Analysis:The U.S. may be less prepared for the next pandemic than it was for the current one because of threats, resignations and politics--NY Times survey .

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State and local public health departments across the country have endured not only the public’s fury, but widespread staff defections, burnout, firings, unpredictable funding and a significant erosion in their authority to impose the health orders that were critical to America’s early response to the pandemic.

While the coronavirus has killed more than 700,000 in the United States in nearly two years, a more invisible casualty has been the nation’s public health system. Already underfunded and neglected even before the pandemic, public health has been further undermined in ways that could resound for decades to come. A New York Times review of hundreds of health departments in all 50 states indicates that local public health across the country is less equipped to confront a pandemic now than it was at the beginning of 2020.

“We have learned all the wrong lessons from the pandemic,” said Adriane Casalotti, chief of public and government affairs for the National Association of County and City Health Officials, an organization representing the nearly 3,000 local health departments across the nation. “We are attacking and removing authority from the people who are trying to protect us.”

The Times interviewed more than 140 local health officials, public health experts and lawmakers, reviewed new state laws, analyzed local government documents and sent a survey to every county health department in the country. Almost 300 departments responded, discussing their concerns over long-term funding, staffing, authority and community support. The examination showed that:

• Public health agencies have seen a staggering exodus of personnel, many exhausted and demoralized, in part because of abuse and threats. Dozens of departments reported that they had not staffed up at all, but actually lost employees. About 130 said they did not have enough people to do contact tracing, one of the most important tools for limiting the spread of a virus. The Times identified more than 500 top health officials who left their jobs in the past 19 months.

• Legislators have approved more than 100 new laws — with hundreds more under consideration — that limit state and local health powers. That overhaul of public health gives governors, lawmakers and county commissioners more power to undo health decisions and undermines everything from flu vaccination campaigns to quarantine protocols for measles.

• Large segments of the public have also turned against agencies, voting in new local government leaders who ran on pledges to rein in public health departments. In Idaho, commissioners last month appointed a new physician representative to the health board in the Boise region who advocates unapproved treatments for Covid-19 and refers to coronavirus vaccinations as “needle rape.” “We have heard from the voters,” Ryan Davidson, one of the commissioners, said.

• Billions of dollars have been made available to public health by the federal government, but most of it has been geared toward stemming the emergency, rather than hiring permanent staff or building long-term capability. ...

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• There are already signs that the growing shortfalls in public health could have lasting impacts beyond the pandemic.

  More than 220 departments told The Times they had to temporarily or permanently abandon other public health functions to respond to the pandemic, leading to a spike in drug overdoses and a disturbing drop in reports of child abuse. Several health officials pointed to runaway infections of sexually transmitted diseases, with gonorrhea cases doubling and syphilis on pace to triple in one county in Pennsylvania. Oswego County, N.Y., recorded a surge in lead poisoning. In Texas, requests for exemptions to the usual suite of required childhood immunizations have risen sharply.

  Mandates and mobilizations to protect public health have long been part of American life; colonists issued quarantine laws and fines for disobeying them as early as the 1700s. Public health departments later delivered vaccines to halt diseases such as smallpox and polio, upgraded water systems to limit typhoid and cholera, curbed sexually transmitted diseases and helped guarantee the safety of food in restaurants.

  But not since the flu pandemic of 1918 has the country faced a disease outbreak that called for unelected health officials to impose widespread mask mandates and business closures.

  As scientists helped overcome many infectious diseases, the focus on keeping Americans healthy turned more to individualized treatment for ailments such as heart disease and cancers, said David Rosner, a historian at Columbia University who specializes in the history of public health.

  Many, particularly in conservative circles, have increasingly embraced individual rights over collective responsibilities, a trend that Dr. Rosner said is undercutting the notion of a social contract in which people work together to achieve a greater good....