Pandemic lays bare the starvation of America's public-health system, AP and Kaiser Health News report

"The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century," begins a comprehensive story by reporters for The Associated Press and Kaiser Health News.

"State and local government health workers on the ground are sometimes paid so little, they qualify for public aid. They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs. Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%."

Change in public-health staff per resident, by state, 2010-19

That shows at the Kentucky River District Health Department, where Public Health Director Scott Lockard "is battling the pandemic with 3G cell service, paper records and one-third of the employees the department had 20 years ago," the story reports. "He redeployed his nurse administrator to work round-the-clock on contact tracing, alongside the department’s school nurse and the tuberculosis and breastfeeding coordinator. His home health nurse, who typically visits older patients, now works on preparedness plans. But residents aren’t making it easy on them.

“They’re not wearing masks, and they’re throwing social distancing to the wind,” Lockard said in mid-June, as cases surged. “We’re paying for it.”

In some states, health departments are coronavirus stepchildren. "Melanie Hutton, administrator for the Cooper County Public Health Center in rural Missouri, pointed out the local ambulance department got $18,000, and the fire and police departments got masks to fight covid-19, but “For us, not a nickel, not a face mask. We got five gallons of homemade hand sanitizer made by the prisoners.”

The crisis has been long in the making, the story says: "Over time, their work had received so little support that they found themselves without direction, disrespected, ignored, even vilified. The desperate struggle against covid-19 became increasingly politicized and grew more difficult. States, cities and counties in dire straits have begun laying off and furloughing their limited staff, and even more devastation looms, as states reopen and cases surge."