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Home Health Pandemic exposes weakness in Pa. counties without health departments, like Westmoreland

Pandemic exposes weakness in Pa. counties without health departments, like Westmoreland

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When Kim Ward was sworn in as a Westmoreland County commissioner in 2008, one of her first questions was: Who oversees the county’s health department?

The former respiratory therapist was stunned to learn there wasn’t one.

Westmoreland, like 61 of Pennsylvania’s 67 counties, leaves the issue of public health to the state to handle. Only four cities statewide have their own health departments. That reality of the state’s public health infrastructure would come back to haunt and frustrate local officials 12 years after Ward asked her question, when the corona­virus pandemic arrived in early 2020.

The “haves” with their own health departments possess the kind of authority and information necessary to act quickly to protect residents throughout the pandemic. But it was needed especially early on, said Ward, a Hempfield Republican now serving as the state’s Senate Majority Leader. She was startled to learn first responders could not access data that identified addresses where there had been covid-19 cases.

“With only 10 local health departments in the commonwealth, the majority of our counties fall under the (Department of Health) for communicable disease prevention and control,” Ward said at the time. “This means while more specific geographic information of covid-19 cases are available in some counties … the majority of counties do not … because the state Department of Health has refused to release any information on covid-19 cases beyond the county in which they are located.

First responders — paramedics, firefighters, police officers and others — said they needed that information to take proper precautions. State officials balked, citing Pennsylvania’s 1955 infectious disease control law, which allows the health department to keep reports of contagious diseases confidential.

Next door, Allegheny County has had its own health department since 1957. For decades, county officials have interpreted the law differently. Starting early in the pandemic, they loaded address information into a database that alerted first responders to the need for extra precautions in specific locations.

Under fire from Ward and first responders, the state eventually relented and released such information to county emergency management officials. It also later began to detail cases publicly down to the ZIP code level, though counties with health departments have detailed theirs down to municipal and neighborhood levels.

As weeks turned to months, other holes in Pennsylvania’s public health infrastructure surfaced. Some dealt with data inconsistencies and how and where to make testing available. Others dealt with education and messaging over the din of politics that quickly surrounded the pandemic.

Ward’s initial question aside, officials in Westmoreland County going back more than 20 years can’t remember once debating deficits in the county’s public health infrastructure or whether to create a county health department.

County Commissioner Gina Cerilli said there was never a need.

“It wasn’t an issue until covid. But now I think it would be a discussion for the future,” Cerilli said shortly after she and fellow commissioners Doug Chew and Sean Kertes all contracted the virus. Kertes is still experiencing serious post-recovery complications from covid-19.

Local benefits

State law provides financial support for counties to establish health departments of their own, or jointly with other counties. It also allows for such responsibilities to be ceded to the state.

Allegheny, Bucks, Chester, Erie, Montgomery and Philadelphia counties all operate health departments. The cities of Allentown, Bethlehem, York and Wilkes-Barre have municipal versions.

Erie County, with about 80,000 fewer residents than Westmoreland, spent nearly $8.2 million last year on its health department, which was established in 1956. State and federal money underwrote about $5.25 million of that, with the county adding another $1.6 million. The remainder of the budget came from fees for services, donations, interest income and a fund balance from the prior years.

In Washington County, Commissioner Diana Irey Vaughan said, at the beginning of the pandemic, officials there wrestled with the challenge of getting out the message about masks and social distancing. Absent a local health department and concerned about information being politicized, she looked to officials at Washington Hospital to spread those messages to the public.

Irey Vaughan cited the difficulty local officials faced in getting timely data about infections and test results. There were inconsistencies between the data they received from the state and the information the local coroner’s office provided.

“It was even frustrating for our hospitals to obtain accurate information in a timely manner,” she said.

Years ago, Washington County officials discussed the possibility of establishing a local health department. That conversation was revived when the pandemic hit, Irey Vaughan said.

Upfront investments in public health that lead to a deeper knowledge of the community could be a bargain in the long term, said Dr. Noble A-W Maseru, a professor of public health practice at the University of Pittsburgh Graduate School of Public Health. He compared it to the cost of preventing a serious illness versus the cost of treating it later.

Members of Voice of Westmoreland have spoken out on public health issues in the wake of the pandemic. The progressive grassroots group has repeatedly called on county commissioners to raise public awareness of the issue and lobby state and federal agencies to provide more resources locally.

