DANVILLE — The Boone County Health Department has been logging overtime since the start of the COVID-19 pandemic in March, and while the workload has increased dramatically, the agency’s daily responsibilities have not ceased — creating a dilemma for an already stretched-too-thin staff.
As of July 30, the county had 70 cases of COVID-19 confirmed by the Boone County Health Department, with 52 recovered cases and no deaths to report.
While the confirmed case total may seem slight compared to other counties in the state, Administrator Julie Miller said that, for a staff of three in a county with approximately 22,000 residents, it has caused a significant increase in workload.
“What we are finding is that it isn’t just us — it is a statewide problem,” Miller said. “We are dealing with a pandemic, but our other daily responsibilities still exist. We are dealing with reportable diseases that have to be addressed. At one point, I was dealing with a Lyme disease and a possible mumps case. We still have immunizations, sexually transmitted disease and we are getting pulled in many different ways — and a lot of staff in a lot of counties are having a rough time because of the hours that people are putting in.”
And as researchers learn more about the virus, the staff has to be educated and apply that knowledge daily.
“There are constant changes and I understand why they change, because we are learning more and more about the disease,” she said. “We saw that with H1N1, but I think this is a whole lot more.”
Miller said her staff’s daily responsibilities have grown exponentially and she fears there may be “burn out.”
“I have two clerks and me,” she said. “I need another nurse and at the very least one full-time sanitarian, and that is at a minimum. When you look at funding, we were cut 25% a few years ago. Two years ago we got some of that funding back, but not all. When you do that, our costs have gone up and we’ve lost all of our county funding.”
Miller noted a dire need for updated equipment — particularly transportation related — for the agency moving forward.
“The cost of keeping cars on the road, vaccine costs go up all the time,” she said. “I may order that this week and the price next month will be higher.”
Miller said that if funding isn’t found, she fears that a restructuring of services by the health department will be inevitable.
“I fear that we will have to reduce what we can do,” she said. “With the staffing we have, people will eventually burn out. There is just so much we can do. It will cause a problem. How can we do flu vaccines where we have to travel to different places and manage a pandemic at the same time? If we get a vaccine, how in the world are we going to manage that?”
Miller, who serves as vice president of the West Virginia Public Health Association, said the group meets via teleconference frequently, which gives her insight into the struggles around the state that run parallel with her own.
The WVPHA expressed concerns to U.S. Senators Joe Manchin, D-W.Va., and Shelley Moore Capito, R-W.Va., in hopes that stimulus funding could be funneled directly to the health departments in need.
Miller said it took three attempts at the application process through the state for Boone County to get its share of the $625 million in federal stimulus that was released in April to West Virginia.
The Boone County Health Department secured approximately $49,000, which Miller said was helpful, but merely provided a band-aid for a larger problem that primarily revolves around a lack of adequate staffing. She’d like to see federal stimulus funding go directly to the health departments without the state serving as guardian of the coffer.
“We want that money to come directly to the health departments and not be sent to the CDC (Centers for Disease Control and Prevention) or the state,” she said. “One of our goals is to have funding based on $8 per capita, with a minimum of $200,000 per county and a ceiling of $1 million.”
She added, “Some of the larger counties have spent $100,000 or more fighting the pandemic,” she said. “We don’t have any funding to spend fighting it. Across the state, it is my understanding that we are losing good people because they can’t take the stress.”
Miller added, “Finding staff for a health department isn’t easy, because this isn’t a path that most people look to. We are at the forefront of this (pandemic) but we aren’t the ones you see on television all the time.”
Miller said she and her small staff take pride in answering questions from the public on a daily basis, and much of that time is spent educating the public and providing comfort to the elderly.
West Virginia Senator and Boone County-based geriatric physician Dr. Ron Stollings offered perspective from a medical perch and that of a state-level elected official.
“We’ve got to direct money to our local health departments to help out the functionality and robustness of our response,” Stollings said. “That didn’t happen, and in fact I don’t think money has gone there yet months later even after we know that they are understaffed, underfunded and under-equipped.”
Stollings said that the public health infrastructure across the state needs to be evaluated and upgraded.
He said the West Virginia School of Public Health has been a bright light for the state in terms of stepping in to provide support.
“That is what you look for, is an opportunity for students to get a real practicum and what better way to get real-time experience than through a pandemic,” Stollings said. “In turn, they are providing essential services that our state needs. We must invest in public health moving forward. My hope is that we’ve learned from this.”
Gilmer County native Boyd Vanhorn is the administrator for the Grafton-Taylor County Health Department and president of the West Virginia Association of Local Health Departments.
“No one else that I know of could sustain the level of work and stress that Julie Miller and her staff in Boone County has undergone for the last five months,” Vanhorn said. “She is dedicated to public health in a way that very few are.”
Vanhorn expressed the stresses of departments similar to Boone County.
“We were to some degree decimated by the 25% cut a few years ago,” he said. “It is my belief that our current administration is working hard and diligently to get and provide funding, but sometimes these things move slowly and unfortunately is the nature of governmental funding.”
According to Vanhorn, as of June 1, 13% of health departments in West Virginia had less than 30 days cash on hand, with nearly half having 90 days or less.
“We were left without a foundation to stand up to a pandemic,” he added. “We weren’t staffed properly and that is where preparation begins.”
Vanhorn noted that regular communication with Gov. Jim Justice’s staff has been beneficial to identifying problems and establishing directives to solve them.
Vanhorn said grants related to infrastructure and laboratory processing in particular are in motion.
“This has been a problem,” he said. “We want more testing, but when you do a lot of testing in one day it jams up the labs. We only have so much capacity there. The DHHR has been working on a grant to enhance laboratory services and response. Our folks in DHHR are working hard on these problems.”
The grant will provide a team of 11-13 people on a regional basis with a response team formed under the umbrella of the federal funding.
“Most of us haven’t received the dollars yet and ramping that team up doesn’t happen with the snap of the fingers,” Vanhorn concluded. “You have to recruit and find the employees, train and retain them and all of those things are tricky in the middle of a pandemic like this.”