Magnificent News: The Health 202: Feds supercharged public health. Now the challenge is wisely spending it.

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Your health policy appointment.

By Dan Diamond
with Alexandra Ellerbeck

After pleading poverty for years, public health has collected a coronavirus-related windfall.

Now officials have a new challenge: responsibly spend the money — while convincing Congress to set aside funds for future priorities too.

"I'm worried that we will think this is the end of investing in public health," said Dara Lieberman, director of government relations at Trust for America's Health, an organization dedicated to boosting community health.

Hundreds of billions of dollars flowed into public health in 2020.

Lawmakers greenlit historic stimulus packages in the rush to beat back the pandemic.

One number to remember: $305.6 billion. That's how much last year's packages provided in supplemental funding to public health agencies, like the Centers for Disease Control and Prevention, and the nation's public health fund, according to a Congressional Research Service report.

And that number doesn't include tens of billions of dollars made available under this year's American Rescue Plan, like the $7.4 billion already earmarked to hire and train public health workers.

Speaker of the House Nancy Pelosi raps her gavel after the House voted to pass on coronavirus relief package on March 10. (Photo by Drew Angerer/Getty Images)

The funds could transform the nation's threadbare public health departments. Desperate for resources, many were still relying on fax machines during the pandemic, as Sarah Kliff and Margot Sanger-Katz detailed in the New York Times last year. And the monies represent a breakthrough after Tea Party Republicans and the Trump administration repeatedly tried to cut agencies like CDC in varied efforts.

"After years of fighting to defend against budget cuts, I believe there is now broad understanding and support for investing in public health infrastructure, workforce, and preparedness," Rep. Frank Pallone (D-N.J.), who chairs the House Energy and Commerce committee, told The Health 202.

But that new money is pouring into a system that's still full of cracks.

It's putting pressure on officials and appropriators to ensure the funds go where they should.

"If you think of public health as a building, we haven't quite built the foundation yet," said Lieberman, pointing to shortfalls in staffing, data systems, surveillance and other areas, chronicled by TFAH's new report. "We've flooded public health money for the covid response atop this crumbling foundation."

For instance, TFAH notes that while the United States spent nearly $4 trillion on health in 2019 — driven by interventions like hospital care and prescription drugs — just 2.6 percent of that spending went toward public health and prevention.

Now dollars will rain on cash-starved public health officials as they weigh investments in data systems, genomic sequencing and other potentially transformative initiatives.

Harris County Public Health contact tracing facility in Houston. (AP Photo/David J. Phillip)

Some officials privately concede — having watched how pandemic aid was misspent last year — that they're worried some of their own investments could backfire. No one wants to be responsible for the next Solyndra, the taxpayer-funded solar-panel company that failed and became a scapegoat for the Obama administration.

Other experts are publicly preaching patience. "There's no doubt in my mind that the influx of funds will require some catch-up time for staff to be hired, for programs to be put in place, and then for those programs to actually be implemented," said Eduardo Sanchez, the chief medical officer for prevention of the American Heart Association.

Meanwhile: lawmakers' spending largesse may not last.

That could complicate funding for all the other health challenges that aren't explicitly coronavirus-related.

Umair Shah, Washington state's health secretary, traced how money that was set aside to fight the Ebola pandemic in 2014 was transferred to fight the Zika virus in 2016, as the earlier emergency was quickly forgotten.

"Policymakers look at that [leftover funding] and say, 'you already got those dollars. So we don't need to give you more,'" Shah said.

Rich Besser, head of the Robert Wood Johnson Foundation and the former acting head of the CDC, said he's troubled about a "standard operating procedure" mentality: a massive funding response to a crisis, followed by a quick retreat, citing the management of Hurricane Katrina and other prior disasters.

"The dollar figures [to fight coronavirus] are bigger than we've seen before," Besser said. "But that kind of cyclical funding is not healthy… we need long-term, sustainable, flexible funding."

