Georgia's emergency planning may receive unprecedented scrutiny as the state deals with the new coronavirus pandemic. In particular, the coronavirus emergency raises questions about state funding for the Department of Public Health's epidemiology section, the home of the Georgia Public Health Laboratory, now charged with identifying coronavirus cases.
The epidemiology section’s state appropriations have been flat, at best, for the past 15 years. The 2009 state budget actually allotted more money for the epidemiology section than the current year’s spending plan does.
Overall, Georgia’s spending per resident on public health ranks 37th among the states, a standing only slightly improved since 2009. Then, as officials scrambled to contain the H1N1 virus, also known as the swine flu, Georgia ranked 39th.
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For more than a century, public health in Georgia has been a modest undertaking. The first state health lab opened in 1905 in what once had been stables in the Capitol's dank basement. For decades, the state's public health efforts have been overshadowed by the federal Centers for Disease Control and Prevention, which opened in the 1940s on Peachtree Street in downtown Atlanta. Now the state lab is headquartered on Clairmont Road in Decatur, less than two miles from the CDC's campus near Emory University, and a satellite facility operates in Waycross, about 250 miles southeast of Atlanta. A third state lab, in Albany, closed because of budget cuts almost a decade ago.
State officials did not respond to specific questions about their preparedness for a pandemic, including the details of the surge plan for the public health lab. In a news conference Thursday, Dr. Kathleen Toomey, Georgia’s public health commissioner, said additional testing equipment would be installed in the state lab by Monday and that more staff would be trained to conduct tests. By the end of the week, she said, officials hope to greatly increase the lab’s testing capacity.
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Experts said Georgia’s situation reflects a national problem: public health tends to draw the attention it warrants only during emergencies.
"That's a known phenomenon — the cycle of panic and neglect," said Dr. Cyrus Shahpar, a former CDC official who runs an epidemic prevention program for a nonprofit called Resolve to Save Lives.
Governments tend to invest in areas where results are tangible, such as economic development, Shahpar said. “When you invest in preparedness, you invest in making sure there’s nothing happening.”
The last major U.S. pandemic occurred before most current Americans were born. In 1957 and 1958, an outbreak of an Asian influenza killed 116,000 Americans and another 1 million people worldwide. Public awareness of the need to plan for such events fades over time, Shahpar said. “It gets forgotten.”
More recent outbreaks, such as H1N1 in 2009 or the Ebola epidemic of 2014, sickened relatively few people in the United States. But each could have been seen as a call to arms for disease prevention, experts said.
"There's a high level of skill and knowledge in the state and local health departments," said John Auerbach, president of the Trust for America's Health, a nonprofit that advocates for public health spending. "We have been asking these really skilled and dedicated people to do more with less resources."
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But Auerbach, a former CDC official who also was the state health commissioner of Massachusetts, added: “In between emergency situations, there is an inclination by policy makers to forget about public health.”
Auerbach’s organization has given mixed reviews to Georgia’s public health efforts. It was one of 12 states in the organization’s newly published annual report to get a middling grade from the organization; 25 states and the District of Columbia received a top rating, and 13 got the lowest scores.
Georgia got points for allowing nurses to work across state lines during emergencies and for preparedness by its hospitals.
But Georgia ranks near the bottom in vaccinations for seasonal influenza. For years, Georgia’s state lab was among a handful around the country lacking accreditation from a national public health organization. And it wasn’t until this year the state finally got credit for having a surge plan – a detailed outline of how it would deal with increased testing demands during an outbreak that lasts six to eight weeks.
Georgia’s public health system itself is unusual. Georgia is one of just three states that cede authority over local health departments to counties — in Georgia’s case, 159 local boards of health, each of which sets its own budget and its own priorities. A network of state-run district offices tries to coordinate the counties’ efforts.
Staffs in the county and district offices have learned from a series of emergencies over the past decade, said Dr. Lawton Davis, president of the Georgia Public Health Association and health director of the Coastal Health District in Savannah.
“H1N1 was a big wake-up call,” Davis said, and was followed by several natural disasters that required a public health response: three hurricanes on the southeast Georgia coast and one that moved from the Florida Panhandle into southwestern Georgia.
“We’ve become much better at communicating and disseminating accurate information,” Davis said. “You can never plan for every contingency. But as far as communication and testing, the state by and large has done very well.”
Still, funding remains a concern. This year, the public health agency’s epidemiology section is budgeted to receive $5.4 million in state money — significantly less than the $6.8 million dedicated to the veterinary and poultry labs.
The General Assembly this week approved a request by Gov. Brian Kemp for $100 million to respond to the coronavirus. When asked during a news conference how the money would be spent, Kemp said, “I don’t think we have an answer for that.”
But the money will be available “when we need it,” Kemp said. “We’re going to have a lot of resources available.”
In addition to the state funding, the public health lab was due to receive $6.5 million in federal grants, a figure that has remained virtually unchanged since 2014.
This week, the CDC announced it would give Georgia an additional $14.8 million to respond to the coronavirus and to the disease it causes, COVID-19. It is part of the nearly $1 billion in emergency funding recently approved by Congress.
But Shahpar, of Resolve to Save Lives, said Congress should have acted sooner. As early as January, he said, public health experts warned that the coronavirus was spreading across the globe.
The extra money is “invaluable,” said Auerbach, of the Trust for America’s Health. “But it’s one-time money that will go away.”
Once the coronavirus is gone — and until the next emergency arises — most states will continue to lack sufficient numbers of public health workers, supplies and other resources, Auerbach said. “We haven’t made progress in that regard.”