"Even for having the best in the United States, it's not saying very much," Iton said. "Because that core infrastructure of local public health has been frayed over the past decade.”
Public health in California are largely run by the counties. That includes 29 county laboratories that test for things like sexually transmitted diseases, tuberculosis and West Nile Virus.
State Sen. Richard Pan, D-Sacramento, chairs the Senate Health Committee. He said county health departments are key to protecting the public, but their job is to stop outbreaks before they start. That made them vulnerable to budget cuts during the Great Recession, which began in December 2007.
“Public health took cuts," Pan said. "Because, after all, when something isn’t happening, you go, 'Well, do you need these people right now? We kind of need people for other things, so we should lay off these people.' ”
California created a standalone Department of Public Health in 2007. But the department’s seen drops in funding from both the state and federal governments. The state Legislative Analyst’s Office said if spending had been maintained at 2007 levels, the department would have had a nearly $4 billion budget today. Instead it’s closer to $3 billion.
There has been some reinvestment by the state. In last year's budget, lawmakers allocated $40 million for the prevention and control of infectious diseases.
Iton said, despite the cuts, the state’s leaders have done a good job reacting to the coronavirus so far. But he’s worried about medical responders being stretched too thin.
“You’re going to start to see fatigue in the folks that are on the front lines of this," Iton said. "And because there's so few of them, and they don't have the reinforcements, and they haven't had the essential infrastructure support that they've needed over time, you're going to start to see cracks in the system.”
And how big those cracks get will depend on how long the outbreak continues.