And pandemic-related funding isn't untouchable. The Biden administration dipped into $2 billion set aside for health priorities like coronavirus testing to help cover the surge of unaccompanied children at the southern border, POLITICO's Adam Cancryn wrote this month.

Rep. Tom Cole (R-Okla.), the top Republican on the appropriations subcommittee that oversees health care funding, said the controversy over the origins of coronavirus — which has become a rallying point for some GOP lawmakers — has the potential to set back future funding debates.

"Did it come out of a lab in China? Was our country involved, indirectly, some way in funding it? That's a legitimate question and … what I fear is that would lead to a backlash," the Oklahoma Republican said.

Cole talks to Rep. Liz Cheney (R-Wyo.) on the House floor. (Photo by Melina Mara/The Washington Post)

Lawmakers say they're trying to look beyond the pandemic.

Some have been grilling Biden officials who are on Capitol Hill to testify about the administration's budget this week.

Sen. Patty Murray (D-Wash.), who chairs the Senate's Health, Education, Labor and Pensions Committee, reintroduced a bill to improve the nation's public health infrastructure. Rep. Rosa DeLauro (D-Conn.), who chairs the House appropriations committee, told The Post that she was focused on improving the public health workforce.

Cole cited a longstanding priority: fighting Alzheimer's disease, citing data that the U.S. government spends hundreds of millions per year on dementias. "If you could just slow the average onset of Alzheimer's by five years, you could save 42 percent of the money," said Cole. "If you could cure it, my god."

Meanwhile, officials are bracing for the challenge of proving that public health dollars contained in the coronavirus packages were well-spent.

"There's no parade when public health goes well, because people's water is clean, their restaurants are safe to eat at, right?" said Carolyn Mullen, senior vice president of government affairs and public relations at the Association of State and Territorial Health Officials. "And no one realizes that's the work that public health does day in and day out."

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Ahh, oof and ouch

AHH: New York City is getting rid of the remote option for schools in the fall.

The announcement from Mayor Bill de Blasio on Monday means that all students and staff will be back in school buildings full-time. This past school year, a majority of New York public school students — about 600,000 — stayed home amid the coronavirus pandemic.

"New York is one of the first big U.S. cities to remove the option of remote learning altogether for the coming school year," the New York Times's Eliza Shapiro reports. "But widespread predictions that online classes would be a fixture for school districts may have been premature. Gov. Philip D. Murphy of New Jersey announced last week that the state would no longer have remote classes come fall, after similar announcements by leaders in Connecticut and Massachusetts."

A classroom in Brooklyn. (Mark Lennihan/Associated Press)

De Blasio (D) also announced that teachers, who have been eligible for vaccines since January, would no longer be granted medical waivers to work from home. The mayor had indicated in recent months that he expected a remote option in the fall, but he said during the news conference that he changed his mind amid plummeting case rates.

OOF: The "lab leak" hypothesis is getting another look.

President Donald Trump and his allies pushed the idea that the coronavirus did not jump from animals to humans naturally, but instead originated in a laboratory in Wuhan, China. At the time, the administration proffered little evidence for the claim and the media and many scientists were quick to dismiss it. Some initial media reports described the lab leak theory as "debunked" or characterized it as a "conspiracy theory."

"It has become evident that some corners of the mainstream media overcorrected," The Washington Post's Aaron Blake writes.

The World Health Organization team is briefed outside of the Huanan Seafood Market on the third day of a field visit in Wuhan, China. (AP Photo/Ng Han Guan)

There has been a growing willingness to entertain the lab leak theory as researchers have yet to identify an animal origin for the virus. Leading infectious-disease expert Anthony S. Fauci, who initially downplayed the possibility of the coronavirus emanating from a lab, was recently asked if he was still confident of that opinion. "No, actually," he said.

The origins of the coronavirus are still an open question, and there's a danger of overcorrecting in the opposite direction. "Many people are talking about the new evidence as if it comes close to proving the 'lab leak' theory. It doesn't; it just renders it more plausible," Aaron writes.

