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Local public health departments are key to Minnesota's coronavirus fight -- many are already stretched thin

Saint Paul Pioneer Press - 3/7/2020

Mar. 7--Minnesota's local public health departments are the first line of defense against COVID-19 and many are understaffed and lacking funding to deal with widespread coronavirus infections.

"We certainly could use some more help," Gina Adasiewicz, deputy public health director for Dakota County, said Friday after a group of local health officials met to discuss virus preparations with Congresswoman Angie Craig.

After the state's first case of coronavirus was discovered Friday in Ramsey County, Minnesota will be reliant on local public health departments in its COVID-19 fight. During a pandemic, local public health workers are responsible for monitoring infected patients, making sure people under quarantine have supplies and helping medical providers slow the spread of the virus.

Local leaders say they're up to the task, but note that if a large portion of the state's population gets sick, many local public health departments will be strained.

"It would take a whole lot more staff than what we are working with right now," Adasiewicz said.

RESPONSE HAS ALREADY BEGUN

Dakota County, the state's third largest county with about 425,000 residents, now has three public workers dedicated to the coronavirus. It has the potential to tap most, if not all, of a staff of 100 public health workers to help respond.

County leaders are already reassigning and training staff to respond to a flood of questions about the virus from residents. "Our phones are ringing off the hook," Adasiewicz said.

Kathy Hedin, Ramsey County interim public health director, seeks to assure residents that its health workers have responded to similar crises before. The county of about 550,000 residents has about 300 public health employees, most of whom are trained to respond to health emergencies.

Health officials in the six counties covered by Craig's congressional district told her responding to COVID-19 comes with many different challenges. Other important programs have to be put on the "back burner" to respond to the crisis and even then they have to do a lot with few people, local officials said.

LOTS OF RESPONSIBILITIES, SMALL STAFFS

For instance, Rice County has a small health staff, but heightened risk for COVID-19 spread. With Carlton and St. Olaf colleges and Shattuck-St. Mary's boarding school, the county has a large number of students living in close contact -- many of whom often travel home.

"We are in higher risk, but that doesn't impact our funding," Tracy Ackman-Shaw, Rice County emergency preparedness coordinator. "Looking at funding, it's important to look at the actual needs and impact on the county."

Craig assured local leaders that Minnesota's$10 million portion of $8 billion in funding approved Thursday by Congress to respond to the coronavirus would soon be available to community health groups. The Minnesota Legislature is also working to approve $25 million to combat the coming outbreak and $8 million of that is dedicated to public health.

"I know how tough Minnesotans are and I know how we come together in a crisis," Craig said. "At the end of the day, I know Minnesota will come together to get through what is happening here."

A FOCUS ON PARTNERSHIPS

State and local health officials were quick to praise Minnesota's preparedness and the communication between local, state and federal agencies.

"I'm grateful to be in the state of Minnesota," said Arnold Vang, who runs the quarantine facility at the Minneapolis-St. Paul International Airport for the Center for Disease Control and Prevention. "We have phenomenal partnerships."

Besides airline travelers, Vang and his team are also responsible for screening people who enter the state by land and through ports. They work closely with health officials, airlines and state medical providers to screen people coming into the state.

"We have a communicable disease response plan that's been established and in place throughout the years," Vang said.

There is one piece of emergency preparedness that's currently frustrating local leaders -- especially in counties with smaller staffs.

Public health officials have until June to complete a large scale emergency preparedness exercise for the CDC. Preparations for that test are pulling staff away from coronavirus response, local officials said.

Congresswoman Craig said she would ask the CDC if there is a way to extend the deadline for completing the exercise. "It's all hands on deck for COVID-19," she said.

MANY WON'T BE TESTED

If the COVID-19 outbreak becomes widespread, there are a number of challenges public health officials will face to provide care to those who are infected.

Many people who are sick won't know if they have the virus. The state currently has limited capacity to test ill people so health officials are only checking people with symptoms who have been in contact with someone known to be infected or traveled to an area where the virus is widespread.

People who are hospitalized are also being tested after they are checked for the flu and other respiratory diseases. The state estimates it will test 6,000 people over the next year.

"We are never going to be able to identify every person who has this," said Ruth Lynfield, an epidemiologist for the state. "That's not a good use of resources."

A PANDEMIC WILL CHALLENGE RESOURCES, WORKERS

Health officials are also worried the masks, gowns and gloves medical workers need to stay safe could be in short supply. If health workers can't avoid exposure, there will be no one to care for the infected.

"It's going to be a problem if we are going to have to furlough health care workers because they are sick," Lynfield said.

She suggested that virtual doctor appointments, or telemedicine, might be a way to address access to care shortages in rural areas or when a lot of people are ill.

There's also an acute concern for residents in long-term care and assisted living facilities. The elderly and people with underlying health conditions are especially susceptible to the coronavirus.

Elder care facilities already face staffing shortages and many of their lower paid employees do not have sick time, Lynfield said

"We need to do whatever we can to ensure sick people are not going into long-term care facilities and interacting with the very vulnerable residents who are there," she said.

Finally, health officials say communities need to be ready to check in on one another to make sure no one falls through the cracks. They suggest reaching out now to elderly neighbors and people who live alone to find out the best way to check on them.

"We really have to have that responsibility to check in," said Cheryl Peterson-Kroeber, director of emergency preparedness for the Department of Health. "It's going to be that kind of thing that keeps people safe."

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