NAVAJO COUNTY — Faced with the worst disease outbreak in memory, Navajo County this week welcomed a $205,000 state and federal grant to improve its response.
The hastily mounted project funded mostly by the federal Centers for Disease Control “in a crisis situation to rapidly mobilize, surge and respond to public health emergencies occurring in Arizona,” according to the memorandum of understanding.
COVID-19 has infected some 600,000 Americans and killed more than 23,000 so far, shutting down whole sections of the economy to slow the spread of the virus.
Apache and Navajo counties have been among the hardest hit in Arizona, with high per capita infection and death rates.
The rapid spread of the virus across the country exposed widespread flaws in the nation’s public health system, with federal agencies like the CDC mostly offering up advice while 50 state governors and 2,500 local public health agencies scrambled to make life-and-death decisions on still fragmentary data.
In this case, local public health officials found themselves trying to slow the spread of the virus without clear authority or even enough test kits to trace contacts, check everyone with symptoms or sometimes even conduct widespread testing in places like nursing homes.
“COVID-19 grant funds will help the county build its capacity to perform disease investigations and contact tracing,” said Jeff Lee, Navajo County Public Health Director.
“We have already hired two additional nurses to help, and we may look to bring on up to four more. This additional capacity allows us to perform more in-depth investigations to determine the exposure point — where the patient may have contracted the virus. It also helps us contact as many people as possible who might have been exposed to the patient and work limit the spread,” Lee said in an email to the Independent.
County public health departments generally don’t have the resources to respond in a comprehensive way to even the ongoing health threats, like the opiate epidemic or the spread of sexually transmitted diseases or things like hepatitis. The wildfire spread of COVID-19 quickly outstripped local resources.
“Arizona has been pre-approved for rapid funding by the CDC for public health emergencies of large scale, complexity or consequence that would have an overwhelming impact upon and exceed the resources available within the state,” according to the intergovernmental agreement describing the scope of the work under the new contract.
The grant is supposed to strengthen incident management, strengthen biosurveillance, strengthen “surge” management of resources and speed activation of emergency responses among other things.
It is a cost reimbursement grant, so the county will submit its first request at the end of the month.
The CDC has handed out similar grants all across the country, flush with big increases in its budget as part of the Congressional response to the pandemic. The gap in the public health system left little choice but to shut down large sectors of the economy when the virus did start to spread in the U.S. Health departments didn’t have enough test kits or manpower to conduct vigorous contact tracing.
Lack of disease creates lack of funding
Decades of relative freedom from once commonplace scourges like measles, smallpox, polio and other infectious diseases had led to steady reductions in the nation’s public health budgets and capacity. In the past decade, overall healthcare spending grew by 52 percent, but the budgets of local public health departments shrank by 24 percent, according to a 2019 report by the Trust for America’s Health. The CDC budget remained essentially flat for a decade. Currently, the nation spends 3 cents on public health for every dollar spent on healthcare – although numerous studies demonstrate that spending on public health yields greater savings than almost any other health care sector, mostly by preventing disease and disability.
Between 2008 and 2007, local health departments eliminated 50,000 jobs – roughly 23 percent of the total workforce.
Counties and states have trimmed programs focused on providing vaccinations, tests for sexually transmitted disease and monitor of threats in food and water supplies. Measles and syphilis have both made a comeback and smoking rates among teenagers have increased as spending on public health has declined.
In 2019, a consortium of public health organizations lobbied the federal government for $1 billion to modernize the data infrastructure for reporting data and trends on public health. Currently, the CDC relies on reports from state health agencies over which it has no authority, resulting in a patchwork of data and surveillance. The effort to modernize the data keeping system won $50 million of the $1 billion requested. After COVID-19 shut down the economy, Congress included another $500 million in its relief package – still half of the amount requested last year.
The Trust for America’s Health issued a recent report saying it would take an extra $5.4 billion annually to modernize the current, US public health infrastructure.
The lack of a comprehensive public health infrastructure has hit rural areas like Navajo County especially hard – including the Navajo Nation, with a scattered, fragmented healthcare system that spends about half as much per capita as even your average, underserved rural areas.
Despite the widespread presence of the virus the county health department and private labs are running only about 1,400 tests per week in Navajo County, with a population of 110,000. About 23 percent of the tests are coming back positive, the highest percentage in Arizona, where the average is closer to 8 percent. That would seem to indicate only people with a known exposure and serious symptoms are getting tested in Navajo County, which means health officials have detected only a fraction of the actual infections. Studies suggest that 25 to 50 percent of those infected have noticeable symptoms.
Neighboring Apache County still ramping up its testing capacity. The number of tests went from 219 in the week of March 15 to 628 in the week of April 5 to 938 the week of April 12. About 8 percent of the test results so far have come back positive. However, Apache County has one of the fastest growth rates per capita in the state.