Lancaster County lacked a timely, coordinated and data-driven response during the outbreak of the coronavirus last spring, possibly resulting in preventable sickness and deaths and highlighting the need for a county-run public health department, advocates and some community leaders say.
A dozen years after a failed push for a county health department, the local Partnership for Public Health says lessons learned from the pandemic make this the right time to renew a community conversation about whether a county-led agency should take charge of disease prevention and health-emergency preparedness.
The advocates propose a lean office led by a chief health strategist focused on gathering and analyzing data, coordinating initiatives, such as childhood immunizations and wellness programs, with hospitals and organizations already involved in those efforts, and seeking state and federal grants currently not available to the county.
Importantly, a county department would be a trusted and accountable source of up-to-date information during a health crisis, they say.
The proposed department would initially operate with a $2 million annual budget, of which only $160,000, or 8%, would come directly from county taxpayers, according to projections by the Partnership for Public Health. State funding and grants would drive most of the agency’s operations.
“A lot of people call us and say, ‘What do you mean we don’t have a health department?’” said Susan Baldrige, the Partnership’s executive director. “People assume a county this size has a health department.”
Six Pennsylvania counties have health departments: Philadelphia, Allegheny, Montgomery, Bucks, Chester and Erie, the last two of which have fewer people than Lancaster County, population 545,700.
The partnership has begun an effort to inform community leaders and the public about the benefits of putting a county-run department in charge of public health. Baldrige hopes the conversation leads the county commissioners to explore the issue and seek a state Health Department certificate that would allow the county to have its own department, if it chose to do so.
But county Commissioner Josh Parsons told LNP | LancasterOnline he’s skeptical a county health department would have delivered better results during the pandemic, which he said were good even compared to counties with health departments. He pointed to a Philadelphia Inquirer story that raised questions about $13 million the Chester County health department spent on unreliable COVID-19 antibody tests.
Parsons also said he believes that state law governing county health departments requires a “large bureaucracy, including a board of health,” and not the kind of smaller, collaborative model the Partnership proposes.
Meanwhile, Commissioner Craig Lehman told LNP | LancasterOnline that he is open to a conversation. In May, Lehman said the county needed a public health department to avoid the delays in emergency response experienced during the pandemic.
“A county public health department is needed now more than ever,” he said at a May 29 COVID-19 news conference at the Lancaster County Public Training Safety Center in Manheim, noting that the county had federal funds to help with start-up costs.
While Parsons and Commissioner Ray D’Agostino, who did not respond to a request for comment for this story, didn’t endorse Lehman’s proposal in May, they did express openness to a discussion.
Parsons in an email said Lancaster County responded to the pandemic “as quickly and effectively as virtually any county,” an assessment with which Baldrige disagreed. She called the county’s response “a patchwork” with hospitals, health centers, emergency medical services, nursing homes and others “trying to get us through this.”
She said the Pennsylvania Health Department’s statewide, “one-size-fits-all” approach to the pandemic and its lag in sharing data with Lancaster County further “led to frustration and delay here.”
“That information was often no longer useful by the time local leaders received it,” she said.
Meanwhile, the counties with health departments had access to COVID data, established 24-hour COVID hotlines, had stockpiles of personal protective equipment and began contact tracing within two weeks of the first cases. In contrast, Lancaster County waited two months for federal funds before ramping up contact tracing.
When the pandemic ends, a county health department would focus on routine public health issues that make people sick and run up health care costs, Baldrige said. The department, for example, could lead initiatives attacking opioid abuse, lead poisoning, heart disease, obesity and childhood diseases.
Al Duncan, CEO of the company that operates Miller’s Smorgasbord, AmishView Inn and Suites and other tourism-based enterprises, said he has long been concerned about the health and economic impact of an infectious outbreak, and the pandemic only reinforced his view “10-fold.”
“It’s not a matter of if (another) crisis occurs. It’s a matter of when,” Duncan said. “My word, if we don’t seize this opportunity, do we go another five, 10 years until we have a public health department?”
April Hershey, Warwick School District superintendent, said it sometimes felt like a scramble as school leaders sought trustworthy information to help them decide when and how to reopen.
Hershey said she sees value in setting up a county health department that understands this communities’ circumstances and would be able to help leaders “sift through the often-conflicting and ever-changing advice that comes from federal and state agencies to ensure that we’re making the best choices we can for the safety of our students and staff.”
Penn Medicine Lancaster General Health, which contracted with county government to receive up to $24.7 million in federal funds to conduct countywide testing and contact tracing, wants to learn more about the Partnership’s proposal and welcomes a dialogue with Lancaster County leaders to “collectively address the lessons learned from the current pandemic,” spokesman John Lines said.
Lancaster Health Center, which treats the medically underserved in Lancaster city, had success with contact tracing for the patients it serves, said Alisa Jones, the center’s president and CEO. But she said it’s likely the fragmented response outside of the city resulted in infected people and their contacts not being identified.
A county health department could plan for a countywide response and implement the plan on Day 1 of a crisis, Jones said.
“When we don’t have that professional, accountable, countywide perspective, then we waste time” mounting a response, Jones said. “It takes us time to … figure out what’s happening and to interpret the guidance” from state and federal officials. “Every minute that we delay is a potential for lives lost.”
Lancaster County was fortunate to receive substantial federal funding for testing and contact tracing, Jones said, but that doesn’t guarantee a similar response in the future.
Fifteen year ago, Hilda Shirk was a consultant who led a United Way initiative to advocate for a county health department.
In 2007, the then-board of commissioners agreed to ask the state Health Department for a certificate of approval, the first step in the state’s consideration of whether it’s appropriate for a county to have a health department. Shirk said the state granted the certificate, but afterward the push for a health department faltered, a casualty of the Great Recession. The issue never came before the commissioners for a vote.
Shirk now is volunteering her expertise to the Partnership’s new effort. Baldrige said the lean, collaborative, data-focused model she is proposing is little different from Shirk’s earlier proposal, which secured a state certificate of approval.
“We didn’t envision a strategic data person” in 2007, Shirk said. “But there was an emphasis on centralized data collection. There is a real concern that we don't have one place to go, one repository for information that is agnostic. We have different entities collecting data for their use, but not for the benefit of the county as a whole.”
A department would study the data to see where the county is falling short compared to other counties and states and seek to do better.
“The state doesn’t do that” for the county, Shirk said.
Shirk said another advantage of a county health department is employing its own restaurant inspectors, displacing state inspectors and establishing “a culture of partnership versus heavy-handed regulation.”
Shirk said the pandemic has demonstrated how devastating a public health emergency can be to the entire community and how difficult it is to manage through existing systems.
“It does require strong expertise and coordination,” she said. “We have great people and a real desire to respond appropriately to our residents. We’ve got that going for us. But we’re too smart to leave it as it is. We don’t want to scramble again.”
Manheim Township Commissioner Tom O’Brien said he plans to ask fellow commissioners in coming weeks to adopt a resolution calling on the Lancaster County commissioners to establish a health department. O’Brien said the impact of COVID-19 on long-term care facilities in the township convinced him of the need for a better countywide response.