As coronavirus threatens, Alaska's decline in public health preparedness becomes clear

In a clear sign of how the state public health work force has been hollowed out by years of budget cuts, Gov. Mike Dunleavy proposed adding 10 new temporary state jobs in the health department to deal with the novel coronavirus threat.

While Dunleavy and health commissioner Adam Crum say the state is prepared and ready to respond to the challenge ahead, that is wishful thinking or worse.

That this emergency requires the state to try to hire skilled health workers on a temporary basis—jobs that have been difficult to fill for a long time—reflects a serious decline in preparedness created by years of cutbacks as Alaska reduced spending on crucial services needed during a crisis.

Chalk this up as fallout from the mindless mantras of “right-sized government” and “shrinking the government footprint.” The decline in public health service capabilities has gone unreported by Alaska news organizations and drawn little attention from elected officials, mainly because there hasn’t been a crisis recently.

The state public health labs in Anchorage and Fairbanks could soon be overloaded, if they are not already, with a large number of specimens from patients who may or may not have the disease, but need to be checked because of concerns from health care providers.

This is on top of the other work that has kept the labs busy year-round—dealing with hepatitis, sexually transmitted diseases, tuberculosis, the flu, food-borne pathogens, HIV and other public health threats.

The labs conducted 209,000 tests in 2019, with a total workforce of 38, down from 51 eight years ago.

Private labs are not equipped to handle the work of the state labs.

The potential magnitude of the challenge is that there could be a far greater demand for suspected specimens to be analyzed and processed than during the last major public health crisis, the 2009-2010 H1N1 flu pandemic.

Dunleavy said he wants to add one temporary microbiologist to the Fairbanks lab, but that would not come close to making up for the cutbacks over the last seven years or so.

In 2013, there were 12 public health microbiologists at the Anchorage lab and 10 in the Fairbanks lab. Today there are 11 microbiologists in Anchorage and 5 in Fairbanks.

“Non-competitive salaries and information technology limitations continue to challenge laboratory operations in the rapidly changing technological and scientific arena,” the state said in December 2018.

The shrinking of the public health nursing workforce shows a bigger decline. There were 110 public health nurses in 2013, while today there are 89 authorized positions.

However, the state employee directory only shows 72 occupied public health nursing positions statewide. As a retired regional manager notes in the comments below, the number of authorized positions is misleading as the state is not a competitive employer.

“A major part of the work this year focused on H1N1 response and immunization activities,” the state said in a late 2010 report about public health nurses. “Public health nurses provided community education on the importance of hand washing, covering coughs, and staying home when sick. Information was also distributed regarding home care and treatment, school and work attendance guidelines, when to seek further medical attention, and when to stay home. Alaskans had numerous other questions regarding H1N1, and Public Health Center staff provided many answers to a worried public. Once the H1N1 vaccine became available, public health nurses vaccinated 68,232 Alaskans against this disease, giving 48% of the vaccine administered by health care providers in Alaska.”

Since 2014, the nursing and support staff workforce reductions have led to a major decline in the ability to provide services.

“Professional registered nurses and administrative staff continue to decline job offers or seek other employment, making it difficult to recruit and retain qualified staff. Particularly challenging to fill are key administrative positions (i.e. data entry staff) and public health nurse positions at single-nurse public health centers (i.e. Tok, Delta, and Sitka) which required itinerating nurses from larger, though understaffed, locations. The reduced workforce decreases capacity to provide timely and effective response to emerging outbreaks and threats while maintaining other core services,” the state said in December.

The overall staffing level for public health nursing has been cut from 199 in 2013 to 159 today.

The new temporary jobs Dunleavy has proposed include five public health nurses, three nurse epidemiologists, one microbiologist in Fairbanks and one emergency manager.

“These positions will be based statewide and will be able to travel as needed to rural communities to help monitor and screen for COVID-19,” a Dunleavy press release says.

Dunleavy told reporters the state is as prepared or better prepared than any other state. I’m not sure that is correct, given the staff reductions.

“We know how to deal with fires, we know how to deal with earthquakes, we know how to deal with volcanoes, high winds, etc. And so this being a health issue we wanted to make sure that we have protocols in place, once this virus arrives, and we think it probably will with the way it’s spreading, that we’re are prepared for it,” Dunleavy said. “From a 30,000-foot level we’re feeling pretty good about where we’re at and how things are going.”

The danger of this unwarranted optimism is that the state won’t do enough to prepare and won’t act quickly enough because “we’re feeling pretty good.”

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