State Lab technician Christy Spratt innoculates tubes with fecal samples for E. coli testing.
State Lab technician Christy Spratt innoculates tubes with fecal samples for E. coli testing in the old state lab in downtown Raleigh. Photo credit: Rose Hoban

A new report shows North Carolina is ready to respond to infectious disease outbreaks, but also points out gaps in the public health response system.

By Rose Hoban

A report issued this week ranks North Carolina near the top of states in protecting people against infectious-disease outbreaks.

The report by the Trust for America’s Health and the Robert Wood Johnson Foundation found that North Carolina and seven other states met seven or eight key indicators for infectious disease preparedness.

A report from the Trust for America's Health shows North Carolina to be one of the most prepared states in the case of infectious disease outbreak.
A report from the Trust for America’s Health shows North Carolina to be one of the most prepared states in the case of infectious disease outbreak. Image courtesy TFAH.

The benchmarks included vaccination rates, public health lab preparedness and reporting of infections acquired in hospitals.

North Carolina did well on most indicators except for public health funding, vaccinating toddlers against whooping cough and preparing for the health impacts of climate change.

Lynnette Tolson, head of the North Carolina Public Health Association, said the state has some reasons to be proud of how well professionals respond to outbreaks.

“In 1980, North Carolina was the third highest in tuberculosis outbreaks across the country; but in 2012, we had the lowest incidence ever in North Carolina of TB,” Tolson said. “We are now 29th in the nation.”

Tolson said public health workers in North Carolina have responded to more than 300 outbreaks in 2012 and 2013.

The report noted that since the 1940s, there have been tremendous advances in infectious-disease prevention efforts, which have saved countless lives.

But the nation’s ability to prevent and control outbreaks is hampered by outdated systems and limited resources, the report said, adding that infectious diseases cost the country more than $120 billion annually.

“We have a relatively low vaccination rate, lower than it should be and lower than in other countries,” said Tom Inglesby, director of the Center for Health Security at the University of Pittsburgh Medical Center, who reviewed the report for the Trust for America’s Health. He helped present the findings during a national conference call with reporters.

Inglesby said many people believe, mistakenly, that the medical profession has infectious disease under control.

“We’ve seen resurgence of a number of threats that had been eradicated in the U.S., namely, measles, pertussis, tuberculosis, particularly in urban areas,” he said.

The medical-care systems have each been making improvements, but don’t communicate as well as they should during outbreaks, according to Jeffrey Levi, head of the Trust for America’s Health and a study author.

“Electronic health records over the long run should improve care, but the public health system has been left out of the movement to EHR,” Levi said. “That means public health won’t benefit from the efficiencies and data that we can get out of EHRs” in the event of outbreaks.

North Carolina received high marks for pushing for influenza vaccination for more than half the population, for offering human papilloma virus vaccination to teens and for mandating that hospitals, clinics and nursing homes report health care-associated infections to the state for tracking.

Mixed results for public health system

North Carolina’s new public health lab in Raleigh was cited in the report as being able to handle a significant surge in demand for testing during outbreaks. The lab was also lauded for being able to transport and test samples all day, every day of the year .

Funding for the new lab was designated during the early 2000s, in the wake of SARS, anthrax scares and fears of bioterrorism. Planning funds came from CDC bioterrorism grants and state money funded the building of the new facility, which opened last year.

“The old lab was so bad that you had to unplug one piece of equipment to run another,” said Leah Devlin, who was state health director when funding for the lab was designated by the General Assembly. (Devlin is also a board member of N.C. Health News.) “The building was never built to be a lab. There was no way to do security of samples correctly, maintain chain of custody; it was impossible to work out of that place.”

She said once legislators toured the old lab, many backed the creation of a new facility. But Devlin also noted that “was a different time.”

She said that in some ways, while building the new lab, the state benefited from the economic downturn, when construction and procurement costs dropped.

“They got a lot more for their money,” Devlin said.

But in recent years, the North Carolina General Assembly has cut funding for public health at the same time as counties’ revenues have been shrinking, with the result of diminished local capacity.

In the last state budget, legislators cut funding for oral health, trimmed the budget for the Division of Public Health and eliminated funding for teen tobacco-cessation activities. In previous years, legislators have cut funding for childhood vaccinations, local health department accreditation programs and the public health lab.

“The locals are stretched thin,” said Tolson, who said cuts came at the local level first, with state cuts further cutting into local capacity.

“Maybe a county will take a full-time communicable-disease nurse and make her a part-time nurse doing communicable disease, and have her do something else in the clinic; so she’s got two responsibilities,” Tolson explained. “Then if there is an outbreak, that means you pull that nurse out of the clinic in order to investigate the outbreak.”

She said that becomes a problem particularly in smaller counties, where more low-income people depend on health department clinics for treatment and there’s little other access to care. So even if cuts don’t target the budget to control outbreaks, they eventually do end up affecting a county’s ability to respond.

“If you take from part A to give it to part B, then part A gets deflated,” Tolson said.

“A key challenge for the public health workforce is communicating the value of what we do,” wrote Ed Baker, former head of the N.C. Institute of Public Health in a recent report. “Because our focus is on preventing disease and injuries, the results of our work tend to be invisible, and people take it for granted.”

According to another TFAH report, North Carolina ranks among the bottom in public health funding, spending an average of $14.16 per person, compared to a national average of $27.40. At least three-quarters of local health departments in North Carolina have had staff losses, furloughed staff or cut programs since 2011.

Federal and state budget cuts to public health have also been damaging, Levi said.

“Not everything can be done on the cheap,’’ he said. “You can never become lax. We can’t always be playing catch-up.”

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