OUCH: Don't kiss your chickens, the Centers for Disease Control and Prevention warns.

A salmonella outbreak linked to backyard poultry has led to 163 illnesses and 34 hospitalizations across 43 states, the CDC said last week.

The likely source of the outbreak is contact with backyard poultry, the New York Times's Derrick Bryson Taylor reports.

Annie, a domesticated Rhode Island red chicken, in Maryland eats a cicada. (Chip Somodevilla/Getty Images)

"Don't kiss or snuggle the birds, as this can spread germs to your mouth and make you sick," the CDC warned. The agency also recommended that people wash their hands for 20 seconds after touching the birds and said children under 5 should not touch the birds.

Chick sales often rise during times of economic stress, perhaps as a way for people to create more food security. During the pandemic, many first-time buyers panic bought chickens. By the middle of December 2020, there were more than 1,700 salmonella infections across all 50 states.

More in coronavirus news

The World Health Organization is pushing to vaccinate 10 percent of every country's population by September. The WHO's director general, Tedros Adhanom Ghebreyesus, called on member states to support a massive vaccine push, during the annual World Health Assembly in Geneva, The Post's Erin Cunningham reports.

World Health Organization Director General Tedros Adhanom Ghebreyesus at the opening of the 74th World Health Assembly. (Laurent Gillieron/Keystone via AP)

The CDC is probing rare cases of heart inflammation in vaccinated teenagers and young adults. Most of the cases have been mild, and officials do not know if they are linked to the shots, The Post's Joel Achenbach and Lena H. Sun report.
The nation's first live in-person trade show will take place on June 1 in Las Vegas. It will be a test for casinos and resorts, which are pushing for employees to get vaccinated, The Post's Laurie McGinley reports.

At the border

Biden is under pressure to stop using a pandemic-era public health rule to deport migrants.

"President Biden is coming under increasing pressure to abandon a Trump-era immigration rule that has sealed off the United States to most migrants during the pandemic, with human rights officials and two of the administration's own medical consultants saying the measure endangers vulnerable families," the New York Times's Zolan Kanno-Youngs reports.

The Trump administration justified the order as a public health measure aimed at preventing the spread of the coronavirus in the United States, but human rights advocates say the policy puts families in danger. Two medical experts who consult with the Department of Homeland Security's Office for Civil Rights and Civil Liberties sent a complaint to members of Congress saying there is no public health justification for the rule and that it incentivizes parents to send their children over the border alone.

Asylum-seeking children identify themselves to a U.S. border patrol agent. (Adrees Latif/Reuters)

Health and Human Services Secretary Xavier Becerra confirmed during a Monday media call that the administration is reviewing the immigration rule but did not commit to any timeline for lifting it.

Becerra also told reporters that the administration has scrapped plans to house children under 12 at the Fort Bliss army base in Texas. Advocates had raised concern about placing young children at the base amid complaints of inadequate conditions.

Elsewhere in health care

Major hospital systems are betting on advanced care in the home.

"Hospital-level care at home — some of it provided over the internet — is poised to grow after more than a decade as a niche offering, boosted both by hospitals eager to ease overcrowding during the pandemic and growing interest by insurers who want to slow health care spending. But a host of challenges remain, from deciding how much to pay for such services to which kinds of patients can safely benefit," Kaiser Health News's Julie Appleby reports.

Kaiser Permanente and the Mayo Clinic announced plans this month to collectively invest $100 million in Medically Home, a Boston-based company specializing in providing technology to support in-home care. Several other major hospital systems launched programs aimed at expanded in-home care last summer. Amazon and a coalition of industry groups have said that they will lobby to expand to change state and federal laws to allow for a broader range of in-home services.

"But hospitals have other financial considerations that are also part of the calculation. Systems that have built sparkling new in-patient facilities in the past decade, floating bonds and taking out loans to finance them, need patients filling costly inpatient beds to repay lenders and recoup investments," Julie writes.