“If Westmoreland County would do more to get more testing done, we would be able to isolate (infected) people and that would have contributed to keeping our small businesses open and getting our kids back to school,” said Diana Steck, a retired nurse from North Huntingdon who serves as volunteer coordinator for VOW’s covid project. “Yes, we don’t have a county health department, but the commissioners know our communities. They could step up to the plate and interact with the state.”

Steck expressed concerns about testing “the disenfranchised and the poor” and questioned the lack of local plans for getting people vaccinated.

“It should not be up to someone in Harrisburg to try to figure this out,” she said. “They don’t know our community.”

‘Stepping up’

Public health encompasses myriad issues, from infectious disease to nutrition, environmental issues and maternal health as well as factors that contribute to high mortality rates, such as addiction, heart disease and obesity. Once brushed aside as the poor cousin of medicine and modern medical miracles, public health has taken on a new prominence in the era of a virus that knows no bounds.

Westmoreland-based Excela Health, a hospital and health care system, has been thrust into the breach.

Dr. Carol Fox, chief medical officer, and her staff have held regular conference calls with first responders and emergency management officials to coordinate local resources. Fox also has regularly spoken publicly to warn of the pandemic’s local danger.

In many ways, her expanded role reflects those filled by officials in local public health departments elsewhere — such as Dr. Debra Bogen, director of Allegheny County’s Health Department, who updates the public each week on the coronavirus pandemic along with County Executive Rich Fitzgerald.

Fox’s expanded duties came as Excela Health, like countless community health systems across the country, faced pressures on multiple fronts last spring. While it struggled to acquire sufficient personal protective equipment for front-line workers, it had to stanch the financial bloodletting when the state required hospitals to halt elective surgeries and procedures.

Greensburg-based Mutual Aid, the region’s largest ambulance service, has had a ringside seat to the unfolding dynamic, said spokesman Lorenzo Garino.

“Excela has done an excellent job of stepping up in the absence of a county health department,” Garino said. “We communicate regularly. We’re working together on a daily basis to make sure community needs are met.”

The effort has been anything but simple.

“It’s a challenge, to say the least,” Fox said.

Understaffed, underfunded

Until the pandemic struck, public health was relegated to the back burner in Pennsylvania and elsewhere.

Pennsylvania had a public health nursing staff of 210 in 2008. When the pandemic arrived last spring, that figure was down to 170. Almost immediately, the nurses who are the heart of the state’s district offices often were overwhelmed.

The Trust for America’s Health reported there were 55,000 job cuts in the U.S. public health sector between 2004 and 2018. At the same time, funding for the U.S. Centers for Disease Control and Prevention was reduced by 10%.

A University of Minnesota analysis of state-level public health spending in 2019 found Pennsylvania ranked 45th in the nation, spending $15 per resident annually in a state of about 12.8 million people. Such investments varied dramatically by state, ranging from $140 per person in New Mexico to $7 per person in Missouri. Kentucky, which ranked 25th, spent $35 per resident.

The Pennsylvania Department of Health, which provides public health services for 59% of all Pennsylvanians — 41% are served by county and city health departments — continues to struggle with financial issues. In the midst of the pandemic, budget documents show the state reduced funding for the Department of Health by $20 million, relying on onetime federal CARES Act grants to backfill the lack of state money.

The department’s budget in the 2020-21 fiscal year is $183 million, down from $203 million the prior year.

“There has been over the years concern raised about the reduction of public health professionals in state government,” Dr. Rachel Levine, the state’s health secretary, told the Tribune-Review. “That’s largely driven by the fact that we have had to cut consistently, year in and year out, and do more with less. There has been attrition, and we’re not backfilling those positions.”

One of the most serious issues she has faced during the pandemic has been the state’s outdated data systems, which weren’t designed to interface with one another and are losing bits of data that could be critical to knowing where and which groups are hit hardest and understanding and combating the pandemic. The state is looking to update those systems as well as to collaborate more closely with various research universities here to leverage its resources.

She said she and her department work closely with counties and cities that have local health departments.

“There are certainly advantages for counties to have a local department,” Levine said. “But it takes local funding to do that. It is a commitment.”

Deb Erdley is a Tribune-Review staff writer. You can contact Deb at 724-850-1209, derdley@triblive.com or via Twitter .

Coronavirus | Local | Pennsylvania | Top Stories | Westmoreland


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