Arwady, Chicago’s chief physician, warns that coronavirus risks may rise as federal funding drains

Dwindling federal public health funding and low participation in booster vaccines threatens to raise the risk of COVID-19 again in Chicago, according to Public Health Commissioner Dr. Allison Arwady.

“COVID has not gone away,” she said last week at an event to promote vaccination on the Southwest Side.

The news comes at a time when the risk of infection in the city is low, with fewer hospitalizations and a significant drop in deaths compared to last year. Then, a new variant of the virus, Omicron, began to gain momentum and a deadly spike in cases loomed. More than 10,000 city residents are diagnosed with COVID daily. More than 300 Chicagoans were hospitalized each day in December and January on average, and dozens died each day. Today, on average, about 400 Chicagoans are diagnosed with COVID — and about 30 are hospitalized — each day, with a fatality rate of less than one per day.

But two factors risk undoing some of that progress.

Chicagoans have become lax about getting the latest booster shots—only about 15% of those eligible received the latest dose targeting strains of the omicron variant, the culprit behind mass hospitalizations and deaths last winter.

And federal funds are beginning to dry up, leaving health departments locally and across the country — many of which have already been decimated over the past 20 years — to fend for themselves with inadequate resources.

In 2002, Chicago had a public health workforce of 1,600 employees. That number fell to less than 600 by 2019, largely due to federal cuts, a city spokesperson said, before rising to just over 800 in response to the pandemic.

Allison Arwady, commissioner of the Chicago Department of Public Health, receives a bivalent booster shot for COVID-19 during a news conference Tuesday at CVS Pharmacy in West Lawn, where health officials encouraged people to get a booster shot for COVID-19 and influenza.  Vaccine before the holidays.

Allison Arwady, commissioner of the Chicago Department of Public Health, receives a bivalent booster shot for COVID-19 during a news conference Tuesday at CVS Pharmacy in West Lawn, where health officials encouraged people to get a booster shot for COVID-19 and influenza. Vaccine before the holidays.

In recent interviews with the Sun Times, Arwady said the pandemic has exposed what she describes as a funding shortcoming in public health departments. Health departments are on a lifeline from Washington, and that funding tends to spike during crises and then fade away.

That’s a problem, she said, because other health crises pop up, whether it’s an unexpected outbreak, like monkeypox, or a particularly bad flu season. And for each crisis, local health officials must build programs knowing that they will eventually end them once the current health threat has receded.

Chicago has received an unprecedented amount of federal taxpayer funding since the pandemic hit in 2020. The city’s health department, which is funded almost entirely by federal tax dollars, has gone from about $220 million annually to about $1 billion for the current year.

The money has been earmarked for staff, community vaccination centers, home visits for COVID shots, education and outreach, marketing and testing, disease tracing, contract tracing, as well as many other programs. Newer tracing efforts, such as monitoring wastewater to help detect community spread early, are products of pandemic funding.

Now that money is poised to disappear. Almost all of them — nearly 90% — will disappear within the next two years, Arwady said.

It’s a cycle that repeats itself after every crisis, she said, and it doesn’t have to be like this. Congress could commit to a more steady stream of funding for public health rather than amassing tons of money — much of it with strings attached — all at once to tackle a single event, such as a once-in-a-century pandemic. He said.

Of course, the current epidemic is historical and requires huge resources. But as tens of millions of dollars in federal funding dry up in the first half of next year, the city is losing scores of employees funded by a nonprofit affiliated with the US Centers for Disease Control and Prevention.

Arwady said restrictions on COVID-19 funding are also straining efforts to get the word out about the need for booster shots. Without additional protection from the new boosters, cases are likely to increase.

“Our boost rates, not just here but across the country, are not where they should be,” Arwady said. “I need to do the kind of vaccine outreach we were doing at the beginning of COVID but I am unable to do that.”

Gloria Roberts, 61, receives a Pfizer COVID-19 booster vaccine at Walgreens in Chatham on Tuesday.

Gloria Roberts, 61, receives a Pfizer COVID-19 booster vaccine at Walgreens in Chatham on Tuesday.

Arudi is concerned about the lack of uptake of the new booster COVID drug, particularly in communities — like the Southwest Side where she recently visited — that are still at high risk of infection, hospitalization and death.

Progress over the past three years has required continued education, often convincing people with inadequate access to health care that they should suddenly trust a broken system. Many people are still not fully immunized, let alone boosted.

Arwadi received sympathetic earshots from two state senators, though no quick fixes were forthcoming.

“As Congress has worked to fund our domestic response to COVID-19, our public health officials need more resources and flexible tools to address evolving disease threats,” Sen. Dick Durbin said in a statement to the Sun-Times.

He said the money in a bill he co-sponsored would “provide consistent and predictable increases in funding” for health agencies.

According to the statement, Sen. Tammy Duckworth “knows that Congress must do more to ensure that our public health departments are provided the support and flexibility they need to protect the public health and well-being of our communities.”

A recent report published in Public Health Management and Practice last month underscores the need for local health agencies to continuously strengthen public health protection.

“A strong public health infrastructure is essential to ensuring that communities are able to deliver essential public health functions,” said the authors of the report, which was published in the journal Public Health Management and Practice last month. “Even before the COVID-19 pandemic, many state and local health agencies operated at sufficient minimum staffing levels to meet health needs and protect and promote health in the communities they serve.”

While acknowledging that funding cuts are to be expected, Arwady argues that a sudden and large drop should be avoided.

“We have a case pop up at least once a year,” Arwady adds. “Since all funding comes in the short term, you can’t keep preparing for whatever comes next.”

Brett Chase’s report on the environment and public health was made possible by a grant from The Chicago Community Trust.

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