UC Davis Medical Center, where a California resident was admitted to be treated for coronavirus. | Justin Sullivan/Getty Images Coronavirus threat gives strapped state health agencies a new crisis

WASHINGTON — The fumbled response to the first coronavirus case potentially contracted within a U.S. community, in California, shows how health professionals on the front lines can be quickly overmatched by the stealthy disease.

And the prospect of more widespread outbreaks could put major stress on state and local health departments that are underfunded and already grappling with a bad flu season, vaping-related illnesses and the ravages of the opioid epidemic. The departments have already seen the Centers for Disease Control and Prevention's budget for state and local emergency preparedness cut by a third from fiscal 2003 to 2019, with small increases the past two years not making up for the losses.


The fragile state of public health defenses became clear this week, when a California woman potentially exposed dozens of people at a small hospital more than a week before she was diagnosed with coronavirus, because she didn’t initially meet the criteria to be tested. Even after she was transferred to a larger facility, it took until Sunday to confirm a diagnosis because the CDC also at first said the patient did not meet the testing criteria.

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.

In New York City, which has committed more than 100 health department employees to containing the virus, public health staff are rotating shifts to minimize disruptions to other tasks like restaurant inspections and monitoring the flu.

In a closed-door meeting at the White House Tuesday, Trump administration officials urged a group of state and local counterparts to be prepared in case the coronavirus spreads. The message comes as President Donald Trump tried on Wednesday to tamp down fears of a large-scale outbreak in the United States, contradicting a top CDC official who just 24 hours before had said the infection will inevitably spread throughout American communities. Minutes later, CDC confirmed the California case.

Congress, meanwhile, is wrestling with a $2.5 billion funding request from the Trump administration that top Democrats, and even a few Republicans, have decried as far too little.

State and local health officials are trying to ensure they get a fair share of the dollars, in anticipation of paying for everything from around-the-clock monitoring and new lab equipment to temporary housing for quarantined patients.

Trump sought to reassure states that more funds will come: “We’ll take care of states because states are working very hard,” he said on Wednesday.

HHS Secretary Alex Azar told a congressional hearing hours earlier that the $2.5 billion request — $1.25 billion of which are new dollars —includes funding for the CDC to pay state and local governments back for expenses, like laboratory work and tracing people who had contact with possibly infected patients.

But lawmakers including Senate Minority Leader Chuck Schumer want much more. The New York Democrat unveiled an $8.5 billion plan that includes $2 billion to reimburse state and local governments. But even if the request were approved, it would take weeks for state and local health departments to actually see the new money, according to Auerbach.

In the meantime, CDC says its working with localities and urging them to base their responses off 2017 guidelines on how communities can slow the spread of the flu.

“In my lifetime, it’s been Ebola, it’s been Zika, it’s been vector-borne disease, it’s been the flu, it’s been measles outbreaks, mumps,” said Randall Williams, director of the Missouri Department of Health and Senior Services. “These are all things that we don't start the year budgeting for or planning for, and they arise, and so an essential skill set in public health is the ability to adapt to existential issues.”

Victoria Colliver contributed to this report.