On the federal level, the Centers for Disease Control and Prevention, the nation’s main public health agency, has seen its budget fall 10 percent over the last decade, adjusting for inflation, according to the Trust for America’s Health report. The C.D.C. saw a 2 percent increase in its budget program funding between the 2018 and 2019 fiscal years, after accounting for interagency transfers and one-time funding, and as measured in inflation-adjusted dollars.

And while the report found that total state spending on public health increased 2 percent in the 2018 fiscal year, 17 states and the District of Columbia cut public health funding that year, while 21 percent of local health departments reported reductions in budgets for the 2017 fiscal year.

The federal Public Health Emergency Preparedness program, which helps state and local health departments prepare for and respond to emergencies, including outbreaks of infectious diseases, has also seen funding reductions, falling from $940 million in the 2002 fiscal year to $617 million in the 2019 fiscal year, according to statistics compiled by the Trust for America’s Health.

Some of the states hardest hit by the coronavirus run the gamut in terms of public health emergency preparedness, according to rankings by Trust for America’s Health, with Washington State in a top category of preparedness, California in the middle, and New York in the bottom.

Still, even Washington State’s system has been hampered by a lack of resources needed for upkeep, equipment and the flexibility to respond to emergencies. In recent weeks, state lawmakers there discussed adding $5 million to the budget to aid the state’s coronavirus response. That later rose to $100 million. Then, this week, just as lawmakers were finalizing the budget, they doubled the new funding to $200 million.

Around the country, some public health systems are actually in stronger shape than in years past. Amelia Clark, administrative officer of the Spokane Regional Health District in eastern Washington, said her agency had grown to 263 employees from 221 employees 10 years ago.

“Washington’s done a pretty good job of funding public health,” she said.

Still, the Spokane agency has been contracting with retired public health workers in recent days to help handle what is expected to be a wave of coronavirus cases. By the end of a week in which cases of the virus in the United States rose above 2,100 and schools and offices closed, the stress on local health care systems was already being felt.