential growth.”

Willeford’s team tries to stop outbreaks before they begin. When it works, it doesn’t make headlines.

“Public health has always done its best work when nothing happens,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Now they are on the front lines of the battle to contain the coronavirus outbreak.

“We had several near misses like Ebola and swine flu,” Benjamin said. “This for all practical purposes is the big one we’ve been waiting for.”

It has hit a public health system strapped for resources. Only 3 percent of total health spending goes to public health, Benjamin said.

The Alabama Department of Public Health lost $21 million in Medicaid revenue last year and another $5 million from local governments. A report about outbreak and emergency preparedness by the Trust for America’s Health found that Alabama had the second largest percentage rate drop in public health funding from 2018 to 2019 behind New Hampshire.

Alabama State Health Officer Dr. Scott Harris said last year the department would close some county health offices and limit hours in others to save money.

There’s no database of funding for local health departments, but research by the University of Washington shows it can vary widely. Their sample showed a range from $1.10 per capita all the way up to $48.74, with a median of $9.15.

“I can’t tell you where Alabama specifically stands regarding its local public health funding,” said Betty Bekemeier, professor of public health at the University of Washington. “No one can since comparable local public health data don’t really exist across states and even within a state.”

The Jefferson and Mobile County Departments of Health operate independently with funding from local taxes. The rest of the counties fall under the jurisdiction of the Alabama Department of Public Health.

“Public health departments are all very different,” Benjamin said. “We always say if you’ve seen one local health department, you’ve seen one local health department.”

Willeford said Jefferson County’s local funding provides protection from state budget cuts, but doesn’t leave a lot of room for frills.

The Jefferson County Department of Health doesn’t have a state-of-the-art laboratory or a broadcast studio. On the day Jefferson County Health Officer Dr. Mark Wilson announced the first restrictions to keep people at home and apart, technical limitations forced him to announce it outside and in person.

“We receive local tax funding that takes care of us,” Willeford said. “It allows us to weather a storm. But most of that budget goes to keeping the lights on.”

An infusion of federal cash to fight the coronavirus has boosted the state’s ability to fight coronavirus, but the increase in cases has Willeford concerned. Now that several business have closed by order of the Jefferson County Health Officer, the department is using inspectors to monitor patients under quarantine to make sure they stay home.

“Normally we all have our own areas we work on,” Willeford said. “But right now, we’re all working together on this issue.”